Combination of Pulmonary Rehabilitation and Neuromuscular Electrical Stimulation in COPD Patients: A Randomized Clinical Trial of Efficacy

Abstract

Aims: Effectiveness of combination of pulmonary rehabilitation (PR) and neuromuscular electrical stimulation (NMPR) in severe chronic obstructive pulmonary disease (COPD) is well established. We verified the effects of NMPR compared with pulmonary rehabilitation and sham stimulation (SSPR) in patients with moderately impaired COPD.Methods: Quadriceps strength (sit-to-stand test: STST) and exercise capacity (6 minute walking test: 6MWT) were considered primary outcomes. Lung function, dyspnoea (modified Medical Research Council: mMRC) and quality of life (St. George's Respiratory Questionnaire: SGRQ) secondary outcomes.Results: 83 stable patients in stage II, moderate COPD (23 female; mean age, 61.7 ± 9.1 years; FEV 1 59.8 ± 7.3% of predicted) were enrolled. Quadriceps strength was enhanced by SSPR (STST + 7±1.7 repetitions; p≤0.001); NMPR further increased strength (+10±1.6 repetitions; p≤0.001) with a significant difference (p≤0.05) between the treatments. SSPR significantly increased exercise capacity (6MWD + 85.3±11.5 m; p=0.01); NMPR further increased the distance walked (6MWD +146.4±32.7 m; p=0.01) with a significant difference (p≤0.05) between the treatments. None of the two treatments influenced lung function. Quality of life score (SGRQ -8.3±2.1; p=0.01) and dyspnoea score (mMRC-0.7±0.18; p=0.01) decreased after SSPR suggesting a positive effect. NMPR did not further improve the score. Conclusions:This study confirms that PR is able to ameliorate quadriceps strength, exercise capacity, quality of life and dyspnoea in moderately impaired COPD patients. NMPR may further improve quadriceps strength and exercise capacity with respect to PR alone.

The Effect of Adding Neuromuscular Electrical Stimulation with Endurance and Resistance Training on Exercise Capacity and Balance in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

“…As expected, the pulmonary characteristics have not changed after six months of training. These results are in agreement with previous studies [ 21 ].…”

“…The decrease in the heart rate still supported the finding of physiological benefits of exercise training [ 23 ]. Our finding supports those of previous studies that showed that NMES alone or combined with a pulmonary rehabilitation on severe COPD patients had reduced the dyspnea, exercise capacity, and femoris quadriceps strength in subjects with COPD [ 8 , 21 ].…”

“…Besides, another explanation could be taken into consideration that skeletal muscle hypertrophy is achieved by positive protein balance and fusion of satellite cells to myofibers after exercise training in COPD patients [ 26 ]. Similar to what was found in previous studies, leg muscle strength has improved significantly more in the ET + RT + NMES group than in the ET + RT group [ 21 ]. Our results are in agreement with Bezzera and coworkers, who found a significant increase in muscle strength of knee extensors and flexors when applying combined training (NMES + ET) in the elderly [ 27 ].…”

“…The 6MWD increased significantly after the training program in favor of the ET + RT + NMES group. This could be explained by improved physiological conditions, a good exercise response, and a reduction of dyspnea [ 21 ]. The improved walking distance may also be related mostly to the enhanced muscle strength.…”

Effects of neuromuscular electrical stimulation on exercise capacity, muscle strength and quality of life in COPD patients: A Systematic Review with Meta-Analysis

“…Of the 32 19–50 randomized clinical trials included in this review, nine were on neuromuscular electrical stimulation alone compared to a control or sham, from which six performed neuromuscular electrical stimulation in clinical setting and three performed in home. Twelve studies were on combined neuromuscular electrical stimulation and conventional rehabilitation (pulmonary rehabilitation or physical therapy) compared to conventional rehabilitation, from which eleven performed neuromuscular electrical stimulation in clinical setting and one performed in home.…”