Frotzler et al. 2008
Switzerland/UK
Downs & Black =16
Pre-Post
N = 11

Population: 11 participants with SCI between T3 and T12 and ASIA grade A
Treatment: FES cycling, five 60-min sessions per week for 12 months
Outcome Measures: Femur and tibia: trabecular, cortical, and total BMD, BMC and total cross-sectional area by pQCT.

Distal Femur: 1. Trabecular BMD increased by 14.4±21.1%
2. Total BMD increased by 7.0±10.8%
3. Total cross-sectional area increased by 1.2±1.5%
Femoral Shaft: 1. Cortical BMD decreased by 0.4±0.4%
2. BMC decreased by 1.8+3.0%
Tibia: No significant changes in bone parameters.

Frotzler et al. 2009
Switzerland/UK
Downs & Black =13
Pre-Post
N = 5

Population: 4 men and 1 woman (mean age 38.6+8.1), with SCI between T4 and T7, ASIA grade A, who showed significant effects on bone parameters due to high-volume FES cycling
Methods: Follow-up on Frotzler et al. 2008: 4 participants stopped FES cycling and 1 had reduced training (two-three 30-minute sessions/week)
Outcome Measures: Trabecular and total BMD and BMC by pQCT.

1. Participants who stopped training: Distal femur: 73%±13.4% of total gain in BMDtrab; 63.8%±8.0% in BMDtot, and 59.4%±3.9% in BMC were preserved after 12 months of detraining
2. Participant with reduced training:  96.2% of total gain in BMDtot and 95% of gain in BMDtrab in the distal femur were preserved

BeDell et al. 1996; USA
Downs & Black =10
Pre-post
N=12

Population: 12 men, ages 23-46, complete injuries between C5-T12, no controls.
Treatment: FES+ FES-cycle ergometer. Participants participated in a 3-phase training program of FES-CE. Phase 1: quads strengthening. Phase 2: FES-CE progression until 30 min continuously. Phase 3a: 24x 30-mins continuous exercise sessions performed 3x/wk. Phase 3b: An extra 24x 30-min sessions adding simultaneous arm ergometry (8 participants only).
Outcome measure: BMD by DPA

1. At baseline, SCI participants were not significantly different from aged-matched able-bodied ambulatory men for lumbar-spine BMD. However, BMD was significantly lower for participants at the hip (p<0.025) for bilateral trochanters, Wards triangles, and femoral necks.
2. Only the L2-L4 values demonstrated any positive training effects (p=0.056). Further training (Phase 3b) did not demonstrate further increase in BMD at any site.

Pacy et al. 1988; UK Downs & Black =10
Pre-post
N=4

Population: 4 men, ages 20-35, all participants had paraplegia, no controls
Treatment: FES+ FES-CE. Part 1 was quads strengthening with ↑ load ranging from 1.4-11.4 kg bilateral for 15 mins for 5x/wk (10 wks). Part 2 was FES-CE at 50 rpm with resistance (0-18.75 W). Performed for 15 mins, 5x/wk (32 wks).
Outcome measures:BMD byDXA

1. No significant change in lumbar spine and femoral shaft and/or distal tibia trabecular BMD after the intervention.

Chen et al. 2005;
Taiwan
Downs & Black = 9
Pre-post
N=30

Population: 15 men, ages 23-37, with complete SCI, C6-T8. 15 able-bodied controls
Treatment: FES-cycle ergometer. Participants performed FES-CE exercises with minimal resistance for 30 minutes/day, 5 days/week for 6 months. Follow-up 6 months after intervention.
Outcome measures: BMD by DXA

1. At baseline, participants’ BMD at the femoral neck, distal femur and proximal tibia was lower than controls.
2. After 6 months, BMD of the distal femur and proximal tibia increased significantly (p<0.05). BMD in the distal femur, proximal tibia, and heel decreased significantly after 6 months without intervention (p<0.05). The BMD of the femoral neck decreased progressively throughout the treatment (p>0.05).

Hangartner et al. 1994; USA
Downs & Black = 9
Pre-post
N=15

Population: 15 men and women, ages 17-46, complete and incomplete injury between C5-T10, no controls.
Treatment: FES+ FES-cycle ergometer. Either 1. FES knee extension exercises (n=3) or 2. FES-CE (n=9) or 3. both (n=3). Sessions were 3x/week for 12 wks except Group 3 had 24 weeks.
Outcome measures: CT

1. Participants in the exercise groups continued to lose bone at the distal and proximal end of the tibia, but it was less than expected from the regression lines.

Mohr et al. 1997; Denmark
Downs & Black = 9
Pre-post
N=10

Population: 10 men and women, ages 27-45, with injuries either at C6 or T2, no controls
Treatment: FES. Stimulated the legs for 30 min, 3x/wk for 6 months. followed by 1x/wk for 6 months.
Outcome measures: BMD by DXA, bone turnover markers.

1. After 12 mos. of training, there was a significant 10% increase in proximal tibia BMD (p< 0.05) but no change at the lumbar spine or femoral neck.
2. After 6 mos. of reduced training, BMD for the proximal tibia returned to baseline.
3. Blood and urine markers were within normal limits at baseline and there was no significant change with PES.