Neuromuscular electrical stimulation improves exercise tolerance in chronic obstructive pulmonary disease patients with better preserved fat-free mass

Lara Maris Nápolis, Simone Dal Corso, José Alberto Neder, Carla Malaguti, Ana Cristina Oliveira Gimenes, Luiz Eduardo Nery, Lara Maris Nápolis, Simone Dal Corso, José Alberto Neder, Carla Malaguti, Ana Cristina Oliveira Gimenes, Luiz Eduardo Nery

Abstract

Background: High-frequency neuromuscular electrical stimulation increases exercise tolerance in patients with advanced chronic obstructive pulmonary disease (COPD patients). However, it is conceivable that its benefits are more prominent in patients with better-preserved peripheral muscle function and structure.

Objective: To investigate the effects of high-frequency neuromuscular electrical stimulation in COPD patients with better-preserved peripheral muscle function.

Design: Prospective and cross-over study.

Methods: Thirty COPD patients were randomly assigned to either home-based, high-frequency neuromuscular electrical stimulation or sham stimulation for six weeks. The training intensity was adjusted according to each subject's tolerance. Fat-free mass, isometric strength, six-minute walking distance and time to exercise intolerance (Tlim) were assessed.

Results: Thirteen (46.4%) patients responded to high-frequency neuromuscular electrical stimulation; that is, they had a post/pre Δ Tlim >10% after stimulation (unimproved after sham stimulation). Responders had a higher baseline fat-free mass and six-minute walking distance than their seventeen (53.6%) non-responding counterparts. Responders trained at higher stimulation intensities; their mean amplitude of stimulation during training was significantly related to their fat-free mass (r = 0.65; p<0.01). Logistic regression revealed that fat-free mass was the single independent predictor of Tlim improvement (odds ratio [95% CI] = 1.15 [1.04-1.26]; p<0.05).

Conclusions: We conclude that high-frequency neuromuscular electrical stimulation improved the exercise capacity of COPD patients with better-preserved fat-free mass because they tolerated higher training stimulus levels. These data suggest that early training with high-frequency neuromuscular electrical stimulation before tissue wasting begins might enhance exercise tolerance in patients with less advanced COPD.

Figures

Figure 1
Figure 1
Intensity of stimulation during hf-NMES training. Note that “responders” (open squares) were training at higher levels of intensity over six weeks than “nonresponders” (solid squares) (* p

