Aerobic training effects of electrically induced lower extremity exercises in spinal cord injured people

Eleven people with spinal cord injury (SCI) (C4-T6) participated in a program of functional electric stimulation (FES) of their paralyzed leg muscles using the REGYS I system. Individualized protocols consisted of an initial phase of weight lifting, an intermediate phase of ergometer pedalling against 0 Kilopond (kp) alternated with 1/8kp for six two-minute runs separated by two-minute rest periods, and a final phase of 36 sessions of continuous ergometer pedalling against variable resistance. A metabolic analyzer measured exercise stress test parameters before and after each phase while subjects pedalled against incremented resistance. Peak oxygen consumption and total stress test time increased markedly. The respiratory exchange ratio (R=VCO2/VO2) at termination, however, did not differ from unity at any phase, indicating that fatigue (defined as a failure to maintain a pedalling frequency of 35 rpm) occurred when the anaerobic threshold was reached, and that FES exercise can increase the aerobic capacity of persons with SCI. The initial velocity of quadriceps shortening (derived from patellar tendon displacements) also decreased in five of eight subjects tested, suggesting corresponding increases in quadriceps twitch time. Since muscle inactivity converts slow-twitch to fast-twitch fibers, our subjects' increased muscle endurance accompanied by decreased muscle-shortening velocity were compatible with a disproportionate increase in the function of slow-twitch fibers relative to fast-twitch fibers. Although these findings demonstrate that lower extremity FES exercises can safely achieve significant aerobic training effects in patients with SCI, the peak levels of cardiorespiratory performance were similar to those reported for quadriplegic people performing maximal voluntary upper extremity exercises.     

Functional electrical stimulation leg cycle ergometer exercise: training effects on cardiorespiratory responses of spinal cord injured subjects at rest and during submaximal exercise.

This study investigated the cardiorespiratory (CR) responses at rest and during submaximal (0-W) functional electrical stimulation (FES)-induced leg cycle ergometer (LCE) exercise prior to and following a progressive intensity FES-LCEa exercise training program in spinal cord injured (SCI) subjects. Seven quadriplegics and six paraplegics participated in FES-LCE training three sessions per week for approximately 12 weeks (36 sessions). Monitored CR responses, including oxygen uptake (VO2), pulmonary ventilation (VE), respiratory exchange ratio (RER), arteriovenous O2 difference (a-vO2), blood pressure (BP), heart rate (HR), stroke volume (SV), total peripheral resistance (TPR), and cardiac output (Q), were determined before and after training. Power output (PO) increased significantly (p < .05) over the duration of the training program, indicating increased in strength and endurance of the paralyzed muscles used. Respiratory responses were not significantly altered by training in both groups. FES-LCE training significantly increased resting HR and SBP in quadriplegics and lowered SBP, DBP, and MAP in paraplegics. In both groups, HR and BP during submaximal exercise significantly decreased and SV and Q significantly increased after completion of the training program. These results suggest that FES-LCE training improves peripheral muscular and central cardiovascular fitness in SCI subjects. Posttraining HR and BP may also be more stable in quadriplegics and alleviate hypotension. This therapeutic exercise may ultimately lead to improved rehabilitation outcome and reduced stress during activities of daily living, and possibly reduce the risks for secondary CR disabilities.     

The effects of lower-extremity functional electric stimulation on the orthostatic responses of people with tetraplegia

OBJECTIVE: To determine whether application of functional electric stimulation (FES) to lower-limb muscles during postural tilting improves orthostatic tolerance in people with tetraplegia. DESIGN: A crossover design. SETTING: A rehabilitation hospital. PARTICIPANTS: Sixteen acute and chronic subjects with tetraplegia (15 men, 1 woman) with complete motor function loss at the C3-7 levels were recruited. Time since injury ranged from 2 to 324 months (mean, 118.9+/-104.2 mo). INTERVENTION: Subjects were tested on a progressive head-up tilting maneuver with and without the application of FES at 0 degrees , 15 degrees , 30 degrees , 45 degrees , 60 degrees , 75 degrees , and 90 degrees continuously for up to 1 hour. FES was administered to 4 muscle groups including the quadriceps, hamstrings, tibialis anterior, and gastrocnemius muscles bilaterally at an intensity that provided a strong, visible, and palpable contraction. This was to produce a muscle pumping mechanism during the tilting maneuver. MAIN OUTCOME MEASURES: Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, perceived presyncope score, and the overall duration of orthostatic tolerance, that is, the time that subjects could tolerate the tilting maneuver without developing severe hypotension or other intolerance symptoms. RESULTS: When the tilt angle was increased, the subjects' SBP and DBP tended to decrease, whereas the heart rate tended to increase in both testing conditions. Adding FES to tilting significantly attenuated the drop in SBP by 3.7+/-1.1 mmHg (P = .005), the drop in DBP by 2.3+/-0.9 mmHg (P = .018), and the increase in heart rate by 1.0+/-0.5 beats/min (P = .039) for every 15 degrees increment in the angle of the tilt. FES increased the overall mean standing time by 14.3+/-3.9 min (P = .003). CONCLUSIONS: An FES-induced leg muscle contraction is an effective adjunct treatment to delay orthostatic hypotension caused by tilting; it allows people with tetraplegia to stand up more frequently and for longer durations.     

