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Faculty Advisor(s)

Kurt Jackson, PT, PhD

Description

Purpose/Hypothesis: Recumbent steppers are commonly used for improving cardiovascular and muscular endurance in neurological populations. Prior research has shown that using specific verbal cues and a foot strap can significantly alter lower extremity muscle activity and recruitment in healthy individuals during recumbent stepping. The purpose of this case series was to measure lower extremity muscle activity during recumbent stepping under a variety of stepping conditions in persons with multiple sclerosis.

Number of Subjects: 3 adults (2 F, 1 M; age 40 -54) with multiple sclerosis (MS) with varying levels of lower extremity motor function and disability.

Materials and Methods: During a single session, electromyography (EMG) was used to measure muscle activity of the tibialis anterior (TA), medial gastrocnemius (MG), rectus femoris (RF), biceps femoris muscles (BF), and vastus lateralis (VL) for 30 seconds at a constant resistance and step rate during six different stepping conditions: 1) Stepping with no foot strap (StepNFS), 2) Stepping with a foot strap (StepFS), 3) Verbal cues to pull with toes using a foot strap (PullTFS), 4) Verbal cues to push with heel using a foot strap (PushHFS), 5) Verbal cues to push with toes using a foot strap (PushTFS), 6) Verbal cues to pull with heels using a foot strap (PullHFS).

Results: Subject 1 demonstrated the greatest combined muscle activity during the PullTFS condition and the lowest during the PushHFS. Subject 2 demonstrated the greatest combined muscle activity during the PullHFS condition and the lowest during the PedalNFS. Subject 3 demonstrated the greatest combined muscle activity during the PullHFS condition and the lowest during the PedalNFS. The activity of individual muscles was highly variable between subjects and stepping conditions.

Conclusions: Individuals with MS with different levels of disability demonstrate highly variable muscle recruitment under different recumbent stepping conditions. However, use of a foot strap and verbal cues to emphasize pulling while stepping may increase overall muscle activity as well as recruitment of specific muscles such as the anterior tibialis and bicep femoris that are less active when stepping without verbal cues or a foot strap.

Clinical Relevance: When prescribing recumbent stepping exercise, clinicians should be aware that using a foot strap and specific verbal cues, can substantially alter lower extremity muscle recruitment in persons with MS. However, responses can be highly variable and may require the use of surface EMG to determine specific muscle responses between individuals.

Publication Date

5-8-2025

Disciplines

Physical Therapy | Rehabilitation and Therapy

The Effect of Recumbent Stepping on Leg Muscle Activity in Individuals With Multiple Sclerosis

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