SCI & Exercise

Gains in aerobic capacity with whole-body functional electrical stimulation row training and generalization to arms-only exercise after spinal cord injury


Study design

Longitudinal study in adults (n = 27; 19–40 years old) with tetraplegic or paraplegic spinal cord injury (SCI).


Determine physiological adaptations and generalizable fitness effects of 6 months of whole-body exercise training using volitional arm and functional electrical stimulation (FES) leg rowing.


Outpatient hospital-based exercise facility and laboratory.


Participants enrolled in hybrid FES-row training (FESRT) and performed peak exercise tests with arms-only (AO; baseline and 6 months) and FES rowing (baseline, 3, 6 months).


Participants demonstrated increased aerobic capacity (VO2peak) after FESRT (p < 0.001, np2 = 0.56) that tended to be higher when assessed with FES than AO rowing tests (0.15 ± 0.20 vs. 0.04 ± 0.22 L/min; p = 0.10). Changes in FES and AO VO2peak were significantly correlated (r = 0.55; p < 0.01), and 11 individuals demonstrated improvements (>6%) on both test formats. Younger age was the only difference between those who showed generalization of training effects and those who did not (mean age 26.6 ± 5.6 vs. 32.0 ± 5.7 years; p < 0.05) but changes in FES VO2peak correlated to time since injury in individuals <2 years post-SCI (r = −0.51, p < 0.01, n = 24). Lastly, VO2peak improvements were greater during the first 3 months vs. months 4–6 (+7.0% vs. +3.9%; p < 0.01) which suggests early training adaptations during FESRT.


Gains in aerobic capacity after whole-body FESRT are better reflected during FES-row testing format. They relate to high-intensity exercise and appear early during training, but they may not generalize to equivalent increases in AO exercise in all individuals with SCI.

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Fig. 1: Changes in aerobic capacity after FESRT when assessed with AO or FES-row testing.
Fig. 2: Relationship of change in AO VO2peak with change in FES VO2peak.
Fig. 3: Changes in FES VO2peak over time.

Data availability

Part of the dataset generated during and analyzed in this study is not publicly available because it is still being analyzed, but the data can be made available from the senior author on reasonable request.


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The authors would like to acknowledge the generous support of our funding agencies, the study participants, and the staff at the Exercise for Persons with Disabilities program.


This study was supported by the Craig H. Neilsen Foundation (542007), the National Institutes of Health (R01HL117037), National Institute on Disability, Independent Living, and Rehabilitation Research (90SI5021), and the Gordon Center for the Cure and Treatment of Paralysis.

Author information




HWM was responsible for study conceptualization, data analysis and interpretation, and writing and revising the manuscript. GP was responsible for data acquisition and conducting exercise tests, and he supervised FESRT. JAT was responsible for study conceptualization, data interpretation, and revising the manuscript. IV was responsible for study conceptualization, data analysis and interpretation, and writing and revising the manuscript.

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Correspondence to Hannah W. Mercier.

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Mercier, H.W., Picard, G., Taylor, J.A. et al. Gains in aerobic capacity with whole-body functional electrical stimulation row training and generalization to arms-only exercise after spinal cord injury. Spinal Cord (2020).

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