Should We Use the Functional Electrical Stimulation-Cycling Exercise in Clinical Practice? Physiological and Clinical Effects Systematic Review With Meta-analysis

Abstract

Objective

To examine the evidence regarding functional electrical stimulation cycling's (FES-cycling's) physiological and clinical effects.

Data Sources

The study was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses protocol. PubMed, Embase, Cochrane Review, CINAHL, Scopus, Sport Discus, and Web of Science databases were used.

Study Selection

Randomized controlled trials involving FES-cycling were included. Studies that did not involve FES-cycling in the intervention group or without the control group were excluded. Two reviewers screened titles and abstracts and then conducted a blinded full-text evaluation. A third reviewer resolved the discrepancies.

Data Extraction

Meta-analysis was performed using inverse variance for continuous data, with effects measured using the mean difference and random effects analysis models. A 95% confidence interval was adopted. The significance level was set at P<.05, and trends were declared at P=.05 to ≤.10. The I² method was used for heterogeneity analysis. The minimal clinically important difference was calculated. Methodological quality was assessed using the risk of bias tool for randomized trials. The Grading of Recommendations Assessment, Development, and Evaluation method was used for the quality of the evidence analysis.

Data Synthesis

A total of 52 studies were included. Metabolic, cardiocirculatory, ventilatory, and peripheral muscle oxygen extraction variables presented statistical (P<.05) and clinically important differences favoring FES-cycling, with moderate-to-high certainty of evidence. It also presented statistical (P<.05) and clinically important improvements in cardiorespiratory fitness, leg and total body lean mass, power, physical fitness in intensive care (moderate-to-high certainty of evidence), and torque (low certainty of evidence). It presented a trend (P=.05 to ≤.10) of improvement in muscle volume, spasticity, and mobility (low-to-moderate certainty of evidence). It showed no difference (P>.10) in 6-minute walking distance, muscle cross-sectional area, bone density, and length of intensive care unit stay (low-to-moderate certainty of evidence).

Conclusions

FES-cycling exercise is a more intense stimulus modality than other comparative therapeutic modalities and presented clinically important improvement in several clinical outcomes.