Is 20 minutes of FES Cycling good enough for health gains?
Functional Electrical Stimulation cycling, also known as FES cycling or using an FES bike, is a rehabilitation technique that uses electrical stimulation to activate skeletal muscle in individuals with spinal cord injury or other types of neurological injury. This technique is well established in the homes of hundreds of people in the UK as well as in NHS and private facilities. In this article we address the topic of how often you should exercise with this technology. For example, is 20 minutes, three times per week really enough?
What is FES Cycling?
The RehaMove 2 based on the MOTOmed Muvi model
This technique involves the use of a specialised bike, such as our RehaMove FES cycling system that sends electrical stimulation to the muscles of the legs and/or the arms. This enables a participant to pedal a passive/active bike even with paralysed muscle. At the very least, for leg exercise, the quadriceps muscle and the hamstring muscle group would be exercised. Using the bike produces strong muscle contractions in the involved muscle groups.
This clever system synchronises the delivery of the muscle stimulation so it is correctly timed to the position and speed of the bike pedals. This way, each muscle contraction occurs at the appropriate time to support active exercise.
The benefits of FES Cycling
FES cycling with a RehaMove system can provide a range of benefits for individuals with chronic SCI, including muscle strength improvement, preservation of bone density, assistance with spasticity, and generally improving an individual's physical activity level. One of the main drivers for using FES cycling after a spinal cord or other catastrophic injury is sustaining long-term cardiovascular fitness. If you invest in this technology you want to use it routinely for the long term. Basically it’s a way of getting exercise that would otherwise be impossible to get due to paralysis.
There have been many studies showing the overall benefits of FES cycling but these studies do not necessarily use the same volume, or intensity of exercise.
As a "rule of thumb", we will often suggest that initially clients should train three times per week and for 20 minute sessions.
Is that enough?
The answer is – it depends. FES cycling is best carried out as volitional cycling where participants initiate the cycling motion via the contraction of their muscles due to receiving controlled electrical stimulation. If the stimulation is not intense enough then the bike will generally move the legs in passive cycling; which involves the machine cycling for the participants without any input. This movement is better than nothing but is not as health giving as volitional cycling.
Intense volitional FES cycling will lead to significant contraction amplitudes in both quadriceps and the gluteal muscle group or any other involved muscles. Participants may increase their heart rate and gain metabolic efficiency. In this scenario, 20 minutes of FES cycling can work perfectly for participants.
However, the effectiveness of FES cycling depends on several factors, including the intensity and resistance of the exercise, the muscle group being stimulated, and the goal of the exercise session.
For instance, if the goal is to increase or preserve muscle strength, then 20 minutes of an FES cycling session three times per week may not be enough. A longer session duration or higher intensity may be required to achieve the desired outcome. There are individual variations in this.
Training versus Exercise
Any training programme depends on thinking about these steps
We always encourage our RehaMove system users to think of this as a long term venture. When clients first start to use a FES bike their muscles may take time to adapt and respond to the stimulation. They may find that for much of a session they will be passive cycling in the beginning.
This is still beneficial in the early stages of rehabilitation when participants may lack the muscle strength to initiate the cycling motion themselves. Client's can usefully think of the whole process as training rather than exercise. In other words, it's best to set short term exercise goals and gradually refine these over time.
Overall, 20 minutes of FES cycling is generally an efficient duration for most individuals in achieving their desired goals. After all, no one generally wants to spend their whole lives in therapy - there are other things to do!
What we find is that we need to deal with human nature. When a system is new we are inspired to use it - but we need to stick at it and move to make using an FES Cycling system a lifestyle habit.
It’s no different for any of us - if we wish to remain health for a long active life we give ourselves the best chance of doing that is we make exercise a habit.
It is going to be down to individual desires. We have some clients who train every day and have conditioned their muscles to work in this fashion. As we point out above, and in other articles focusing on training, the most important aspect of any exercise is to first of all adhere to it.
Conclusion
FES cycling is a great form of exercise to improve muscle mass, metabolic efficiency, and cardiovascular health. However, before starting an FES exercise plan, it is advisable to consult with a healthcare professional to create an individualized program that meets specific needs and goals. There are some contraindications such as uncontrolled autonomic dysreflexia, unhealed fractures, open wounds or denervation that may prevent the use of the technology and we will always verify that an FES Cycling system is safe before advocating it's use.