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Acute cardiorespiratory physiological responses to functional electrically stimulated cycling in individuals with subacute phase traumatic cervical spinal cord injuryZhenzhen Gao, Yajun Mao, Shiyan Wang & Zhiwen Zhu ?This study aims to assess the cardiovascular, respiratory, and gas metabolic responses elicited during functional electrical stimulation (FES)-cycling exercise in individuals with subacute traumatic motor-complete cervical spinal cord injury (CSCI) classif i ed as ASIA Impairment Scale (AIS) grades A and B. This assessment was conducted utilizing cardiopulmonary exercise testing (CPET). Participants who met the eligibility criteria, characterized by subacute traumatic motor-complete CSCI, fi rst underwent static pulmonary function testing. This was followed by a recumbent FES-cycling protocol, which involved incremental speed increases of 5 revolutions per minute (RPM). Throughout the exercise, continuous monitoring of electrocardiographic data, blood pressure, respiratory parameters, and gas metabolism was performed using CPET. Key physiological metrics, including minute ventilation (VE), tidal volume (VT), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), oxygen uptake (VO 2 ), and oxygen pulse (O 2 pulse), were recorded at 2-minute intervals. A total of 18 participants in the subacute phase of recovery, with an injury duration ranging from 19 to 61 days, completed the study. Static pulmonary function testing indicated the presence of restrictive ventilatory dysfunction in all participants, with 22.2% exhibiting concurrent obstructive ventilatory dysfunction and 77.8% demonstrating a reduced ventilatory reserve. During FES-cycling exercise, signif i cant inter-phase variations were observed across all measured parameters (p < 0.05). The variables of VE, SBP, DBP, HR, VO 2 , and O 2 pulse exhibited concordant trends with the progression of RPM, with statistically signif i cant dif f erences identif i ed between successive phases for VE, VO 2 , and O 2 pulse (p < 0.05). Conversely, VT displayed discordant trends in relation to RPM. Individuals in the subacute phase of traumatic motor-complete CSCI demonstrate signif i cant acute cardiorespiratory physiological responses to FES cycling exercise. These responses encompass an augmentation in VE, VT, and VO 2 , concomitant with an escalation in HR, O 2 pulse, and BP.Keywords Functional electrical stimulation, Cervical spinal cord injury, Subacute phase, Cardiopulmonary exercise testingTraumatic spinal cord injury (SCI) represents a clinically signif i cant and profoundly disabling condition, with an incidence rate in China estimated at approximately 65 cases per million individuals. Cervical spinal cord injury (CSCI) is the most prevalent and impactful subtype 1 , primarily characterized by paralysis of the limbs and compromised function of the diaphragm, intercostal muscles, and abdominal muscles. Th is neuromuscular impairment leads to respiratory failure, limited thoracic expansion, and reduced cough and expiratory capacity, resulting in mixed ventilatory dysfunction 2 . Additionally, high-level SCI is associated with complex cardiovascular impairments linked to autonomic dysfunction, including bradycardia, neurogenic shock, Department of Rehabilitation Medicine, The First Af f i liated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), No. 54 Youdian Road, Hangzhou 310006, Zhejiang, China. ? email: 997128816@qq.comOPENScientif i c Reports | (2025) 15:28489 1 | https://doi.org/10.1038/s41598-025-14627-3www.nature.com/scientificreports