Changes in spastic muscle tone increase in patients with spinal cord injury using functional electrical stimulation and passive leg movements

OBJECTIVE: Comparison of cycling interventions to reduce spastic muscle tone increase in patients with spinal cord injury. SETTING: Neuroprosthetic outpatient clinic in a university hospital. METHODS: Five patients with spinal cord injury took part in a crossover study in which the lower limbs (1) were stimulated by functional neuromuscular electrical stimulation (FES) to induce leg cycling movements and (2) were passively moved by an ergometer machine. Patients sat in a comfortable chair fastened to the ergometer while FES was done to induce leg cycling (active session). During the passive leg movement session the ergometer moved their legs for the same period of time at the same velocity and frequency. MAIN OUTCOME MEASURES: The change in spastic muscle tone increase before and after each training session was tested with the modified Ashworth Scale and the pendulum test of spasticity (relaxation index and peak velocity). RESULTS: The averaged data of the relaxation index increased after FES by about 68%. Compared with the slight increase after the passive movement training of 12%, this is statistically significant (P = 0.01). Peak velocity increased after FES by around 50%, while it was nearly unchanged after the passive intervention (1%); this is also significant (P = 0.01). This was similar with the peak velocity and the modified Ashworth Scale. CONCLUSION: The study presents further interesting aspects of the usefulness of FES in patients with spinal cord injury to reduce spastic muscle tone.     

有氧训练对早期脑梗死患者心血管及运动功能的影响

目的: 探讨有氧训练对早期脑梗死患者心血管及运动功能的影响。方法：早期脑梗死患者60例,随机分为观察组和对照组各30例,2组均给予对症常规药物治疗及康复训练,观察组在此基础上增加坐位下MOTOmed viva2踏车有氧训练。治疗前后评定2组患者心率、血压、血氧饱和度,阻力大小以及主观疲劳感,并检测患侧股四头肌肌力,患侧股四头肌、小腿三头肌、腘绳肌肌张力,以及下肢Fugl-Meyer运动功能评分（FMA）。结果：治疗4周后,2组血压、心率、血氧饱和度及患侧下肢股四头肌、小腿三头肌、腘绳肌肌张力治疗前后及组间比较差异均无统计学意义。治疗后,2组踏车阻力、股四头肌肌力及FMA评分均较治疗前明显提高（P<0.05）,且观察组更高于对照组（P<0.05）;2组主观疲劳感均较治疗前明显降低（P<0.05）,且观察组更低于对照组（P<0.05）。结论：脑梗死患者早期给予踏车有氧训练安全可靠,可以提高患者的运动功能。     

Intensive Training of Subjects with Chronic Hemiparesis on a Motorized Cycle Combined with Functional Electrical Stimulation (FES): A Feasibility and Safety Study

