Positive effects of functional electrical stimulation-assisted cycling on perception of effort, cerebral blood flow and cognition in post-stroke patients

Background FES-assisted cycling may reduce perceived effort by lowering the required motor command compared to voluntary cycling. While benefits on effort perception have been shown during walking in stroke and multiple sclerosis patients, its effectiveness during cycling in stroke rehabilitation remains unproven. Thus, this work aimed to test the effect of functional electrical stimulation-assisted cycling on stroke patients’ perception of effort (primary aim) in a randomized controlled study design. In an exploratory way, this work also aimed to examine the effect of FES-assisted cycling on cerebral blood flow and cognitive performance (exploratory aims) in a subsample. Methods Fifteen post-stroke patients completed functional electrical stimulation-assisted and traditional cycling sessions separated by 72h. Perceived effort, cardio, and cerebrovascular parameters were monitored during exercise. Cognitive performance was assessed before and after each session. Qualitative data were reported after both sessions. Results Patients reported a lower perceived effort during functional electrical stimulation- assisted cycling than traditional cycling. Both sessions increased heart rate, end-tidal CO 2 , cardiac output, and cerebral artery blood flow velocity, with higher blood lactate levels after functional electrical stimulation-assisted cycling. Functional electrical stimulation-assisted cycling positively impacted cognitive performance. Conclusion Traditional and functional electrical stimulation-assisted cycling induced similar increased cardio and cerebrovascular responses. However, patients perceived functional electrical stimulation-assisted cycling as less effortful than traditional cycling. As effort is a barrier to regular exercise engagement and adherence, these results are promising for implementing functional electrical stimulation-assisted cycling in stroke patients’ rehabilitation.