title: Increasing muscle mass in spinal cord injured persons with a functional electrical stimulation exercise program.
abstract: OBJECTIVE
  To determine the magnitude of changes in muscle mass and lower extremity body composition that could be induced with a regular regimen of functional electrical stimulation (FES)-induced lower-extremity cycling, as well as the distribution of changes in muscle mass among the thigh muscles in persons with spinal cord injury (SCI).
  
  
  METHODS
  Thirteen men with neurologically complete motor sensory SCI underwent a 3-phase, FES-induced, ergometry exercise program: phase 1, quadriceps strengthening: phase 2, progressive sequential stimulation to achieve a rhythmic pedaling motion (surface electrodes placed over the quadriceps, hamstrings, and gluteal muscles); phase 3, FES-induced cycling for 30 minutes. Participants moved from one phase to the next when they met the objectives for the current phase.
  
  
  METHODS
  Computed tomography of legs to assess muscle cross-sectional area and proportion of muscle and adipose tissue. Scans were done at baseline (before subjects started the program), at first follow-up, typically after 65.4+/-5.6 (SD) weekly sessions, and at second follow-up, typically after 98.1+/-9.1 sessions.
  
  
  RESULTS
  Increases in cross-sectional areas were found in the following muscles: rectus femoris (31%, p<.001). sartorius (22%, p<.025), adductor magnus-hamstrings (26%, p<.001), vastus lateralis (39%, p = .001), vastus medialis-intermedius (31%, p = .025). Cross-sectional area of adductor longus and gracilis muscles did not change. The ratio of muscle to adipose tissue increased significantly in thighs and calves. There was no correlation among the total number of exercise sessions and the magnitude of muscle hypertrophy.
  
  
  CONCLUSIONS
  Muscle cross-sectional area and the muscle to adipose tissue ratio of the lower extremities increased during a regular regimen of 2.3 FES-induced lower extremity cycling sessions weekly. The distribution of changes was related to the proximity of muscles to the stimulating electrodes.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of California at Los Angeles School of Medicine, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Scremin
authors.forename: L
authors.initials: L
authors.lastname: Kurta
authors.forename: A
authors.initials: A
authors.lastname: Gentili
authors.forename: B
authors.initials: B
authors.lastname: Wiseman
authors.forename: K
authors.initials: K
authors.lastname: Perell
authors.forename: C
authors.initials: C
authors.lastname: Kunkel
authors.forename: O U
authors.initials: OU
authors.lastname: Scremin
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D004599:Electric Stimulation Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy; D007866:Leg; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000534:rehabilitation*; D014057:Tomography, X-Ray Computed