{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:12:08Z","timestamp":1783941128547,"version":"3.55.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T00:00:00Z","timestamp":1695340800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the combined effects of neuromuscular electrical stimulation-resistance training (NMES-RT) and functional electrical stimulation-lower extremity cycling (FES-LEC) compared to passive movement training (PMT) and FES-LEC in adults with SCI on (1) oxygen uptake (VO<jats:sub>2<\/jats:sub>), insulin sensitivity and glucose disposal in adults with SCI; (2) Metabolic and inflammatory biomarkers; (3) skeletal muscle, intramuscular fat (IMF) and visceral adipose tissue (VAT) cross-sectional areas (CSAs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Thirty-three participants with chronic SCI (AIS A-C) were randomized to 24\u2009weeks of NMES-RT\u2009+\u2009FES or PMT\u2009+\u2009FES. The NMES-RT\u2009+\u2009FES group underwent 12\u2009weeks of evoked surface NMES-RT using ankle weights followed by an additional 12\u2009weeks of progressive FES-LEC. The control group, PMT\u2009+\u2009FES performed 12\u2009weeks of passive leg extension movements followed by an additional 12\u2009weeks of FES-LEC. Measurements were performed at baseline (BL; week 0), post-intervention 1 (P1; week 13) and post-intervention 2 (P2; week 25) and included FES-VO<jats:sub>2<\/jats:sub> measurements, insulin sensitivity and glucose effectiveness using the intravenous glucose tolerance test; anthropometrics and whole and regional body composition assessment using dual energy x-ray absorptiometry (DXA) and magnetic resonance imaging to measure muscle, IMF and VAT CSAs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-seven participants completed both phases of the study. NMES-RT\u2009+\u2009FES group showed a trend of a greater VO<jats:sub>2<\/jats:sub> peak in P1 [<jats:italic>p<\/jats:italic>\u2009=\u20090.08; but not in P2 (<jats:italic>p<\/jats:italic>\u2009=\u20090.25)] compared to PMT\u2009+\u2009FES. There was a time effect of both groups in leg VO<jats:sub>2<\/jats:sub> peak. Neither intervention elicited significant changes in insulin, glucose, or inflammatory biomarkers. There were modest changes in leg lean mass following PMT\u2009+\u2009FES group. Robust hypertrophy of whole thigh muscle CSA, absolute thigh muscle CSA and knee extensor CSA were noted in the NMES-RT\u2009+\u2009FES group compared to PMT\u2009+\u2009FES at P1. PMT\u2009+\u2009FES resulted in muscle hypertrophy at P2. NMES-RT\u2009+\u2009FES resulted in a decrease in total VAT CSA at P1.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>NMES-RT yielded a greater peak leg VO<jats:sub>2<\/jats:sub> and decrease in total VAT compared to PMT. The addition of 12\u2009weeks of FES-LEC in both groups modestly impacted leg VO<jats:sub>2<\/jats:sub> peak. The addition of FES-LEC to NMES-RT did not yield additional increases in muscle CSA, suggesting a ceiling effect on signaling pathways following NMES-RT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p>identifier NCT02660073.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2023.1254760","type":"journal-article","created":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T09:24:21Z","timestamp":1695374661000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Effects of two different paradigms of electrical stimulation exercise on cardio-metabolic risk factors after spinal cord injury. A randomized clinical trial"],"prefix":"10.3389","volume":"14","author":[{"given":"Ashraf S.","family":"Gorgey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Refka 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