# Recumbent FES‐Cycling Exercise Improves Muscle Performance and Ambulation Capacity in Hospitalized Patients: A Randomized Controlled Trial

## TL;DR

A study found that using electrical stimulation cycling while lying down can improve muscle strength and walking ability in hospitalized patients with muscle weakness.

## Contribution

This is the first randomized trial showing that recumbent high-intensity FES-cycling improves muscle performance and ambulation in hospitalized patients.

## Key findings

- FES-cycling improved torque and power output significantly more than usual care.
- Ambulation capacity improved threefold in the FES-cycling group compared to controls.
- Neuromuscular efficiency increased in patients receiving FES-cycling.

## Abstract

Acquired muscle weakness is a prevalent complication during hospitalization. Supportive technologies, such as functional electrical stimulation cycling (FES‐cycling), are increasingly recognized as a tool with the potential to improve physical exercise in patients constrained to bed rest.

In this randomized clinical trial, patients admitted to a high‐complexity ward exhibiting clinical signs of muscle weakness (e.g., report of loss of strength, gait, or balance deficit due to weakness or restriction to bed) were enrolled. Participants were randomly allocated to a recumbent high‐intensity, low‐volume FES‐cycling exercise or a control group. The primary outcomes measured were torque, power output, stimulation cost (neuromuscular efficiency), and ambulation capacity.

The analysis included 16 patients (eight in each group). Postintervention, the FES‐cycling group presented a greater increase in both absolute (4.25 ± 3.15 vs. 0.04 ± 3.49 Nm, p = 0.02) and percentage torque (117 ± 88 vs. 8% ± 53%, p < 0.01) compared to the control. Similarly, the FES‐cycling group presented higher absolute (3.91 ± 2.25 vs. 0.57 ± 1.82 watts, p < 0.01) and percentage power (61 ± 36 vs. 10% ± 23%, p < 0.01), along with a higher absolute (−2903 ± 2598 vs. −523 ± 1319 μC/watt, p = 0.03) and percentage stimulation cost (−33 ± 18 vs. −6% ± 1 8%, p = 0.01). Additionally, enhanced ambulation capacity was observed in the FES‐cycling group, with 6 patients showing improvement versus 2 in the control group (p = 0.03).

Recumbent high‐intensity, low‐volume FES‐cycling exercise increased muscle strength, power, and neuromuscular efficiency in hospitalized patients with muscle weakness. Improvements in ambulation capacity were also noted, supporting the intervention potential.

Both groups received the usual routine hospital care. Beyond usual care, the intervention group received the high‐intensity, low‐volume FES‐cycling exercise protocol. Study highlights are as follows: (1) High‐intensity, low‐volume FES‐cycling exercise increased strength, power, and neuromuscular efficiency. (2) Ambulation capacity improved threefold in the FES‐cycling exercise group compared to the control.