Lower-extremity functional electrical stimulation decreases platelet aggregation and blood coagulation in persons with chronic spinal cord injury: a pilot study.
BACKGROUND
Individuals with spinal cord injury (SCI) develop premature cardiovascular disease. Regular exercise reduces the incidence and symptoms of cardiovascular disease in able-bodied individuals; these salutary effects of exercise have not been documented in persons with SCI.


OBJECTIVE
To evaluate the effects of functional electrical stimulation leg cycle ergometry (FES-LCE) exercise training on platelet aggregation and blood coagulation in persons with SCI.


METHODS
Subjects (n=14) with stable chronic (>1 year) paraplegia (T1-T10) or tetraplegia (C4-C8).


METHODS
Blood samples were collected before and after the first and eighth sessions (2 sessions per week for 4 weeks) of FES exercise.


RESULTS
Platelet aggregation was inhibited by 20% after the first session and by 40% (P < 0.001) after the eighth session. Thrombin activity was unchanged after the first session (10.7 +/- 0.85 s to 10.43 +/- 0.56 s) and decreased after the eighth session (12.5 +/- 1.98 s to 11.1 +/- 1.7 s; P < 0.0003). Antithrombin III activity increased after the first (103.8% +/- 8.9% to 110% +/- 6.9%; P < 0.0008) and eighth sessions (107.8% +/- 12.1% to 120.4% +/- 13.1%; P < 0.0001). Cyclic adenosine monophosphate increased after the first (9.9% + 2.5% to 15.8% +/- 3%; P < 0.001) and eighth sessions (17.8% +/- 4.2% to 36.5% +/- 7.6%; P < 0.0001). After the eighth session, factors V and X increased significantly (88% +/- 27% to 103% +/- 23%, P < 0.0001; 100% +/- 40% to 105% +/- 7%, P < 0.01, respectively); factors VII and VIII and fibrinogen did not change significantly. A significant reduction in platelet activation/aggregation was demonstrated in response to FES-LCE. The decrease in thrombin level was caused by the simultaneous increase in antithrombin activity.


CONCLUSIONS
These findings provide new insight into the potential protective effects of FES-LCE against the risk of cardiovascular disease.
Kahn
Nighat N
NN
Center of Excellence, James J. Peters VA Medical Center, 130 W. Kingsbridge Road, Bronx, NY 10468, USA. nighat.kahn@va.gov
Feldman
Susan P
SP
Bauman
William A
WA
D000990:Antithrombin III / Q000378:metabolism; D001777:Blood Coagulation / Q000502:physiology*; D001779:Blood Coagulation Factors / Q000378:metabolism; D002908:Chronic Disease; D000242:Cyclic AMP / Q000097:blood; D004599:Electric Stimulation Therapy / Q000379:methods*; D016552:Ergometry / Q000379:methods; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D010865:Pilot Projects; D010974:Platelet Aggregation / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000097:blood / Q000473:pathology / Q000628:therapy; D013917:Thrombin / Q000378:metabolism; D013997:Time Factors
D001779:Blood Coagulation Factors; D000990:Antithrombin III; D005340:Fibrinogen; D000242:Cyclic AMP; D013917:Thrombin