Background and Purpose. This study tested the safety and ability of subjects with chronic hemiplegia to tolerate intensive training using a motorized cycle combined with functional electrical stimulation (FES) system. Methods. A case series of 10 subjects with chronic stroke participated in 30‐minute three times per week cycling on a stationary motorized cycling system combined with FES (RT300^TM). The stimulation activated the dorsal and plantar flexors, the quadriceps and the hamstrings using four channels and a stimulation pattern that assisted cycling motion of the paretic lower limb. Patients were instructed to cycle as close as possible to 60 rpm and the resistance to cycling was gradually increased using a computer‐based algorism. The training lasted eight weeks. Results. All 10 participants completed the training without adverse reactions to the training or the FES. The kcal utilized during the training increased significantly (p = 0.0003) between session 1 (2.2 ± 0.47), session 12 (4.3 ± 1.2) and session 24 (7.5 ± 1.8). Peak pedaling power increased from 6.5 ± 0.5 W pre‐training to 18.0 ± 5.4 W post‐training. Locomotion variables that improved significantly were time to complete the get up and go test (45.4 ± 54.9 seconds vs. 34.0 ± 31.8 seconds) a 24.6% improvement (p = 0.03) and gait velocity, which increased 25.0% from 0.4 ± 0.3 m/sec to 0.5 ± 0.4 m/sec (p = 0.01). Conclusion. Using a motorized cycle combined with FES intensive training appears safe and can be tolerated by patients with chronic stroke of wide age range, diverse severity of cardio‐pulmonary deconditioning, motor loss and locomotor deficits. Copyright © 2010 John Wiley & Sons, Ltd.     

Effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with knee osteoarthritis

[Purpose] The aim of this study was to investigate the effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with osteoarthritis of the knee. [Subjects] Thirty women over 65 years of age diagnosed with knee osteoarthritis participated in the present study. The subjects were randomly assigned to a control group (n=10), a progressive resistance training group (n=10), or a Russian electrical stimulation group (n=10). [Methods] Each group was treated 3 times weekly for 8 weeks, and each session lasted 45 minutes. Muscle strength was assessed by measuring the peak torque of the quadriceps femoris muscle. Outcome measurements were performed at baseline and at the fourth and eighth weeks of the treatment period. [Results] All groups showed significant intragroup differences in the quadriceps femoris muscle peak torque after the treatment intervention. There were significant intergroup differences between the Russian electrical stimulation group and the other groups. [Conclusion] The results of this study suggest that combined application of progressive resistance training and Russian electrical stimulation can be effective in strengthening the quadriceps femoris muscle in elderly women with knee osteoarthritis.Key words: Knee osteoarthritis, Progressive resistance training, Russian electrical stimulation     

Comparison of selected pulse frequencies from two different electrical stimulators on blood flow in healthy subjects

The purpose of this study was to measure the effects of selected frequencies from two different pulsed electrical stimulators on blood flow, blood pressure, and heart rate. Each of 30 healthy subjects attended 10 study sessions: 1 torque-testing session, 1 control session consisting of no electrical stimulation (ES), and 8 sessions of ES. All subjects received ES at an intensity sufficient to produce torque equal to 15% of the predetermined maximal voluntary contraction of their right quadriceps femoris muscle. The results of a multivariate analysis of variance showed that changes in blood flow during and after ES were dependent on pulse frequency but independent of stimulator type. Further analysis showed significant increases in blood flow with ES using 10, 20, and 50 pulses per second compared with 1 pulse per second. Inconsistent changes in blood pressure and heart rate were produced by ES. Based on the results of this study, effective clinical use of ES for promoting arterial blood flow to muscle would involve pulsed frequencies of 10 to 50 pulses per second.     

表面肌电结合等速测试仪评价功能性电刺激对脑卒中患者下肢痉挛及其功能影响的临床研究

目的:运用表面肌电结合等速测试仪探讨基于正常行走模式的功能性电刺激(FES)对脑卒中患者下肢痉挛及功能的影响.方法:54例脑卒中患者随机分为2组,FES组及安慰刺激组(对照组).2组患者均接受常规的临床及康复治疗.FES组在此基础上接受基于正常行走模式的FES治疗,安慰刺激组给予无电流输出的电刺激.治疗前及治疗4周后,...     

Increasing muscle mass in spinal cord injured persons with a functional electrical stimulation exercise program

