Protocols aiming to increase muscle mass in persons with motor complete spinal cord injury: a systematic review.
Study Goal
The researchers aimed to compare intervention modalities, including Neuromuscular Electrical Stimulation (NMES), for increasing skeletal muscle mass in paralyzed limbs of individuals with chronic, motor complete spinal cord injury.
Results Summary
NMES-based resistance training on the quadriceps produced the largest and most consistent increases in skeletal muscle mass among all interventions reviewed. However, the overall studies demonstrated a high risk of bias, and more high-quality trials are needed to optimize training variables.
Population
Adults (>18 years) with chronic (>1-year post-injury), motor complete spinal cord injury.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
neuromuscular electrical stimulation (NMES) with external resistance | increase | skeletal muscle mass (SMM) | persons with chronic (>1-year post-injury), motor complete spinal cord injury (SCI) | - | produced the largest and most consistent increases | #1 |
resistance training (RT) using NMES on the quadriceps | increase | skeletal muscle mass (SMM) | persons with chronic (>1-year post-injury), motor complete spinal cord injury (SCI) | - | produced the largest and most consistent increases | #2 |
neuromuscular electrical stimulation-based resistance training | increase | skeletal muscle mass (SMM) | adults with motor complete spinal cord injury | - | demonstrates the most robust and consistent evidence for increasing | #3 |
- | decrease | skeletal muscle mass (SMM) | Persons with spinal cord injury (SCI) | - | experience severe reductions | #4 |
PURPOSE: The purpose of this review was to compare all intervention modalities aimed at increasing skeletal muscle mass (SMM) in the paralysed limbs of persons with chronic (>1-year post-injury), motor complete spinal cord injury (SCI). MATERIALS AND METHODS: A systematic review of EMBASE, MEDLINE, Scopus, and SPORTDiscus databases was conducted from inception until December 2021. Published intervention studies aimed to increase SMM (measured by magnetic resonance imaging, computed tomography, ultrasound, muscle biopsy, or lean soft tissue mass by dual X-ray absorptiometry) in the paralysed limbs of adults (>18 years) with SCI were included. RESULTS: Fifty articles were included that, overall, demonstrated a high risk of bias. Studies were categorised into six groups: neuromuscular electrical stimulation (NMES) with and without external resistance, functional electrical stimulation cycling, walking- and standing-based interventions, pharmacological treatments, and studies that compared or combined intervention modalities. Resistance training (RT) using NMES on the quadriceps produced the largest and most consistent increases in SMM of all intervention modalities. CONCLUSIONS: Current evidence suggests that clinical practise aiming to increase SMM in the paralysed limbs of persons with motor complete SCI should perform NMES-RT. However, more high-quality randomised control trials are needed to determine how training variables, such as exercise volume and intensity, can be optimised for increasing SMM. Implications for rehabilitationPersons with spinal cord injury (SCI) experience severe reductions in skeletal muscle mass (SMM) post-injury, which may exacerbate their risk of obesity and metabolic disease.Out of all exercise and non-exercise-based interventions, this systematic review shows that neuromuscular electrical stimulation-based resistance training demonstrates the most robust and consistent evidence for increasing skeletal muscle mass in the paralysed limbs of adults with motor complete spinal cord injury.The findings from this review can be used to inform evidence-based practise for exercise practitioners, as well as direct future research focused on increasing muscle mass in this population.