Handcycling with Concurrent Lower Body Low-frequency Electromyostimulation Significantly Increases Acute Oxygen Uptake: Implications for Rehabilitation and Prevention

Background: Acute increases in exercise-induced oxygen uptake (V̇O) is crucial for aerobic training adaptations and depends on how much muscle mass is involved during exercising. Thus, handcycling is per se limited for higher maximal oxygen uptakes (V̇Omax) due to restricted muscle involvement. Handcycling with additional and simultaneous application of low-frequency electromyostimulation (EMS) to the lower extremities might be a promising stimulus to improve aerobic capacity in disabled and rehabilitative populations.

Method: Twenty-six healthy young adults (13 female, age: 23.4 ± 4.5 years, height: 1.77 ± 0.09 m, mass: 71.7 ± 16.7 kg) completed 4 ×10 minutes of sitting (SIT), sitting with concurrent EMS (EMS_SIT), handcycling (60 rpm, 1/2 bodyweight as resistance in watts) (HANDCYCLE) and handcycling with concurrent EMS of the lower extremities (EMS_HANDCYCLE). During EMS_SIT and EMS_HANDCYCLE, low frequency EMS (impulse frequency: 4Hz, impulse width: 350 µs, continuous stimulation) was applied to gluteal, quadriceps and calf muscles. The stimulation intensity was selected so that the perceived pain could be sustained for a duration of 10 minutes (gluteus: 80.0 ± 22.7 mA, quadriceps: 94.5 ± 20.5 mA, calves: 77.5 ± 19.1 mA).

Results: Significant mode-dependent changes of V̇O were found ( < 0.001, = 0.852). Subsequent post-hoc testing indicated significant difference between SIT EMS_SIT (4.70 ± 0.75 10.61 ± 4.28 ml min kg, < 0.001), EMS_SIT HANDCYCLE (10.61 ± 4.28 13.52 ± 1.40 ml min kg,  = 0.005), and between HANDCYCLE EMS_HANDCYCLE (13.52 ± 1.40 18.98 ± 4.89 ml min kg,  = 0.001).

Conclusion: Handcycling with simultaneous lower body low-frequency EMS application elicits notably higher oxygen uptake during rest and moderately loaded handcycling and may serve as an additional cardiocirculatory training stimuli for improvements in aerobic capacity in wheelchair and rehabilitation settings.