OBJECTIVE: To determine the magnitude of changes in muscle mass and lower extremity body composition that could be induced with a regular regimen of functional electrical stimulation (FES)-induced lower-extremity cycling, as well as the distribution of changes in muscle mass among the thigh muscles in persons with spinal cord injury (SCI). STUDY DESIGN: Thirteen men with neurologically complete motor sensory SCI underwent a 3-phase, FES-induced, ergometry exercise program: phase 1, quadriceps strengthening: phase 2, progressive sequential stimulation to achieve a rhythmic pedaling motion (surface electrodes placed over the quadriceps, hamstrings, and gluteal muscles); phase 3, FES-induced cycling for 30 minutes. Participants moved from one phase to the next when they met the objectives for the current phase. MEASURES: Computed tomography of legs to assess muscle cross-sectional area and proportion of muscle and adipose tissue. Scans were done at baseline (before subjects started the program), at first follow-up, typically after 65.4+/-5.6 (SD) weekly sessions, and at second follow-up, typically after 98.1+/-9.1 sessions. RESULTS: Increases in cross-sectional areas were found in the following muscles: rectus femoris (31%, p<.001). sartorius (22%, p<.025), adductor magnus-hamstrings (26%, p<.001), vastus lateralis (39%, p = .001), vastus medialis-intermedius (31%, p = .025). Cross-sectional area of adductor longus and gracilis muscles did not change. The ratio of muscle to adipose tissue increased significantly in thighs and calves. There was no correlation among the total number of exercise sessions and the magnitude of muscle hypertrophy. CONCLUSIONS: Muscle cross-sectional area and the muscle to adipose tissue ratio of the lower extremities increased during a regular regimen of 2.3 FES-induced lower extremity cycling sessions weekly. The distribution of changes was related to the proximity of muscles to the stimulating electrodes.     

Functional electrical stimulation effect on orthostatic hypotension after spinal cord injury

OBJECTIVE: To investigate the possibility of using functional electrical stimulation (FES) to control orthostatic hypotension in patients with spinal cord injury (SCI) and to clarify the mechanism of the response. DESIGN: Subjects were tilted by 10 degree increments with varying intensities of lower-extremity FES. Stimulation over muscles was compared to stimulation over noncontractile sites. SETTING: Physical therapy department of a major rehabilitation center. PATIENTS: Six patients with SCI above T6 (3 with recent injury recruited consecutively from an inpatient spinal cord rehabilitation unit, and 3 from the community with longstanding injury, recruited as volunteers). MAIN OUTCOME MEASURES: Blood pressure, heart rate, and perceived presyncope score recorded at each tilt angle and analyzed using a multivariate analysis of variance statistical methodology. RESULTS: Systolic and diastolic blood pressure increased with increasing stimulation intensities (systolic, p = .001; diastolic, p = .0019) and decreased with increasing angle of tilt (p < .001) regardless of the site of stimulation. Subjects tolerated higher angles of incline with electrical stimulation than without (p = .03). CONCLUSIONS: FES causes a dose-dependent increase in blood pressure independent of stimulation site that may be useful in treating orthostatic hypotension.     

Physiologic costs of computer-controlled walking in persons with paraplegia using a reciprocating-gait orthosis

Blood pressure, heart rate, oxygen uptake, cardiac output, and the surface electromyogram from key muscle groups in the upper body were measured in four subjects with paraplegia during ambulation using only a reciprocating-gait orthosis (RGO) and using an RGO with movement assisted by functional electrical stimulation (FES) of the hamstring and gluteus maximus muscles. These data were compared to data collected on four able-bodied control subjects during ambulation at matched speeds. Whether walking with FES and RGOs or walking with RGOs alone, subjects had an optimum gait speed at which efficiency was highest. For paralyzed subjects using FES, the optimum walking speed was approximately 1.5 mph (2.4km/hr); without FES, the optimum speed averaged about 0.75mph (1.2km/hr). Blood pressure, heart rate, oxygen uptake, and cardiac output were measured during ambulation with FES and were found to be higher than those of controls, but they were significantly lower than those in the paralyzed subjects in RGOs with no FES. Electromyogram studies showed that the activity in upper body muscles was much higher when walking in RGOs without FES than in RGOs with FES.     

功能性电刺激改善脑卒中患者上肢功能的随机对照研究

摘要 目的：探讨功能性电刺激（FES）对脑卒中偏瘫患者上肢功能的远期影响。 方法：37例初发脑卒中患者分层后随机分为FES组(n=19)和对照组(n=18)。2组常规治疗相同,对照组不给任何电刺激,FES组给予功能性电刺激治疗,一组电极放在患侧前臂背侧远端1/3与1/2处,一组电极放在三角肌中部与冈上肌中部;刺激参数为频率30Hz,脉宽300?滋s,通电/断电比5s/5s,波升／波降1s/1s,强度0—90mA,并随患者感觉而定。治疗每天1次,每次30min,共3周（15次）。入选患者分别于治疗前、治疗后第1个月、3个月、6个月接受以下量表评定：Fugl-Meyer运动功能评定量表中上肢部分（FMA）、改良Barthel指数（MBI）、肩部肌群肌力（MMT）。2组患者一般资料及治疗前各项评定结果差异无显著性意义。 结果：治疗后第1个月、3个月2组在MMT、FMA、MBI差异均有显著性意义（P<0.05）;治疗后第6个月,2组在FMA、MBI差异有显著性意义（P<0.05）,在MMT差异有近似显著性意义(P=0.052)。 结论：FES可以改善初发早期脑卒中患者偏瘫上肢的运动功能,提高日常生活活动能力,疗效可以持续6个月以上。 关键词 脑卒中;功能性电刺激;上肢;随机对照研究 中图分类号：R493,R741 文献标识码：A 文章编号：1001-1242（2010）-02-0152-04     

