Supervised Cycling Training Improves Erythrocyte Rheology in Individuals With Peripheral Arterial Disease

Peripheral arterial disease (PAD) results in insufficient flow to lower extremities. Aerobic exercise provides health benefits for individuals with PAD, but basic science behind it is still debated. Twenty-one PAD patients aged about 70 years with female/male as 7/14 were recruited. Among them, 11 were randomized to have supervised cycling training (SCT) and 10 to receive general healthcare (GHC) as controls. SCT participants completed 36 sessions of SCT at the first ventilation threshold within 12 weeks and the controls received GHC for 12 weeks. Ankle-brachial index (ABI), 6-min walk test (6MWT), peak oxygen consumption (V˙O2peak), minute ventilation (V˙E), minute carbon dioxide production (V˙CO2), erythrocyte rheology, including the maximal elongation index (EImax) and shear stress at 50% of maximal elongation (SS1/2), and the Short Form-36 (SF-36) questionnaire for quality of life (QoL) were assessed before and 12 weeks after initial visit. SCT significantly decreased the SS1/2 as well as SS1/2 to EImax ratio (SS1/2/EImax) and increased the erythrocyte osmolality in the hypertonic region as well as the area under EI-osmolality curve. The supervised exercise-induced improvement of erythrocyte deformability could contribute to the increased peripheral tissue O2 delivery and was possibly related with increased V˙O2peak. The physiological benefit was associated with significantly increased ABI, 6-min walking distance, cardiorespiratory fitness, and SF-36 score. However, no significant changes in aerobic capacity and erythrocyte rheological properties were observed after 12-week of GHC. In conclusion, SCT improves aerobic capacity by enhancing erythrocyte membrane deformability and consequently promotes QoL in PAD patients.

Muscle Electrical Impedance Properties and Activation Alteration After Functional Electrical Stimulation-Assisted Cycling Training for Chronic Stroke Survivors: A Longitudinal Pilot Study

Electrical impedance myography (EIM) is a sensitive assessment for neuromuscular diseases to detect muscle inherent properties, whereas surface electromyography (sEMG) is a common technique for monitoring muscle activation. However, the application of EIM in detecting training effects on stroke survivors is relatively few. This study aimed to evaluate the muscle inherent properties and muscle activation alteration after functional electrical stimulation (FES)-assisted cycling training to chronic stroke survivors. Fifteen people with chronic stroke were recruited for 20 sessions of FES-assisted cycling training (40 min/session, 3–5 sessions/week). The periodically stimulated and assessed muscle groups were quadriceps (QC), tibialis anterior (TA), hamstrings (HS), and medial head of gastrocnemius (MG) on the paretic lower extremity. EIM parameters [resistance (R), reactance (X), phase angle (θ), and anisotropy ratio (AR)], clinical scales (Fugl-Meyer Lower Extremity (FMA-LE), Berg Balance Scale (BBS), and 6-min walking test (6MWT)] and sEMG parameters [including root-mean square (RMS) and co-contraction index (CI) value] were collected and computed before and after the training. Linear correlation analysis was conducted between EIM and clinical scales as well as between sEMG and clinical scales. The results showed that motor function of the lower extremity, balance, and walking performance of subjects improved after the training. After training, θ value of TA (P = 0.014) and MG (P = 0.017) significantly increased, and AR of X (P = 0.004) value and AR of θ value (P = 0.041) significantly increased on TA. The RMS value of TA decreased (P = 0.022) and a significant reduction of CI was revealed on TA/MG muscle pair (P < 0.001). Significant correlation was found between EIM and clinical assessments (AR of X value of TA and FMA-LE: r = 0.54, P = 0.046; X value of TA and BBS score: 0.628, P = 0.016), and between sEMG and clinical scores (RMS of TA and BBS score: r = −0.582, P = 0.029). This study demonstrated that FES-assisted cycling training improved lower limb function by developing coordinated muscle activation and facilitating an orderly myofiber arrangement. The current study also indicated that EIM can jointly evaluate lower extremity function alteration with sEMG after rehabilitation training.Clinical Trail Registration: The study was registered on the Clinical Trial Registry (trial registration number: NCT 03208439, https://clinicaltrials.gov/ct2/show/NCT03208439).

