A systematic review and meta-analysis of physiological and clinical effects of FES-cycling

Arch Phys Med Rehabil. 2024 Jun 22:S0003-9993(24)01057-8. doi: 10.1016/j.apmr.2024.06.003. Online ahead of print.


Objective: To examine the evidence regarding FES-cycling's physiological and clinical effects.

Data sources: The study was conducted in accordance with PRISMA. PubMed, EMBASE, Cochrane Review, CINAHL, Scopus, Sport Discus, and Web of Science databases were used.

Study selection: Randomized controlled trials involving FES-cycling were included. Studies that didn't involve FES-cycling in the intervention group or without the control group were excluded. Two reviewers screened titles and abstracts and then conducted a blinded full-text evaluation. A third reviewer resolved discrepancies.

Data extraction: Meta-analysis was performed using inverse variance for continuous data with effect measured by mean difference and random effects analysis model. A 95% confidence interval was adopted. The significance level was set at p<.05, and trends were declared at p=.05 to ≤ .10. The I2 method was used for heterogeneity analysis. The minimal clinically important difference was calculated. Methodological quality was assessed by the risk-of-bias tool for randomized trials. The GRADE method was used for the quality of the evidence analysis.

Results: A total of 52 studies were included. Metabolic, cardiocirculatory, ventilatory, and peripheral muscle oxygen extraction variables presented statistical (p<.05) and clinically important differences favoring FES-cycling, with moderate to high certainty of evidence. It also presented statistical (p<.05) and clinically important improvement in cardiorespiratory fitness, leg and total body lean mass, power, physical fitness in intensive care (moderate to high certainty of evidence), and torque (low certainty of evidence). It presented a trend (p=.05 to ≤.10) of improvement in muscle volume, spasticity, and mobility (low to moderate certainty of evidence). It showed no difference (p>.10) in six-minute walking distance, muscle cross-sectional area, bone density, and length of ICU stay (low to moderate certainty of evidence).

Conclusions: FES-cycling exercise is a more intense stimulus modality than other comparative therapeutic modalities and presented clinically important improvement in several clinical outcomes.

Keywords: FES-cycling; clinical; electrical stimulation; exercise; functional capacity; muscle; physiology.

Publication types

  • Review