Functional electric stimulation in the reversal of conversion disorder paralysis

Numerous reports have documented the usefulness of functional electric stimulation (FES) in restoring and/or improving the function of organically diseased or paralyzed muscles. There are few reports related to the use of FES in the treatment of conversion disorder paralysis of the hysterical type. This paper presents a case of hysterically paralyzed muscles where the patient received daily treatment with FES for two weeks. Electric current was applied to a weak quadriceps and to paralyzed tibialis anterior muscles. This electrotherapeutic modality was effective in improving the function of the quadriceps and in reversing the paralysis of the tibialis anterior muscles. The improvement in the muscles' functional abilities was documented through the use of quantitative measures of muscle strength as well as computerized analysis of EMG signals. The results showed that the administration of FES resulted in a dramatic increase in motor units recruitment, increased muscle strength, and improved voluntary muscle control.     

Augmenting voluntary torque of healthy muscle by optimization of electrical stimulation

The purpose of this study was to evaluate the ability of electrical stimulation (2,500-Hz sine waves, interrupted for 50 pulsed bursts per second) to improve muscle torque using low-dosage training characteristics. Fifteen healthy subjects (9 men, 6 women), 20 to 32 years of age, participated in the experiment. All subjects received electrical stimulation of the right anterior thigh musculature while their left leg served as the control. Electrical stimulation was repeated eight times per session, each stimulation producing isometric torque equal to 50% of the subject's maximum voluntary isometric contraction. The sessions were repeated twice a week over a period of five weeks. Results showed that electrical stimulation, when used with the specified low-dosage training characteristics of this study, will augment quadriceps femoris muscle torque of men.     

Functional electric stimulation: its efficacy and safety in improving pulmonary function and musculoskeletal fitness.

The efficacy and safety of functional electric stimulation (FES) in improving cardiovascular and musculoskeletal fitness in individuals with spinal cord injury was evaluated. Ten males and two females aged 16 to 46 years began an FES program from three months to 22 years after injury. Seven patients had paraplegia and five had quadriplegia. The FES protocol consisted of three phases: (1) leg extension, the stimulation of the quadriceps muscle group only, first without and then with weights; (2) ergometry, the stimulation of quadriceps, hamstrings, and gluteal muscles to produce a bicycling motion; and (3) resistance, the addition of resistance during the bicycling motion described in phase 2. Values for tidal volume, oxygen consumption, and the respiratory quotient were obtained during each phase. Tidal volume and oxygen consumption levels increased significantly (p less than .001) from the start of FES to both the ergometry and the resistance phases. The respiratory quotient improved significantly (p less than .001) from the start of FES to resistance but not from the start of FES to ergometry. Thigh and calf girths were measured at the start of FES and during resistance. Thigh girths increased significantly from the beginning of the program to the resistance phase, p less than .002 for the right leg and p less than .001 for the left. Calf girth, however, showed no significant increase. Based on these improvements and the absence of any serious complications, we believe that FES is an effective and safe method to improve cardiovascular and musculoskeletal fitness in individuals with spinal cord injury.     

Electrical stimulation: can it increase muscle strength and reverse osteopenia in spinal cord injured individuals?

