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Functional electrical stimulation cycling

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Line drawing to show FES cycling system
Line drawing to show FES cycling system


What is Functional electrical stimulation (FES) cycling?

Functional electrical stimulation (FES) cycling is a rehabilitation method that uses electrodes to activate arm and leg muscles to drive a stationary or mobile bicycle. FES has also been used in rowing, knee extension, standing, and stepping rehabilitation. (Davis 2008)

How FES cycling works

When the system is powered on, the cycle starts to rotate. The electronic system in the cycle determines the position of the crank arms and calculates the proper stimulation timing to the muscles that are hooked up to the system. Squidoo

History of FES

FES technology was first seen for use of bladder and intestinal stimulation. Since the 1960s, FES has been used to evoke muscle contractions in patients with spinal cord injury. Since the 1980s, the technology has been stimulating the muscles for functional use during tasks such as rowing, cycling, standing, and stepping. (Davis 2008)

Who can use FES cycling?

FES cycling can be used by patients with partial or complete arm and leg muscle paralysis. FES cycling has been heavily studied for use with the spinal cord injury population, but there is also growing evidence for use of this technology by patients affected by stroke and multiple sclerosis. (squidoo)

In spinal cord injuries, patients have moderate-severe muscle paralysis, functional lower limb loss, often leading to lower levels of aerobic fitness. Over time, these muscles decrease in size (atrophy) and switch from slow twitch to fast twitch fibers, making the muscles smaller and less able to use aerobic metabolism during exercise. In addition, the muscles lack input from the central nervous system to regulate blood flow. FES cycling has been shown to affect these patterns following spinal cord injury.

FES therapy contraindications

FES therapies should not be used by patients that have a pacemaker, that experience epilepsy, or that have a metal implant near the site of muscle stimulation.

Benefits of FES cycling

Studies have shown that FES cycling increases cardiorespiratory fitness, promotes leg blood circulation, increases activity of metabolic enzymes, increases muscle volume and muscle fiber size, increases strength and endurance, alters the bone mass density, and even shows positive psychosocial effects. When FES cycling is used within a few weeks of the injury, stimulated muscles show less atrophy and over time, show a switch to type I (fatigue resistant) fibers. (Davis 2008)

FES cycling has been shown to increase the blood flow and diameter of the common femoral artery when the upper leg muscles were stimulated. In the same study, blood flow of the other non-stimulated tissues did not show the same increases. (Thjssen 2005) Similarly, bone mineral density and total cross sectional area and muscle cross sectional area increased while fat cross sectional area decreased in the area of the actively stimulated and loaded femur, while these changes were not seen in the passively loaded tibia (Frotzler 2008).

FES cycling products

FES cycles come in a few models. Some cycles incorporate arm and leg stimulation and/or movement, while others only include one stimulation and/or movement. There are also stationary systems (with a seat or to be used with the patient’s wheelchair) or mobile devices (independent of the wheelchair). Two FES cycle manufacturers include Anatomical Concepts and Restorative Therapies, the latter of which has the only system that can be used with children as young as 4 years old.

One of the designs from Restorative Therapies.
One of the designs from Restorative Therapies.
Restorative Therapies FES cycle in use by child
Restorative Therapies FES cycle in use by child
One of the designs from Anatomical Concepts.
One of the designs from Anatomical Concepts.

Product Links

External Links


1. Davis GM, Hamzaid NA, Fornusek C. Cardiorespiratory, Metabolic, and Biomechanical Responses During Functional Electrical Stimulation Leg Exercise: Health and Fitness Benefits. Artificial Organs. 2008;32(8):625-629.

2. Frotzler A, Coupaud S, Perret C, et al. High-volume FES-cycling partially reverses bone loss in people with chronic spinal cord injury. Bone. 2008;43(1):169-176.

3. Thijssen DH, Heesterbeek P, van Kuppevelt DJ, Duysens J, Hopman MT. Local vascular adaptations after hybrid training in spinal cord injured subjects. Med Sci Sports Exerc. 2005;37(7):1112-8.