Neuromuscular electrical stimulation as an adjunct to endurance and resistance training during pulmonary rehabilitation in stable chronic obstructive pulmonary disease

Abstract

Aim: The purpose of this study was to investigate whether adding neuromuscular electrical stimulation (NMES) to a comprehensive pulmonary rehabilitation (cPR) program would have additive effects on clinical-functional outcomes. Methods: Twenty-seven chronic obstructive pulmonary disease patients participating in a 10-week cPR program were randomly allocated to NMES + cPR (n = 13) or Sham + cPR (n = 14) groups. Quadriceps strength, exercise capacity, symptoms, mood, activities of daily living and quality of life were evaluated pre- and post-interventions. Results: There were no significant differences in any of the physiological and subjective improvements induced by NMES + cPR versus Sham + cPR (p > 0.05). In fact, the NMES + cPR group showed lower increases in incremental shuttle walk test (ISWT) distance (38.4 vs 69.2 m, respectively) and %ISWT distance (5.1 vs 9%, respectively) compared with the Sham + cPR group (p < 0.05). Conclusion: The increase in exercise capacity is less important when NMES is used as an adjunct to the cPR.

Keywords:

• chronic obstructive pulmonary disease
• exercise capacity
• exercise training
• function
• neuromuscular electrical stimulation

Acknowledgements

The authors would like to thank J Alberto Neder (Queen’s University) and T Firat (Hacettepe University) for the critical review of the manuscript. ClinicalTrials.gov Identifier: NCT01658046.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance was utilized in the production of this manuscript and provided by M Ravi from the American Journal Experts who conducted native English speaker editing, this was funded by the authors themselves.

Key issues

• Skeletal muscle dysfunction is common and impairs exercise capacity in patients with chronic obstructive pulmonary disease (COPD).

• High-frequency neuromuscular electrical stimulation (NMES) has the same beneficial effects induced by resistance training, improved muscle weakness, exercise intolerance and health-related quality of life in COPD patients.

• This study investigated whether adding NMES to a comprehensive pulmonary rehabilitation (cPR) program would have additive effects on these clinical-functional outcomes.

• In the current study, high-frequency NMES did not add benefit to cPR program including endurance and resistance training in clinically stable patients with COPD.

• According to the findings, there is a less important but significant increase in exercise capacity with NMES if patients are able to attend a cPR program including both endurance and quadriceps resistance training.

• The NMES delivered with a combination with endurance and resistance training was not effective to improve quadriceps muscle strength, symptoms and health-related quality of life in moderate-to-severe COPD.

• This finding could be result from some specificities in the stimulation protocol.

• Effects of various protocols deserve further attention.

Notes