The development and evaluation of functional electrical stimulation rowing for health, exercise and sport for persons with spinal cord injury
At the beginning of this project it was known that functional electrical stimulation (FES) rowing was technically feasible, but no studies on health benefits had been conducted and it was unclear what levels of fitness could be reliably attained by spinal cord injured (SCI) users. This thesis shows that training with the first-generation of the FES-rowing system (RowStim II), seven paraplegics achieved high V02peak values (21.0 - 27.9 ml-kg-1-min-1) and a significant (10%) increase in V02peak. This was also found to significantly improve insulin sensitivity and leptin levels but it had no significant effect on lipid profiles or body composition, possibly caused by technological limitations of the RowStim 11. However, training volumes were positively correlated with improvements in lipid profile and body composition. This motivated further technical development of the RowStim to enable paraplegics to train harder and longer. The development included a more stable seat configuration with redesigned trunk retaining straps, a rigid low friction carriage/brake system, improved leg stabiliser, improved stimulation control and a gravity-assisted return phase. This RowStim III has enabled paraplegics to participate in the British (2004, 2005 and 2006) and World Indoor Rowing Championships (2006). The rowers have achieved higher exercise intensities (26.8 -31.0 ml. kg- I .min-1) and increased exercise volumes (1,150 kcal-week-1) with the RowStim III. Such levels of physical activity, which are difficult to achieve for paraplegics using traditional exercises, are correlated with significant health benefits in the able-bodied. Preliminary results suggest that perfusion of the quadriceps muscle during FES-rowing might limit the exercise time in novice rowers. Other preliminary data from pressure mapping indicate that there is a dynamic pattern during FES-rowing, which might reduce the risk for pressure sores during FES-rowing. This thesis shows that FES-rowing is now a rapidly developing exercise modality, which has been shown to enable safe and well-tolerated exercise for individuals with SCI. It can offer unprecedented levels of cardiovascular fitness, competitive challenges and potentially important health benefits.