Three weeks of a home-based “sleep low-train low” intervention improves functional threshold power in trained cyclists: A feasibility study

Background “Sleep Low-Train Low” is a training-nutrition strategy intended to purposefully reduce muscle glycogen availability around specific exercise sessions, potentially amplifying the training stimulus via augmented cell signalling. The aim of this study was to assess the feasibility of a 3-week home-based “sleep low-train low” programme and its effects on cycling performance in trained athletes. Methods Fifty-five trained athletes (Functional Threshold Power [FTP]: 258 ± 52W) completed a home-based cycling training program consisting of evening high-intensity training (6 × 5 min at 105% FTP), followed by low-intensity training (1 hr at 75% FTP) the next morning, three times weekly for three consecutive weeks. Participant’s daily carbohydrate (CHO) intake (6 g·kg-1·d-1) was matched but timed differently to manipulate CHO availability around exercise: no CHO consumption post- HIT until post-LIT sessions [Sleep Low (SL), n = 28] or CHO consumption evenly distributed throughout the day [Control (CON), n = 27]. Sessions were monitored remotely via power data uploaded to an online training platform, with performance tests conducted pre-, post-intervention. Results LIT exercise intensity reduced by 3% across week 1, 3 and 2% in week 2 (P < 0.01) with elevated RPE in SL vs. CON (P < 0.01). SL enhanced FTP by +5.5% vs. +1.2% in CON (P < 0.01). Comparable increases in 5-min peak power output (PPO) were observed between groups (P < 0.01) with +2.3% and +2.7% in SL and CON, respectively (P = 0.77). SL 1-min PPO was unchanged (+0.8%) whilst CON improved by +3.9% (P = 0.0144). Conclusion Despite reduced relative training intensity, our data demonstrate short-term “sleep low-train low” intervention improves FTP compared with typically “normal” CHO availability during exercise. Importantly, training was completed unsupervised at home (during the COVID-19 pandemic), thus demonstrating the feasibility of completing a “sleep low-train low” protocol under non-laboratory conditions.

Indoor cycling training in rehabilitation of patients after myocardial infarction

Background Standard endurance training used from the second stage of cardiac rehabilitation has many common features with indoor cycling training which is used in fitness clubs. In the study, an attempt was made to evaluate the usefulness of this form of training in a 24-day rehabilitation program for patients after myocardial infarction. The study examined a group of 64 patients (51.34 ± 8.02 years) who were divided into two groups: the IC group (32 patients aged 53.40 ± 4.31 years) with indoor cycling training instead of standard endurance training; and the ST group (32 patients aged 55.31 ± 6.45 years) performing standard training. The level of exercise tolerance (cardiopulmonary exercise testing on a treadmill—Bruce’s protocol), hemodynamic indicators of the left ventricle (echocardiography) and blood lipid profile (laboratory test) were assessed. Results In the IC group there was a significant increase in the test duration (9.21 ± 2.02 vs 11.24 ± 1.26 min; p < 0.001), the MET value (9.16 ± 1.30 vs 10.73 ± 1.23; p = 0.006) and VO2max (37.27 ± 3.23 vs 39.10 ± 3.17 ml/kg/min; p < 0.001). Parallel changes were observed in the ST group, where the following parameters improved: the test duration (9.41 ± 0.39 vs 10.91 ± 2.22; p < 0.001), MET value (8.65 ± 0.25 vs 9.86 ± 1.12; p = 0.002) and VO2max (36.89 ± 6.22 vs 38.76 ± 3.44; p < 0.001). No statistically significant changes were found in the hemodynamic indices of the left ventricle and the lipid profile. Also, the intergroup analysis did not show any statistical significance. Conclusion Based on the research results, it was found that indoor cycling training in the second phase of cardiac rehabilitation is a safe form of therapy and therefore may be an interesting alternative method to the classic bicycle ergometer exercise in the stage of early cardiac rehabilitation.

