Electrical stimulation exercise in advanced multiple sclerosis

People with multiple sclerosis (MS) are generally less active than the general population which may lead to deconditioning that further reduces functional abilities. Regular exercise is beneficial for managing many MS symptoms and reversing deconditioning due to inactivity (Dalgas U, Stenager E, Ingemann-Hansen 2008). However, persons with advanced MS may find exercise very difficult due to significant fatigue, leg muscle paresis and poor shoulder condition (Smith and Hale 2006). To date there is limited research on exercise for persons with advanced MS.

This study used electrical stimulation to allow persons with advanced MS to exercise on a stationary recumbent cycle. The goal was to see whether a 10-week program of this exercise (40 minutes, twice per week) might help persons with advanced MS. During electrical stimulation cycling the subjects are seated on a stationary recumbent cycle ergometer and pairs of gel-backed electrodes are placed on the quadriceps, hamstrings, and gluteal muscles of each leg. The electrical muscle stimulator elicits synchronized muscle contractions (involuntary) which pedal the exercycle. In persons with spinal cord injury this form of cycling training increases leg muscle mass, leg blood flow, and improve glucose metabolism, while providing a light aerobic workout (Davis, Hamzaid, Fornusek 2008).

Dr Fornusek and a participant with MS prepare to begin a session of electrical stimulation cycling.

Dr Fornusek and a participant with MS prepare to begin a session of electrical stimulation cycling.

Electrical stimulation ‘exercycles’ have been designed for persons with complete spinal cord injury but are often not suitable for persons with multiple sclerosis. The stimulation is uncomfortable and the method previously used did not work well in persons with sensation because pain limits the exercise intensity that can be produced. Therefore, we adapted the method of electrical stimulation cycling so that it suited persons with MS and allowed them to produce the strong muscle contractions through the exercise sessions.



When electrical stimulation cycling exercise is adapted to persons with MS it can work well and show benefits. The method allowed greater levels of stimulation to be tolerated than previously reported. Strong muscle contractions were produced and significant increases were found in thigh volume, presumably due muscle hypertrophy. Perceived benefits from participants included improvements in transfer ability, leg circulation, spasticity and strength.



The findings suggest that exercise with electrical stimulation may be beneficial in persons with advanced MS. Further work is required to determine the potential benefits (quality of life, disease progression, metabolic health) of electrical stimulation for persons with MS. Consideration is also needed on how to translate this exercise technology to the MS community. 



Fornusek C, Hoang P (2014). Neuromuscular electrical stimulation cycling exercise for persons with advanced multiple sclerosis. J Rehabil Med 46: 698-702



Dalgas U, Stenager E, Ingemann-Hansen T (2008). Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training. Mult Scler 1435-53.

Davis GM, Hamzaid NA, Fornusek C (2008). Cardiorespiratory, metabolic, and biomechanical responses during functional electrical stimulation leg exercise: health and fitness benefits. Artif Organs 32, 625-9.

Smith C, Hale L (2006). Arm Cranking: an exercise intervention for a severely disabled adult with multiple sclerosis. New Zeal J Physioth. 34,172-8.

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