Chest
Original ResearchCOPDFunctional and Muscular Effects of Neuromuscular Electrical Stimulation in Patients With Severe COPD: A Randomized Clinical Trial
Section snippets
Patient Population
Patients included in this study had severe COPD and a 6-min walking distance of < 400 m. The inclusion and exclusion criteria are detailed further in e-Appendix 1.
Study Design
This was a randomized, double-blind, controlled, and parallel group study. Patients were randomly assigned to NMES or sham training. Patients were evaluated at baseline and at the end of training. Each evaluation included anthropometric measurements, pulmonary function testing, plasma levels of proinflammatory cytokines (IL-6, tumor
Patient Characteristics
The study flow diagram is provided in Figure 1. Of the 53 eligible patients, 22 were randomly assigned to one of the study interventions. One patient assigned to the sham intervention withdrew after the first training session because of discomfort during NMES, and one patient assigned to the active NMES training declined further participation after one session because of anxiety/depression. The remaining results pertain to the 20 patients (NMES, n = 12; sham, n = 8) who completed the study.
Discussion
This exploratory clinical trial was intended to evaluate the physiologic effects of NMES in patients with severe COPD. We found that NMES, delivered entirely at home, promoted muscle growth of the lower limbs and that the improvements in functional capacity were related to the gain in muscle CSA. Furthermore, significant correlations were found between the ability to increase current intensity during training and improvements in muscle CSA and strength and walking capacity. The assessment of
Conclusions
NMES delivered to the thigh and calf muscles in a home-based setting was a useful strategy to increase lower-limb muscle CSA and strength, with a tendency to enhance walking performance in patients with severe to very severe COPD. At the quadriceps level, this training modality helped restore the anabolic/catabolic balance in favor of the former. We found that some patients with COPD were intolerant to the progression of the current intensity and, as such, were not ideal candidates for NMES
Acknowledgments
Author contributions: Dr Maltais was the principal investigator and takes responsibility for the integrity of the work as a whole, from inception to published article.
Dr Vivodtzev: contributed to the study design, the recruitment of patients, the acquisition and analysis of the data, the interpretation of the results, and the redaction of the manuscript.
Dr Debigaré: contributed to the acquisition, analysis, and interpretation of the muscle biopsy samples and/or to the redaction of the
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Funding/Support: This work was supported by Canadian Institutes of Health Research (CIHR) [Grant MOP-115136]. F. Maltais holds a GSK/CIHR Research Chair on COPD at Université Laval.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).