Post-polio syndrome (PPS), sometimes termed Middle age onset Post-polio syndrome, is a condition that affects survivors of poliomyelitis, a viral infection of the nervous system, after recovery from an initial paralytic attack of the virus.  We ask the question whether FES Cycling would be of benefit?

With PPS, typically the symptoms appear 20-40 years after the original infection, at an age of 35 to 60. Symptoms include new or increased muscular weakness, pain in the muscles, and fatigue.

The precise mechanism that causes post-polio syndrome is unknown.  It shares many features in common with myalgic encephalomyelitis, a form of chronic fatigue syndrome that is apparently caused by viral infections, but unlike those disorders it tends to be progressive, and can cause tangible loss of muscle strength.

Treatment is primarily limited to adequate rest, conservation of available energy, and to supportive measures, such as leg braces and energy-saving devices such as powered wheelchairs, plus pain relievers, sleep aids, etc. 

The evidence on strengthening exercises is sometimes conflicting but a key factor seems to be intensity.  Exercises need to be non-fatiguing but a complication is that "fatigue" levels are complicated by individual personality type/attitude and therefore not easy to measure objectively. A key recommendation based on up to date advice and evidence is to suggest people with PPS exercise to a sub-maximal level and to around 50% of their endurance before resting and then starting again.

Electrical stimulation can certainly be used to strengthen weakened muscles or reeducate disused muscles - maybe helping with pain depending on the parameters used.  A key would be finding the right balance between intensity of exercise and avoidance of fatigue.  

Using FES as a tool could allow a physiotherapist to put together a supervised programme that focuses on a limited number of specific muscles to help with fatigue, increase strength and decrease pain.