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

Abstract

This study investigated the effectiveness of adding neuromuscular electrical stimulation (NMES) to endurance training (ET) and resistance training (RT) on exercise tolerance and balance in COPD patients. 42 patients were assigned randomly to the ET + RT + NMES group (n = 22) or ET + RT group (n = 20). Two training programs were performed including 72 sessions. The center of pressure (CoP) displacement in the mediolateral direction (CoPML), in the anteroposterior direction (CoPAP), and the center of pressure velocity (CoPV) were recorded using a stabilometric platform with eyes open (EO) and eyes closed (EC). Time up and go and Berg Balance Scale tests, 6-minute walking test (6MWT), and the maximal voluntary contraction (MVC) were measured before and after the intervention. The walking distance, the dyspnea, and the heart rate were improved after the training period ( p < 0.001 ) for both groups ( p < 0.05 ). The ET + RT + NMES group showed better improvement than the ET + RT group in terms of 6MWD. CoPML, CoPAP, and CoPV were significantly ( p < 0.001 ; p < 0.05 ; p < 0.001 , respectively) more improved in EO and EC conditions in the ET + RT + NMES group than the ET + RT group. BBS, TUG, and MVC values improved in both groups after the training ( p < 0.001 ). The performances in TUG and MVC tests were significantly greater in the ET + RT + NMES group than those in the ET + RT group ( p < 0.01 ; p < 0.001 , respectively). Combining NMES, RT, and ET improves balance in patients with COPD.

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.…”

“…Additionally, seven studies 22,25,26,34,35,41,50 combined neuromuscular electrical stimulation and conventional rehabilitation versus Conventional Rehabilitation and assessed six minutes walking test as an outcome. The meta-analyses showed (Figure 5) a significant improvement in 6MWT of 34.28 meters (95% CI: 6.84, 61.73, N = 262) for participants in the combined Neuromuscular electrical stimulation and conventional rehabilitation group compared to conventional rehabilitation group.…”

Neuromuscular Electrical Stimulation of Abdominal Muscles to Improve Standing Balance

“…Amiridis et al [26] have shown that static balance improves 49.4% with NMES training of the tibialis anterior muscle. And Acheche et al [27] showed a 29.3% improvement in balance after applying NMES combined with VMC to the quadriceps and calf muscles. Furthermore, Bondi et al [28] have reported that static balance improved by 30.3% after 8 weeks of application of NMES to the quadriceps and lumbar paraspinal muscles.…”

Responses to the Letter

“…This sentence includes cardiovascular problems (hypertension and tachycardia), which are transposable to the 6-minute walking test (6MWT) contraindications. In addition, we expressed the performance in the 6-minute walking test distance (6MWTD) in meters (m), which is the common unit used in many publications ( Acheche et al, 2020 ; ATS, 2002 ; Celli et al, 2016 ; Mekki et al, 2019 ; Holland et al, 2014 ; S. J. Singh et al, 2014 ). The distance walked in meters has similar capacity to predict mortality as the values corrected by using reference equations ( Polkey et al, 2013 ; Puhan et al, 2008 ; S. J. Singh et al, 2014 ), so the 6MWTD is reported in meters.…”

“…This sentence includes cardiovascular problems (hypertension and tachycardia), which are transposable to the 6-minute walking test (6MWT) contraindications. In addition, we expressed the performance in the 6-minute walking test distance (6MWTD) in meters (m), which is the common unit used in many publications (Acheche et al, 2020; ATS, 2002; Celli et al, 2016; Mekki et al, 2019; Holland et al, 2014; S. J. Singh et al, 2014).…”