Neuromuscular Electrical Stimulation Preserves Leg Lean Mass in Geriatric Patients

Abstract

Aim This study aimed to examine changes in lean mass during hospitalization in geriatric patients and the effect of muscle activation by neuromuscular electrical stimulation. Methods Thirteen patients (69–94 yr) at a geriatric ward completed tests at hospital admission (days 2–3) and discharge (days 8–10). One leg received daily stimulation of the knee extensors, whereas the other leg served as a control leg. Lean mass was evaluated by dual-energy x-ray absorptiometry scans and muscle thickness by ultrasound scans. Muscle biopsies were collected from both legs at admission and discharge in nine patients and analyzed for fiber size, satellite cell number, and activation and expression of genes associated with muscle protein synthesis and breakdown, connective tissue, and cellular stress. Results The relative decline in leg lean mass and midthigh region lean mass was larger in the control (−2.8% ± 1.5%) versus the stimulated leg (−0.5% ± 1.4%, P < 0.05). Although there were no changes in fiber size or satellite cell number, the mRNA data revealed that, compared with control, the stimulation resulted in a downregulation of myostatin (P < 0.05) and a similar trend for MAFbx (P = 0.099), together with an upregulation of Collagen I (P < 0.001), TenascinC (P < 0.001), CD68 (P < 0.01), and Ki67 (P < 0.05) mRNA. Conclusion These findings demonstrate a moderate decline in leg lean mass during a hospital stay in geriatric patients, whereas leg lean mass was preserved with daily neuromuscular electrical muscle activation. At the cellular level, the stimulation had a clear influence on suppression of atrophy signaling pathways in parallel with a stimulation of connective tissue and cellular remodeling processes.

Preserved capacity for satellite cell proliferation, regeneration, and hypertrophy in the skeletal muscle of healthy elderly men

“…For fiber CSA, 1‐5 nonoverlapping representative images were taken for each biopsy, only intact fibers were analyzed, while longitudinally cut regions as well as fibers on the edge of the biopsy were excluded. Fiber CSA was analyzed with a macro for ImageJ automatically delineating all fibers, followed by manual approval. The total number of fibers (mean ± SD) included for analysis per biopsy was: 1715 ± 758 fibers for analysis of regeneration; 483 ± 218 (range: 100‐1163) type I and 497 ± 244 (range: 87‐1315) type II fibers for SC analysis; and 245 ± 128 (range: 39‐703) type I and 222 ± 137 (range: 31‐746) type II fibers for fiber CSA.…”

COVID-19: Short and Long-Term Effects of Hospitalization on Muscular Weakness in the Elderly

“…The effectiveness of this therapy has been evidenced in immobilized patients after a spinal cord injury, congestive heart failure and chronic obstructive lung disease [60]. In a recent paper, it has been found that daily neuromuscular electrical muscle activation (seven days a week) induced muscle mass preservation in hospitalized geriatric patients; however, the results showed limited evidence of effects on the whole body functional capacity [61]. Rodriguez et al [62] found positive effects on the strength of biceps and quadriceps after a 13-day intervention of neuromuscular electrical simulation in septic patients.…”

Importance of Assessing Muscular Fitness in Secondary Care

“…stimulation (NMES) appears to be a potential adjunct to prevent muscle atrophy and loss of muscle strength (Dirks et al, 2015). Moreover, this technique is a useful clinical tool to preserve leg lean mass during hospitalization in geriatric patients (Karlsen et al, 2020). At the molecular level, NMES stimulates the regenerative capacity of satellite cells and induces downregulation of genes (e.g., myostatin, MuRF1 and MAFbx) involved in muscle atrophy (Karlsen et al, 2020).…”

“…Moreover, this technique is a useful clinical tool to preserve leg lean mass during hospitalization in geriatric patients (Karlsen et al, 2020). At the molecular level, NMES stimulates the regenerative capacity of satellite cells and induces downregulation of genes (e.g., myostatin, MuRF1 and MAFbx) involved in muscle atrophy (Karlsen et al, 2020). NMES intensity should be as high as individually tolerated, and a minimum of three sessions per week with large pulses (between 300 and 450 µs) and high frequency (50-100 Hz in young and around 30 Hz in older adults) should be performed (Adams, 2018).…”