The Effect and Dose-Response of Functional Electrical Stimulation Cycling Training on Spasticity in Individuals With Spinal Cord Injury: A Systematic Review With Meta-Analysis

Background: To investigate the effect and dose-response of functional electrical stimulation cycling (FES-cycling) training on spasticity in the individuals with spinal cord injury (SCI).Method: Five electronic databases [PubMed, Scopus, Medline (Proquest), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)] were searched before September 2021. The human trials and studies of English language were only included. Two authors independently reviewed and extracted the searched studies. The primary outcome measure was spasticity assessed by Modified Ashworth Scale or Ashworth Scale for lower limbs. The secondary outcome measures were walking abilities, such as 6 Min Walk Test (6MWT), Timed Up and Go (TUG), and lower limbs muscle strength (LEMS). A subgroup analysis was performed to investigate the efficacious threshold number of training sessions. A meta-regression analysis was used to examine the linear relationship between the training sessions and the effect on spasticity.Results: A total of 764 studies were identified. After screening, 12 selected studies were used for the qualitative synthesis, in which eight of them were quantitatively analyzed. Eight studies included ninety-nine subjects in total with SCI (male: female = 83:16). The time since injury was from less than 4 weeks to 17 years. The age ranged from 20 to 67 years. American Spinal Injury Association (ASIA) impairment level of the number of participants was 59 for ASIA A, 11 for ASIA B, 18 for ASIA C, and 11 for ASIA D. There were 43 subjects with tetraplegia and 56 subjects with paraplegia. Spasticity decreased significantly (95% CI = − 1.538 to − 0.182, p = 0.013) in favor of FES-cycling training. The walking ability and LEMS also improved significantly in favor of FES-cycling training. The subgroup analysis showed that spasticity decreased significantly only in more than 20 training sessions (95% CI = − 1.749 to − 0.149, p = 0.020). The meta-regression analysis showed training sessions and spasticity were not significantly associated (coefficient = − 0.0025, SE = 0.0129, p = 0.849, R2 analog = 0.37).Conclusion: Functional electrical stimulation-cycling training can improve spasticity, walking ability, and the strength of the lower limbs in the individuals with SCI. The number of training sessions is not linearly related to the decrease of spasticity. Twenty sessions of FES-cycling training are required to obtain the efficacy to decrease spasticity.

Effects of Treadmill Training and Stationary Cycling Training to Improve Ambulatory Function and Cardiovascular Fitness

Background: Stroke is a universal health care disease, the important cause of long time disability in world. Stroke leads to an inactive living, physical restrictions, and not good physical levels, which are related with common post-stroke participation limits. Aerobic capability and walking ability are decreased in old chronic patients of stroke. Aim: To determine the effects of treadmill training and stationary cycling training to improve ambulatory function and cardiovascular fitness in hemiparetic stroke patients Methods: 54 chronic stroke patients were allocated to treadmill training group(n=27) or stationary cycle exercise group (n=27). All participants received conventional physical therapy along with treadmill or stationary cycle training. The 10MWT was conducted to measure gait function and 6 min walk test was used to measure cardiovascular health. Results: The mean of treadmill group for 10 meter walk test is 10.01 + 15.48. The mean of stationary cycle group for 10 meter walk test is 9.80 + 6.77. The mean of treadmill group for 6 min walk test is 22.04+ 17.45. The mean of stationary cycle group for 6 min walk test is 23.20+ 22.92. The p value of 0.000 shows significant difference. This significant difference reflects that both interventions show equal improvement in participants. There is significant difference between pre and post treatment values of both interventions. Both intervention groups displayed significant effect in ambulatory functions and cardiovascular fitness. The results between groups were non significant, it means both interventions showed equal effect but results with in groups were significant. Conclusion: The study showed that treadmill training and stationary cycling training equally enhanced the gait ability and cardiovascular health of chronic stroke patients. Therefore, these exercises could be used to enhance walking and cardiovascular health in management of stroke. Keywords: treadmill training, stationary cycle training, ambulatory function, cardiovascular fitness, stroke