OBJECTIVE: To study the extent to which atrophy of muscle and progressive weakening of the long bones after spinal cord injury (SCI) can be reversed by functional electrical stimulation (FES) and resistance training. DESIGN: A within-subject, contralateral limb, and matching design. SETTING: Research laboratories in university settings. PARTICIPANTS: Fourteen patients with SCI (C5 to T5) and 14 control subjects volunteered for this study. INTERVENTIONS: The left quadriceps were stimulated to contract against an isokinetic load (resisted) while the right quadriceps contracted against gravity (unresisted) for 1 hour a day, 5 days a week, for 24 weeks. MAIN OUTCOME MEASURES: Bone mineral density (BMD) of the distal femur, proximal tibia, and mid-tibia obtained by dual energy x-ray absorptiometry, and torque (strength). RESULTS: Initially, the BMD of SCI subjects was lower than that of controls. After training, the distal femur and proximal tibia had recovered nearly 30% of the bone lost, compared with the controls. There was no difference in the mid-tibia or between the sides at any level. There was a large strength gain, with the rate of increase being substantially greater on the resisted side. CONCLUSION: Osteopenia of the distal femur and proximal tibia and the loss of strength of the quadriceps can be partly reversed by regular FES-assisted training.     

Effects of feedback stimulation training and cyclical electrical stimulation on knee extension in hemiparetic patients

Positional feedback stimulation training and cyclical electrical stimulation were used in combination as a treatment for facilitating knee extension in hemiparetic patients. Forty adult hemiparetic patients who demonstrated minimal active control of their quadriceps femoris muscles were randomly assigned to control or study groups. The control patients received a program of physical therapy, and the study patients received the positional feedback stimulation training in addition to their therapy program. The stimulation training provided the patient with immediate auditory and visual feedback of his changing joint angle while he voluntarily extended his knee. When the patient reached a near maximal extension effort, electrical stimulation of the quadriceps femoris muscle was automatically triggered, completing the patient's available range of motion in extension. The stimulation training was supplemented with two hours of cyclical electrical stimulation daily. At the end of four weeks, analysis revealed a statistically significant increase in knee extension torque and active synergistic range of motion in the study group. No change was noted in their ability to extend their knees using isolated quadriceps femoris muscle control. This study suggests that positional feedback stimulation training is effective when used to augment a facilitation program for improving knee extension control in hemiparetic patients.     

Tolérance locale et cardiovasculaire d'une séance de stimulation électrique des muscles des membres inférieurs chez les patients insuffisants cardiaques

Objective: to evaluate the haemodynamic and clinical tolerance of a session of low frequency electrical stimulation of inferior limbs muscles in patients with congestive heart failure. Patients and méthods: fifteen patients with congestive heart failure were treated with a one-hour session of electrical stimulation of quadriceps and calf muscles (10 Hz frequency, maximal amplitude tolerated, alternative 20 seconds on and off). The cardiac output, the heart rate, the blood pressure and the blood velocity in the femoral artery were evaluated at baseline and during stimulation. The cardiac rythm was evaluated using a 24-hour holter recording. A subjective evaluation of the quality of the induced contractions was performed. Results: electrical stimulation did not induce changes in cardiac output and rythem, in heart rate and in blood pressure. The electrical-induced contractions were of good quality in 11 patients. The mean blood velocity in femoral artery increased during stimulation (37.6% after 20 minutes, 39.6% after 35 minutes, and 41.6% after 50 minutes). Conclusion: a one-hour session of electrical stimulation of quadriceps and calf muscles with stimulation amplitudes sufficient to obtain good-quality contraction and an increase in femoral artery blood velocity does not induce rythmic or haemodynamics variations in patients with congestive heart failure.     

Effects of Combined Training with Breathing Resistance and Sustained Physical Exertion to Improve Endurance Capacity and Respiratory Muscle Function in Healthy Young Adults

[Purpose] In this study, combined training with breathing resistance and sustained physical exertion was carried out to evaluate its physiological effects and its effect on improve endurance capacity. [Subjects and Methods] The subjects were nine healthy adults (mean age 20.4, SD ± 1.7 years). The combined training group (n = 5) carried out 6 weeks of combined training using a cycle ergometer, with exercise load tests and respiratory function tests performed before and after the training. The results of the training were compared to a control group (n = 4) that only performed the cycling exercise without the combined training with breathing resistance. [Results] In the combined training group, ventilatory threshold, maximal load of the cycle ergometer in exercise load tests, and maximal voluntary ventilation increased after training. These increases after training were all significant, but none of these variables changed significantly in the control group. [Conclusion] The results imply that in comparison to conventional training methods, combined training with breathing resistance and sustained physical exertion is beneficial for increasing endurance capacity and respiratory muscle function. This result provides important information regarding the effects of the new training method for improving endurance capacity.Key words: Respiratory muscle training, Exercise tolerance, Cardiorespiratory endurance