title: A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: effects on body composition.
abstract: OBJECTIVE
  To evaluate the effects of functional electrical stimulation (FES)-assisted walking on body composition, compared to a non-FES exercise program in individuals with a spinal cord injury (SCI).
  
  
  METHODS
  Parallel-group randomized controlled trial.
  
  
  METHODS
  Individuals with chronic (≥ 18 months) incomplete SCI (level C2 to T12, AIS C or D) were recruited and randomized to FES-assisted walking (intervention), or aerobic and resistance training (control) sessions thrice-weekly for 16 weeks. Whole body and leg lean mass and whole body fat mass, measured with dual-energy X-ray absorptiometry, and lower-limb muscle cross-sectional area (CSA) and fat CSA, measured with peripheral computed tomography were assessed at baseline, 4 months, and 12 months. Intention-to-treat analyses using repeated measures general linear models were used to assess between-group differences.
  
  
  RESULTS
  Thirty-four individuals were randomized (17 per group); 27 remained at 12 months. There were no significant main effects of FES-assisted walking on body composition variables in intention-to-treat analyses with group means. There was a significant group-by-time interaction for muscle area from baseline to 12 months (P = 0.04). Intention-to-treat analysis of muscle area change scores between baseline and 12 months revealed a significant difference between groups (mean (SD) muscle area change score 212 (517) mm(s) for FES, -136 (268) mm(s) for control, P = 0.026). There were 13 side effects or adverse events deemed related to study participation (7 intervention, 5 control); most were resolved with modifications to the protocol. One fainting episode resulted in a hospital visit and study withdrawal.
  
  
  CONCLUSIONS
  Thrice-weekly FES-assisted walking exercise over 4 months did not result in a change in body composition in individuals with chronic, motor incomplete C2 to T12 SCI (AIS classification C and D). However, longer-term follow-up revealed that it might maintain muscle area.
authors.affiliation: Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada. lora.giangregorio@uwaterloo.ca
authors.forename: Lora
authors.initials: L
authors.lastname: Giangregorio
authors.forename: Catharine
authors.initials: C
authors.lastname: Craven
authors.forename: Kieva
authors.initials: K
authors.lastname: Richards
authors.forename: Naaz
authors.initials: N
authors.lastname: Kapadia
authors.forename: Sander L
authors.initials: SL
authors.lastname: Hitzig
authors.forename: Kei
authors.initials: K
authors.lastname: Masani
authors.forename: Milos R
authors.initials: MR
authors.lastname: Popovic
mesh_terms: D000328:Adult; D000368:Aged; D001823:Body Composition / Q000502:physiology*; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D015444:Exercise / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000502:physiology; D010264:Paraplegia / Q000503:physiopathology / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D011782:Quadriplegia / Q000503:physiopathology / Q000534:rehabilitation; D055070:Resistance Training / Q000379:methods; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D016138:Walking / Q000502:physiology*