Tolerance and physiological correlates of neuromuscular electrical stimulation in COPD: a pilot study

Isabelle Vivodtzev, Benoit Rivard, Philippe Gagnon, Vincent Mainguy, Annie Dubé, Marthe Bélanger, Brigitte Jean, François Maltais, Isabelle Vivodtzev, Benoit Rivard, Philippe Gagnon, Vincent Mainguy, Annie Dubé, Marthe Bélanger, Brigitte Jean, François Maltais

Abstract

Rationale: Neuromuscular electrical stimulation (NMES) of the lower limbs is an emerging training strategy in patients with COPD. The efficacy of this technique is related to the intensity of the stimulation that is applied during the training sessions. However, little is known about tolerance to stimulation current intensity and physiological factors that could determine it. Our goal was to find potential physiological predictors of the tolerance to increasing NMES stimulation intensity in patients with mild to severe COPD.

Methods: 20 patients with COPD (FEV1 = 54±14% pred.) completed 2 supervised NMES sessions followed by 5 self-directed sessions at home and one final supervised session. NMES was applied simultaneously to both quadriceps for 45 minutes, at a stimulation frequency of 50 Hz. Spirometry, body composition, muscle function and aerobic capacity were assessed at baseline. Cardiorespiratory responses, leg discomfort, muscle fatigue and markers of systemic inflammation were assessed during or after the last NMES session. Tolerance to NMES was quantified as the increase in current intensity from the initial to the final NMES session (ΔInt).

Results: Mean ΔInt was 12±10 mA. FEV1, fat-free-mass, quadriceps strength, aerobic capacity and leg discomfort during the last NMES session positively correlated with ΔInt (r = 0.42 to 0.64, all p≤0.06) while post/pre NMES IL-6 ratio negatively correlated with ΔInt (r = -0.57, p = 0.001). FEV1, leg discomfort during last NMES session and post/pre IL-6 ratio to NMES were independent factors of variance in ΔInt (r2 = 0.72, p = 0.001).

Conclusion: Lower tolerance to NMES was associated with increasing airflow obstruction, low tolerance to leg discomfort during NMES and the magnitude of the IL-6 response after NMES.

Trial registration: ClinicalTrials.gov NCT00809120.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Study flow-chart.
Figure 1. Study flow-chart.
Figure 2. Study design and individual current…
Figure 2. Study design and individual current intensities during NMES sessions.
Panel A shows details and schedule of the 3 evaluations sessions. *Incremental shuttle walking test. Peak oxygen consumption (VO2peak) and perception of dyspnea and leg fatigue were assessed at end of ISWT (visit#1). Panel B shows the current intensities applied at the first session (teaching), at the second session (initial evaluation) session and at the 8th session (final evaluation) (from left to right).
Figure 3. Relationships between tolerance to NMES…
Figure 3. Relationships between tolerance to NMES (ΔInt) and its physiological correlates: (A) forced expiratory volume in 1 second (FEV1), (B) fat-free mass, (C) quadriceps strength, (D) VO2peak at end of the incremental shuttle walk (ISWT) (E) the perception of leg discomfort during NMES and (F) the post/pre NMES plasma IL-6 ratio during the final NMES session.
Spearman correlation coefficients are provided.

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