Effects of combined exercise training and electromyostimulation treatments in chronic heart failure: A prospective multicentre study

Abstract

Background Exercise training as part of a comprehensive cardiac rehabilitation is recommended for patients with cardiac heart failure. It is a valuable method for the improvement of exercise tolerance. Some studies reported a similar improvement with quadricipital electrical myostimulation, but the effect of combined exercise training and electrical myostimulation in cardiac heart failure has not been yet evaluated in a large prospective multicentre study. Purpose The aim of this study was to determine whether the addition of low frequency electrical myostimulation to exercise training may improve exercise capacity and/or muscular strength in cardiac heart failure patients. Methods Ninety-one patients were included (mean age: 58 ± 9 years; New York Heart Association II/III: 52/48%, left ventricular ejection fraction: 30 ± 7%) in a prospective French study. The patients were randomised into two groups: 41 patients in exercise training and 50 in exercise training + electrical myostimulation. All patients underwent 20 exercise training sessions. In addition, in the exercise training + electrical myostimulation group, patients underwent 20 low frequency (10 Hz) quadricipital electrical myostimulation sessions. Each patient underwent a cardiopulmonary exercise test, a six-minute walk test, a muscular function evaluation and a quality of life questionnaire, before and at the end of the study. Results A significant improvement of exercise capacity (Δ peak oxygen uptake+15% in exercise training group and +14% in exercise training + electrical myostimulation group) and of quality of life was observed in both groups without statistically significant differences between the two groups. Mean creatine kinase level increased in the exercise training group whereas it remained stable in the combined group. Conclusions This prospective multicentre study shows that electrical myostimulation on top of exercise training does not demonstrate any significant additional improvement in exercise capacity in cardiac heart failure patients.

Exercise-based cardiac rehabilitation in patients with reduced left ventricular ejection fraction: The Cardiac Rehabilitation Outcome Study in Heart Failure (CROS-HF): A systematic review and meta-analysis

“…7 Following proof-of-concept studies by Coats et al 8 and Hambrecht et al 9 which documented the efficacy and safety, respectively, of exercised-based cardiac rehabilitation (ebCR), multiple studies documented its potential to improve functional capacity, QoL and prognosis in patients with heart failure. [10][11][12][13][14][15][16][17] In these studies, however, the populations under investigation were heterogeneous with respect to LV-EF (<35% up to >50%), New York Heart Association (NYHA) classification, and follow-up period. However, the effect of ebCR on morbidity and mortality on top of evidence-based state-of-the-art pharmaco-and device-therapy in high-risk patients with moderately to severely reduced LV-EF is not yet fully established.…”

“…However, the effect of ebCR on morbidity and mortality on top of evidence-based state-of-the-art pharmaco-and device-therapy in high-risk patients with moderately to severely reduced LV-EF is not yet fully established. [10][11][12][13][14][15][16][17] Although current guidelines recommend ebCR as an effective and safe therapeutic intervention, 1,2,6 HFrEF patients are still clearly underrepresented in CR settings worldwide.…”

Editor’s presentation

“…7 The beneficial effect combining exercise training with muscle electrical stimulation has been proposed to overcome barriers in improving exercise tolerance. 8 In a large senior advanced heart failure population, self reported physical activity level conducted before heart failure decompensation was inversely related to mortality. Also, after multivariate analysis, physical activity score predicted mortality independently of several demographic and clinical variables.…”

Electromyostimulation to fight atrophy and to build muscle: facts and numbers

“…Nevertheless, this beneficial effect of superimposed EMS is still discussed controversially since not all studies could confirm these findings . When adding EMS to voluntary contraction in patients already exhibiting muscle atrophy, like CHF, a recently published multicentre randomized prospective study in 91 CHF patients reported no additional improvement in exercise capacity and quality of life when adding EMS to an exercise training program . Additional current clinical trials are performed in different patients cohort (NCT03306056, NCT03020693), and their results will add additional information to this topic.…”