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. 2023 Jun 1;102(6):489-497.
doi: 10.1097/PHM.0000000000002120. Epub 2022 Oct 11.

Optimization of Protocols Using Neuromuscular Electrical Stimulation for Paralyzed Lower-Limb Muscles to Increase Energy Expenditure in People With Spinal Cord Injury

Yiming Ma  1 , Sonja de Groot, Ad Vink, Wouter Harmsen, Christof A J Smit, Janneke M Stolwijk-Swuste, Peter J M Weijs, Thomas W J Janssen
Affiliations

Optimization of Protocols Using Neuromuscular Electrical Stimulation for Paralyzed Lower-Limb Muscles to Increase Energy Expenditure in People With Spinal Cord Injury

Yiming Ma et al. Am J Phys Med Rehabil. .

Abstract

Objective: The aim of this study was to evaluate whether using surface neuromuscular electrical stimulation (NMES) for paralyzed lower-limb muscles results in an increase in energy expenditure and whether the number of activated muscles and duty cycle affect the potential increase.

Design: This was a cross-sectional study.

Results: Energy expenditure during all NMES protocols was significantly higher than the condition without NMES (1.2 ± 0.2 kcal/min), with the highest increase (+51%; +0.7 kcal/min, 95% confidence interval, 0.3-1.2) for the protocol with more muscles activated and the duty cycle with a shorter rest period. A significant decrease in muscle contraction size during NMES was found with a longer stimulation time, more muscles activated, or the duty cycle with a shorter rest period.

Conclusion: Using NMES for paralyzed lower-limb muscles can significantly increase energy expenditure compared with sitting without NMES, with the highest increase for the protocol with more muscles activated and the duty cycle with a shorter rest period. Muscle fatigue occurred significantly with the more intense NMES protocols, which might cause a lower energy expenditure in a longer protocol. Future studies should further optimize the NMES parameters and investigate the long-term effects of NMES on weight management in people with SCI.

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Conflict of interest statement

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Figures

FIGURE 1
FIGURE 1
The placement of the electrodes for gluteals, hamstrings (electrodes with solid outline, left), calves (electrodes with dashed outline, left) stimulation and for quadriceps stimulation (electrodes with dashed outline, right) and the contraction sensor (right).
FIGURE 2
FIGURE 2
Examples of the changes in muscle contraction size (left, participant 4) and sitting pressure variance (right, participant 3) during NMES protocols. Lines are fit through the data by a general fit exponential model with y = ae-bx + c-ed function. Most of the participants showed similar trends as illustrated above.
FIGURE 3
FIGURE 3
Mean energy expenditure (kcal/min) during sitting without NMES and during different NMES protocols (n = 9). *P < 0.05 compared with the mean energy expenditure during sitting without NMES; **P < 0.05 compared with the mean energy expenditure during the protocol 1:4 s GlHamQuaCa; ***P < 0.05 compared with the mean energy expenditure during the protocol 1:8 s GlHam.
FIGURE 4
FIGURE 4
Individual differences in energy expenditure (kcal/min) during the different NMES protocols (n = 9). Percentages indicate the three participants who have very positive increases in energy expenditure during the protocol 1:4 s GlHamQuaCa.
See this image and copyright information in PMC

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