Abstract
Complete lower-limb paralysis resulting from spinal cord injury precludes volitional leg exercise, leading to muscle atrophy and physiological de-conditioning. Cycling can be achieved using phased stimulation of the leg muscles. With training there are positive physiological adaptations and health improvement. Prior to training, however, power output may not be sufficient to overcome losses involved in rotating the legs and little is known about the energetics of untrained paralysed muscles. Here we propose efficiency measures appropriate to subjects with severe physical impairment performing cycle ergometry. These account for useful internal work (i.e. muscular work done in moving leg mass) and are applicable even for very low work rates. Experimentally, we estimated total work efficiency of ten untrained subjects with paraplegia to be 7.6 ± 2.1% (mean ± SD). This is close to values previously reported for anaesthetised able-bodied individuals performing stimulated cycling exercise, but is less than 1/3 of that of able-bodied subjects cycling volitionally. Correspondingly, oxygen cost of the work (38.8 ± 13.9 ml min−1 W−1) was found to be ∼3.5 times higher. This indicates the need, for increased power output from paralysed subjects, to maximise muscle strength through training, and to improve efficiency by determining better methods of stimulating the individual muscles involved in the exercise.
Similar content being viewed by others
Notes
Even then, it may not be. Consider a subject running downhill: external work is negative, and if internal work is neglected a physically-impossible efficiency of less than zero will result (Margaria 1963).
The terms “work” and “energy” are synonymous. They have the units of Joules (J). “Power” is the rate of doing work (it is synonymous with “work rate”). Power is expressed in Watts (W ≡ J s−1).
References
Colombo G, Jörg M, Schreier R, Dietz V (2000) Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Develop 37:693–700
Eichhorn K, Schubert W, David E (1984) Maintenance, training and functional use of denervated muscles. J Biomed Eng 6:205–211
Gaesser GA, Brooks GA (1975) Muscular efficiency during steady-rate exercise: effects of speed and work rate. J Appl Physiol 38(6):1132–1139
Gföhler M, Loicht M, Lugner P (1998) Exercise tricycle for paraplegics. Med Biol Eng Comput 36:118–121
Glaser RM, Figoni SF, Hooker SP, Rodgers MM, Ezenwa BN, Suryaprasad AG, Gupta SC, Mathews T (1989) Efficiency of FNS leg cycle ergometry. In: Proc 11th ann int conf IEEE Eng Med Biol Soc, pp 961–963
Gregory CM, Bickel CS (2005) Recruitment patterns in human skeletal muscle during electrical stimulation. Phys Ther 85(4):358–364
Hunt KJ, Schauer T, Negård N-O, Stewart W, Fraser MH (2002) A pilot study of lower-limb FES cycling in paraplegia. In: Proc 7th ann conf Int Functional Electrical Stimulation Soc, Ljubljana, Slovenia
Hunt KJ, Stone B, Negård N-O, Schauer T, Fraser MH, Cathcart AJ, Ferrario C, Ward SA, Grant S (2004) Control strategies for integration of electric motor assist and functional electrical stimulation in paraplegic cycling: utility for exercise testing and mobile cycling. IEEE Trans Neural Syst Rehabil Eng 12(1):89–101
Janssen TWJ, Glaser RM, Shuster DB (1998) Clinical efficacy of electrical stimulation exercise training: effects on health, fitness, and function. Top Spinal Cord Inj Rehabil 3(3):33–49
Janssen TWJ, Bakker M, Wyngaert A, Gerrits KHL, de Haan A (2004) Effects of stimulation pattern on electrical stimulation-induced leg cycling performance. J Rehabil Res Dev 41(6A):787–796
Kebaetse MB, Lee SC, Johnson TE, Binder-Macleod SA (2005) Strategies that improve paralyzed human quadriceps femoris muscle performance during repetitive, nonisometric contractions. Arch Phys Med Rehabil 86:2157–2164
Kern H, Frey M, Holle J, Mayr W, Schwanda G, Stohr H, Thomas H (1985) Functional electrostimulation of paraplegic patients—1 year’s practical application. Results in patients and experiences. Z-Orthop 123:1–12
Kjaer M, Perko G, Secher NH, Boushel R, Beyer N, Pollack S, Horn A, Fernandes A, Mohr T, Lewis SF, Galbo H (1994) Cardiovascular and ventilatory responses to electrically induced cycling with complete epidural anaesthesia in humans. Acta Physiol Scand 151:199–207
Margaria R (1963) Energy cost of running. J Appl Physiol 18:367–370
Perkins T, Donaldson N, Fitzwater R, Phillips G, Wood DE (2001) Leg powered paraplegic cycling system using surface functional electrical stimulation. In: Proc 7th int workshop on FES, Vienna, Austria
Perkins TA, Donaldson N, Hatcher NAC, Swain ID, Wood DE (2002) Control of leg-powered paraplegic cycling using stimulation of the lumbo-sacral anterior spinal nerve roots. IEEE Trans Neural Sys Rehabil Eng 10(3):158–164
Petrofsky JS, Smith J (1992) Three wheel cycle ergometer for use by men and women with paralysis. Med Biol Eng Comput 30:364–369
Petrofsky J, Heaten H, Phillips C (1983) Outdoor bicycle for exercise in paraplegics and quadriplegics. J Biomed Eng 5:292–296
Petrofsky J, Phillips C, Heaton H, Glaser R (1984) Bicycle ergometer for paralyzed muscle. J Clin Eng 9:13–19
Phillips GF, Adler JR, Taylor SJG (1993) A portable programmable eight-channel surface stimulator. In: Proceedings of the Ljubljana FES conference, pp 166–168
Pons DJ, Vaughan CL, Jaros GG (1989) Cycling device powered by the electrically stimulated muscles of paraplegics. Med Biol Eng Comput 27:1–7
Raymond J, Davis GM, van der Plas M (2002) Cardiovascular responses during submaximal electrical stimulation-induced leg cycling in individuals with paraplegia. Clin Physiol Funct Imaging 22(2):92–98
Theisen D, Fornusek C, Raymond J, Davis GM (2002) External power output changes during prolonged cycling with electrical stimulation. J Rehabil Med 34:171–175
Wasserman K, Whipp BJ (1975) Exercise physiology in health and disease. Am Rev Respir Dis 112(2):219–249
Whipp BJ, Wasserman K (1969) Efficiency of muscular work. J Appl Physiol 26(5):644–648
Winter DA (1979) A new definition of mechanical work done in human movement. J Appl Physiol 46(1):79–83
Acknowledgments
Supported by the UK Engineering and Physical Sciences Research Council and the Swiss Paraplegic Foundation. We thank Lynsey Duffell (Division of Applied Biomedical Research, King’s College London), Pius Hofer and Helga Lechner (Swiss Paraplegic Research, Nottwil), and Stan Grant (formerly of the Faculty of Biomedical and Life Sciences, University of Glasgow) for their contributions to this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hunt, K.J., Saunders, B.A., Perret, C. et al. Energetics of paraplegic cycling: a new theoretical framework and efficiency characterisation for untrained subjects. Eur J Appl Physiol 101, 277–285 (2007). https://doi.org/10.1007/s00421-007-0497-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00421-007-0497-5