References

    1. American Thoracic Society, European Respiratory Society. Skeletal muscle dysfunction in chronic obstructive pulmonary disease: a statement of the American Thoracic Society and European Respiratory Society. Am J Respir Crit Care Med. 1999;159:S1–S40.
    1. Whittom F, Jobin J, Simard PM, LeBlanc P, Simard C, Bernard S, et al. Histochemical and morphological characteristics of the vastus lateralis muscle in patients with chronic obstructive pulmonary disease. Med Sci Sports Exerc. 1998;30:1467–74.
    1. Wouters EF. Local and systemic inflammation in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005;2:26–33.
    1. Sabino PG, Silva BM, Brunetto AF. Nutritional status is related to fat-free mass, exercise capacity and inspiratory strength in severe chronic obstructive pulmonary disease patients. Clinics. 2010 Jun;65:599–605.
    1. Regueiro EM, Di Lorenzo VA, Basso RP, Pessoa BV, Jamami M, Costa D. Relationship of BODE Index to functional tests in chronic obstructive pulmonary disease. Clinics. 2009;64:983–8.
    1. Gosselink R, Troosters T, Decramer M. Peripheral muscle contributes to exercise limitation in COPD. Am J Respir Crit Care Med. 1996;153:976–80.
    1. Orozco-Levi M, Gea J. Muscle changes in chronic obstructive pulmonary disease: the theory of compartments. Arch Bronconeumol. 2000;36:95–102.
    1. American Thoracic Society, European Respiratory Society Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2006;173:1390–1413.
    1. Neder JA, Sword D, Ward SA, Mackay E, Cochrane LM, Clark CJ. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD) Thorax. 2002;57:333–7.
    1. Bourjeily-Habr G, Rochester C, Palermo F, Snyder P, Mohsenin V. Randomised controlled trial of transcutaneous electrical muscle stimulation of the lower extremities in patients with chronic obstructive pulmonary disease. Thorax. 2002;57:1045–9.
    1. Zanotti E, Felicetti G, Maini M, Fracchia C. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest. 2003;124:292–6.
    1. Vivodtzev I, Pépin JL, Vottero G, Mayer V, Porsin B, Lévy P, et al. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely desconditioned and malnourished COPD. Chest. 2006;129:1540–8.
    1. Fazio B. Electric stimulation and neuromuscular diseases. Effects on denervated and dystrophic muscle. Minerva Med. 1988;79:205–8.
    1. Miller C, Thépaut-Mathieu C. Strength training by electrostimulation conditions for efficacy. Int J Sports Med. 1993;14:20–8.
    1. Lieber RL, Kelly MJ. Factors influencing quadriceps femoris muscle torque using transcutaneous neuromuscular electrical stimulation. Phys Ther. 1991;71:715–23.
    1. Bax L, Staes F, Verhagen A. Does neuromuscular electrical stimulation strengthen the quadriceps femoris? A systematic review of randomised controlled trials. Sports Med. 2005;35:191–212.
    1. Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2008 (Based on an April 1998 NHLBI/WHO Workshop). At: (accessed 23 November 2008).
    1. Fletcher CM, Elmes PC, Fairbairn AS, Wood CH. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J. 1959;29:257–66.
    1. Dal Corso S, Napolis L, Malaguti C, Gimenes AC, Albuquerque A, Nogueira CR, et al. Skeletal muscle structure and function in response to electrical stimulation in moderately impaired COPD patients. Respir Med. 2007;101:1236–43.
    1. Vermeeren MA, Creutzberg EC, Schols AM, Postma DS, Pieters WR, Roldaan AC, et al. COSMIC Study Group. Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respir Med. 2006;100:1349–55.
    1. American Thoracic Society Statement: Guidelines for Six-Minute Walk Test. Am J Respir Crit Care Med. 2002;166:111–7.
    1. Neder JA, Nery LE, Castelo A, Andreoni S, Lerario MC, Sachs A, et al. Prediction of metabolic and cardiopulmonary responses to maximum cycle ergometry: a randomised study. Eur Respir J. 1999;14:1304–13.
    1. Cazzola M, MacNee W, Martinez FJ, Rabe KF, Franciosi LG, Barnes PJ, et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur Respir J. 2008;31:416–69.
    1. Celli BR, Cote CG, Marin JM, Casanova C, Oca MM, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005–12.
    1. Harris S, LeMaitre JP, Mackenzie G, Fox KAA, Denvir MA. A randomized study of home-based electrical stimulation of the legs and conventional bicycle exercise training for patients with chronic heart failure. Eur Heart J. 2003;24:871–8.
    1. Vaquero AF, Chicharro JL, Gil L, Ruiz MP, Sanchez V, Lucia A, et al. Effects of muscle electrical stimulation on peak VO2 in cardíac transplant patients. Int J Sports Med. 1998;19:317–22.
    1. Vivodtzev I, Lacasse Y, Maltais F. Neuromuscular electrical stimulation of the lower limbs in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev. 2008;28:79–91.
    1. Bausewein C, Booth S, Gysels M, Higginson I. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane database Syst Rev. 2008;16:CD005623.
    1. Roig M, Reid WD. Electrical stimulation and peripheral function in COPD: a systematic review. Respir Med. 2009;103:485–95.
    1. Vanderthommen M, Duchateau J. Electrical stimulation as a modality to improve performance of the neuromuscular system. Exerc Sci Sports Rev. 2007;35:180–5.
    1. Mafiuletti NA, Pensini M, Martin A. Activation of human plpantar flexion muscles increases after electromyostimulation. J Appl Physiol. 2002;92:1385–92.
    1. Paillard T. Combined application of neuromuscular electrical stimulation and voluntary muscular contractions. Sports Med. 2008;38:161–77.
    1. Jones AM, Campbell IT, Pringle JS. Influence of muscle fibre type and pedal rate on the VO2-work rate slope during ramp exercise. Eur J Appl Physiol. 2004;91:238–45.
    1. Lai HS, De Domenico, Strauss GR. The effect of different electro-motor stimulation training intensities on strength improvement. Aust J Physiother. 1988;34:151–64.
    1. Miller MG, Cheatham CC, Holcomb WR, Ganschow R, Michael TJ, Rubley MD. Subcutaneous tissue thickness alters the effect of NMES. J Sport Rehabil. 2008;17:68–75.
    1. Sillen MJ, Janssen PP, Akkermans MA, Wouters EF, Spruit MA. The metabolic response during resistance training and neuromuscular electrical stimulation (NMES) in patients with COPD, a pilot study. Respir Med. 2008;102:786–9.
    1. Nava S, Fracchia C, Callegari G, Ambrosino N, Barbarito N, Felicetti G. Weakness of respiratory and skeletal muscle after a short course of steroids in patients with acute lung rejection. Eur Respir J. 2002;20:497–9.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj