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Zulbaran-Rojas A, Mishra R, Rodriguez N, Bara RO, Lee M, Bagheri AB, Herlihy JP, Siddique M, Najafi B. Safety and efficacy of electrical stimulation for lower-extremity muscle weakness in intensive care unit 2019 Novel Coronavirus patients: A phase I double-blinded randomized controlled trial. Front Med (Lausanne) 2022; 9:1017371. [PMID: 36561714 PMCID: PMC9763311 DOI: 10.3389/fmed.2022.1017371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background Intensive care unit (ICU) prolonged immobilization may lead to lower-extremity muscle deconditioning among critically ill patients, particularly more accentuated in those with 2019 Novel Coronavirus (COVID-19) infection. Electrical stimulation (E-Stim) is known to improve musculoskeletal outcomes. This phase I double-blinded randomized controlled trial examined the safety and efficacy of lower-extremity E-Stim to prevent muscle deconditioning. Methods Critically ill COVID-19 patients admitted to the ICU were randomly assigned to control (CG) or intervention (IG) groups. Both groups received daily E-Stim (1 h) for up to 14 days on both gastrocnemius muscles (GNMs). The device was functional in the IG and non-functional in the CG. Primary outcomes included ankle strength (Ankles) measured by an ankle-dynamometer, and GNM endurance (GNMe) in response to E-Stim assessed with surface electromyography (sEMG). Outcomes were measured at baseline, 3 and 9 days. Results Thirty-two (IG = 16, CG = 16) lower extremities in 16 patients were independently assessed. The mean time between ICU admission and E-Stim therapy delivery was 1.8 ± 1.9 days (p = 0.29). At 3 days, the IG showed an improvement compared to the CG with medium effect sizes for Ankles (p = 0.06, Cohen's d = 0.77) and GNMe (p = 0.06, d = 0.69). At 9 days, the IG GNMe was significantly higher than the CG (p = 0.04, d = 0.97) with a 6.3% improvement from baseline (p = 0.029). E-Stim did not alter vital signs (i.e., heart/respiratory rate, blood saturation of oxygen), showed no adverse events (i.e., pain, skin damage, discomfort), nor interfere with ICU standard of care procedures (i.e., mechanical ventilation, prone rotation). Conclusion This study supports the safety and efficacy of early E-Stim therapy to potentially prevent deterioration of lower-extremity muscle conditions in critically ill COVID-19 patients recently admitted to the ICU. If confirmed in a larger sample, E-Stim may be used as a practical adjunctive therapy. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT04685213].
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Affiliation(s)
- Alejandro Zulbaran-Rojas
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Ramkinker Mishra
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Naima Rodriguez
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Rasha O. Bara
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Myeounggon Lee
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Amir Behzad Bagheri
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - James P. Herlihy
- Department of Pulmonary Critical Care, Baylor College of Medicine, Houston, TX, United States
| | - Muhammad Siddique
- Department of Pulmonary Critical Care, Baylor College of Medicine, Houston, TX, United States
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States,*Correspondence: Bijan Najafi,
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Nonoyama T, Shigemi H, Kubota M, Matsumine A, Shigemi K, Ishizuka T. Neuromuscular electrical stimulation in the intensive care unit prevents muscle atrophy in critically ill older patients: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29451. [PMID: 35945760 PMCID: PMC9351912 DOI: 10.1097/md.0000000000029451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Critically ill patients in the intensive care unit (ICU) develop muscle atrophy and decreased physical function. Though neuromuscular electrical stimulation (NMES) therapy has been shown to be effective in preventing this, but its effect on older patients is unknown. To examine the course of critically ill older patients treated with NMES in the ICU and to define the impact of its use. A retrospective cohort study was conducted using older ICU patients (≥65 years) categorized into a control group (n = 20) and an NMES group (n = 22). For subgroup analysis, each group was further classified into pre-old age (65-74 years) and old age (≥75 years). The control group showed significant decrease in muscle thickness during ICU and hospital stay. The NMES group showed lower reduction in muscle thickness and showed decrease in muscle echo intensity during hospital stay, compared to the control group. NMES inhibited decrease in muscle thickness in the pre-old age group versus the old age group. The decreasing effect of NMES on echo intensity during hospital stay manifested only in the pre-old age group. We did not find much difference in physical functioning between the NMES and control groups. Lower limb muscle atrophy reduces in critically ill older patients (≥65 years) with NMES and is pronounced in patients aged < 75 years. The impact of NMES on the physical functioning of older patients in ICU needs to be further investigated.
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Affiliation(s)
- Tadayoshi Nonoyama
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
- Department of Rehabilitation, University of Fukui Hospital, Eiheiji, Fukui, Japan
- * Correspondence: Tadayoshi Nonoyama, PT, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan (e-mail: )
| | - Hiroko Shigemi
- Division of Infection Control and Prevention, Faculty of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masafumi Kubota
- Department of Rehabilitation, University of Fukui Hospital, Eiheiji, Fukui, Japan
- Department of Physical Therapy, Graduate Course of Rehabilitation Science, School of Health Sciences, College of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Akihiko Matsumine
- Department of Orthopedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Kenji Shigemi
- Department of Anesthesiology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Tamotsu Ishizuka
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
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Paillard T. Neuromuscular or Sensory Electrical Stimulation for Reconditioning Motor Output and Postural Balance in Older Subjects? Front Physiol 2022; 12:779249. [PMID: 35095554 PMCID: PMC8791235 DOI: 10.3389/fphys.2021.779249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Percutaneous electrical stimulation is used for reconditioning functional capabilities in older subjects. However, its optimal application depends on the specific physiological needs of the individual. Depending on whether his/her needs are related to motor function or sensory and central functions, the relevant modality of electrical stimulation differs significantly. In fact, there are two main modalities of electrical stimulation, that is, neuromuscular electrical stimulation (NMES) and sensory electrical stimulation (SES). NMES involves high-intensity currents (above the motor threshold) and provokes involuntary visible direct muscle contractions. With chronic application, the induced adaptations occur mainly at the neuromuscular function level and thus enhance muscle strength/power and motor output. SES involves low-intensity currents (below, at or only just above the sensory threshold), does not induce any visible muscle contraction and provides only sensory information. With chronic application, the induced adaptations occur at the level of potentiation and transmission of proprioceptive afferents and thus facilitate sensorimotor activity (movement and balance). Overall, SES is interesting for the improvement/maintenance of sensorimotor capabilities in non-frail older subjects while NMES is relevant to develop muscle strength/power and thus reduce the risk of falls due to a lack of muscle strength/power in frail older subjects.
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The Effects of Electrical Stimulation Program on Navicular Height, Balance, and Fear of Falling in Community-Dwelling Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179351. [PMID: 34501940 PMCID: PMC8430807 DOI: 10.3390/ijerph18179351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Intrinsic foot muscle weakness is a crucial cause of balance deficit in the elderly, which leads to a limited range of motion from the fear of falling and subsequently decreases the quality of life. Muscle strengthening via transcutaneous electrical stimulation (TENS) is an effective intervention; however, its effects on elderly people have rarely been reported. This study was conducted to investigate the effects of TENS on navicular height, balance, and fear of falling. METHOD In this study, forty-eight participants aged 65-75 years were included and were randomly divided into two groups: the TENS and control groups. Before and after 4 weeks of training, navicular height, balance, and fear of falling were measured. RESULT After 4 weeks of training, navicular height significantly increased in both groups (p < 0.05); however, the increase was higher in the TENS group (p = 0.035). The TENS group had a better improvement in balance in all four directions-front, back, left, and right (p < 0.05). However, postural balance improvements in the control group were observed in three directions only-front, back, and left (p < 0.05)-without any significant difference between the two groups. Furthermore, the TENS group decreased the scale of fear of falling after 4 weeks of training (p = 0.039). CONCLUSION In summary, the results of this study can be used as part of the muscle strengthening via ES for decreasing the risk of falls or fear of falling in the elderly.
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Rahmati M, Gondin J, Malakoutinia F. Effects of Neuromuscular Electrical Stimulation on Quadriceps Muscle Strength and Mass in Healthy Young and Older Adults: A Scoping Review. Phys Ther 2021; 101:6294526. [PMID: 34106246 DOI: 10.1093/ptj/pzab144] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/27/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Although neuromuscular electrical stimulation (NMES) has been used as a safe and relevant complement to voluntary resistance training, its effectiveness in increasing quadriceps femoris muscle strength and mass in healthy young and older adults has not been determined. The aim of this scoping review was to assess the effects of NMES on quadriceps muscle strength and mass in healthy young and older adults. METHODS CENTRAL, Pedro, MEDLINE, and PubMed were searched from inception to September 2019. Randomized controlled trials (RCTs) that compared NMES with control group or voluntary resistance training for healthy young and older adults were included. Study characteristics, primary and secondary outcome parameters, and details of the NMES intervention were extracted by 2 reviewers. Only studies for which full text was available in English were included. RESULTS Thirty-two RCTs including 796 healthy participants were identified as being eligible for young adults, and 5 RCTs including 123 healthy participants were identified as being eligible for older adults. The available evidence strongly suggests that NMES improves quadriceps muscle strength compared with a control group in young adults, but its efficacy seems lower than that of voluntary resistance training. The available limited evidence regarding the effects of NMES on quadriceps muscle mass compared with control in young adults is inconclusive, with 3 RCTs showing positive effects and 3 RCTs not showing positive effects. The very limited available evidence from 5 RCTs in older adults suggests that NMES might be beneficial for increasing quadriceps muscle strength and mass. CONCLUSION Overall, the evidence indicates that NMES is an efficacious method for increasing quadriceps muscle strength in young adults, whereas its impact on muscle mass requires further investigations. In addition, the effectiveness of NMES needs to be confirmed in older adults on the basis of more high-quality RCTs with larger sample sizes. IMPACT This scoping review of 37 RCTs including 919 people is the first study, to the authors' knowledge, to show that the use of NMES increases quadriceps muscle strength in young adults and might improve quadriceps muscle strength compared with control interventions in older adults. In both young and older adults, the effects of NMES on quadriceps muscle mass are still unclear.
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Affiliation(s)
- Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
| | - Julien Gondin
- Institut NeuroMyoGène (INMG), Université Claude Bernard Lyon 1, Lyon, France
| | - Fatemeh Malakoutinia
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
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Jang EM, Park SH. Effects of Neuromuscular Electrical Stimulation Combined with Exercises versus an Exercise Program on the Physical Characteristics and Functions of the Elderly: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052463. [PMID: 33802260 PMCID: PMC7967594 DOI: 10.3390/ijerph18052463] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022]
Abstract
(1) Background-The application of neuromuscular electrical stimulation (NMES) combined with low-intensity exercise to the elderly can be more efficient than low-intensity exercise only in terms of delaying the loss of muscle mass. We aimed to assess the adjunct of NMES to low-intensity lower limb strengthening exercise to prevent falls in frail elderly for a relatively short period of 4 weeks. (2) Methods-Thirty elderly women aged 65 or above were randomly categorized into three groups: control group (CON, n = 8), exercise group (EX, n = 10), and NMES with exercise group (EX + NMES, n = 9). The exercise group took part in a lower limb strengthening exercise program for one hour three times a week for four weeks. Furthermore, the NMES with exercise group had added NMES stimulation when exercising. The limbs' muscle mass, body fat mass, calf circumference, grip force, five times sit-to-stand test, timed up-and-go test (TUG), one-leg stand test, and Y-balance test (YBT) were evaluated at baseline and 4 weeks after. (3) Results-Comparisons between the three groups showed that the TUG was significantly decreased and the YB was significantly increased in NMES with exercise group (p < 0.05). (4) Conclusions-These results suggested that a combination of NMES stimulation and exercises was more helpful in strengthening balance than exercises alone in the short term.
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Affiliation(s)
| | - So Hyun Park
- Correspondence: ; Tel.: +82-055-380-9465; Fax: +82-55-380-9305
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Liu MN, Yeh HL, Kuan AS, Tsai SJ, Liou YJ, Walsh V, Lau CI. High-Frequency External Muscle Stimulation Reduces Depressive Symptoms in Older Male Veterans: A Pilot Study. J Geriatr Psychiatry Neurol 2021; 34:37-45. [PMID: 32242480 DOI: 10.1177/0891988720915524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Late-life depression (LLD) is a severe public health problem. Given that pharmacological treatments for LLD are limited by their side effects, development of efficient and tolerable nonpharmacological treatment for LLD is urgently required. This study investigated whether high-frequency external muscle stimulation could reduce depressive symptoms in LLD. METHODS Twenty-two older male veterans with major depression were recruited and randomized into a treatment (n = 9) or sham control group (n = 13). The groups received high-frequency external muscle stimulation or sham intervention 3 times per week for 12 weeks. Clinical symptoms and muscle strength were evaluated at baseline and every 2 weeks. RESULTS The 2 groups were homogeneous in age, baseline clinical symptoms, and muscle strength. The treatment group showed significant improvement in depression and anxiety scores and muscle strength (all P < .01), whereas the control group showed no significant change after the 12-week follow-up. Compared to the control group, the treatment group showed significant improvements in depression (Geriatric Depression Scale, P = .009; Hamilton Depression Rating Scale, P = .007) and anxiety scores (HAMA, P = .008) and muscle strength (all P < .001). Changes in depression and anxiety levels were significantly correlated with changes in muscle strength after the study. In the treatment group, we observed a trend of correlation between the reduction in depression and muscle strength gains. CONCLUSION High-frequency external muscle stimulation appears to be an effective treatment for older patients with LLD. Large studies with more tests and/or conducted in different populations are warranted to validate these preliminary findings.
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Affiliation(s)
- Mu-N Liu
- Department of Psychiatry, 46615Taipei Veterans General Hospital, Taipei.,Institute of Brain Science, National Yang-Ming University, Taipei.,Department of Neurology, Memory & Aging Center, University of California, San Francisco, CA, USA
| | - Heng-Liang Yeh
- Health Care Group, Taipei Veterans Home, New-Taipei City
| | - Ai Seon Kuan
- Institute of Public Health, National Yang-Ming University, Taipei.,Division of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
| | - Shih-Jen Tsai
- Department of Psychiatry, 46615Taipei Veterans General Hospital, Taipei.,School of Medicine, National Yang-Ming University, Taipei
| | - Ying-Jay Liou
- Department of Psychiatry, 46615Taipei Veterans General Hospital, Taipei.,School of Medicine, National Yang-Ming University, Taipei
| | - Vincent Walsh
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, 4919University College London, London, United Kingdom
| | - Chi-Ieong Lau
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, 4919University College London, London, United Kingdom.,Department of Neurology, 38029Shin Kong Wu Ho-Su Memorial Hospital, Taipei.,Fu-Jen Catholic University, College of Medicine, Taipei.,Institute of Biophotonics and Brain Research Center, National Yang-Ming University, Taipei.,University Hospital, Taipa, Macau
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Molecular and neural adaptations to neuromuscular electrical stimulation; Implications for ageing muscle. Mech Ageing Dev 2020; 193:111402. [PMID: 33189759 PMCID: PMC7816160 DOI: 10.1016/j.mad.2020.111402] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023]
Abstract
Muscle atrophy and functional declines observed with advancing age can be minimized via various NMES protocols. Animal models have shown that NMES induces motor axon regeneration and promotes axonal outgrowth and fibre reinnervation. The activation of BDNF-trkB contributes to promotion of nerve growth and survival and mediates neuroplasticity. NMES is able to regulate muscle protein homeostasis and elevate oxidative enzyme activity.
One of the most notable effects of ageing is an accelerated decline of skeletal muscle mass and function, resulting in various undesirable outcomes such as falls, frailty, and all-cause mortality. The loss of muscle mass directly leads to functional deficits and can be explained by the combined effects of individual fibre atrophy and fibre loss. The gradual degradation of fibre atrophy is attributed to impaired muscle protein homeostasis, while muscle fibre loss is a result of denervation and motor unit (MU) remodelling. Neuromuscular electrical stimulation (NMES), a substitute for voluntary contractions, has been applied to reduce muscle mass and functional declines. However, the measurement of the effectiveness of NMES in terms of its mechanism of action on the peripheral motor nervous system and neuromuscular junction, and multiple molecular adaptations at the single fibre level is not well described. NMES mediates neuroplasticity and upregulates a number of neurotropic factors, manifested by increased axonal sprouting and newly formed neuromuscular junctions. Repeated involuntary contractions increase the activity levels of oxidative enzymes, increase fibre capillarisation and can influence fibre type conversion. Additionally, following NMES muscle protein synthesis is increased as well as functional capacity. This review will detail the neural, molecular, metabolic and functional adaptations to NMES in human and animal studies.
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Plantar Flexor Strength Training With Home-Based Neuromuscular Electrical Stimulation Improves Limits of Postural Stability in Older Adults. J Phys Act Health 2020; 17:657-661. [DOI: 10.1123/jpah.2019-0501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/11/2020] [Accepted: 03/10/2020] [Indexed: 11/18/2022]
Abstract
Background: The study aimed to determine whether improved muscle strength after 12 weeks of neuromuscular electrical stimulation (NMES) of plantar and dorsiflexors could result in better limits of stability in older adults. Methods: Twenty-seven participants were divided into a control group and a neuromuscular home-based training group. The training group performed a 3-month long NMES training of both plantar and dorsiflexors. Ankle flexor strength and limits of stability were measured. A mediation analysis was conducted to determine whether the NMES effect on the limits of stability was mediated by increased strength. Results: The NMES training increased plantar flexor strength (+47%; β = 0.217, P = .02), and this increase predicted the anterior limits of stability improvement (+27%; β = 0.527, P = .02). The effect of the NMES on the limits of stability was fully mediated by the plantar flexor strength increase (indirect effect: β = 0.1146; 95% confidence interval, 0.020–0.240). Conclusion: It seems that NMES improves the limits of stability through its positive effect on muscle strength. NMES may be utilized in fall-prevention programs.
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Acute and chronic neuromuscular electrical stimulation and postural balance: a review. Eur J Appl Physiol 2020; 120:1475-1488. [DOI: 10.1007/s00421-020-04383-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/23/2020] [Indexed: 01/12/2023]
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Valenzuela PL, Morales JS, Ruilope LM, de la Villa P, Santos-Lozano A, Lucia A. Intradialytic neuromuscular electrical stimulation improves functional capacity and muscle strength in people receiving haemodialysis: a systematic review. J Physiother 2020; 66:89-96. [PMID: 32291224 DOI: 10.1016/j.jphys.2020.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/26/2019] [Accepted: 03/13/2020] [Indexed: 12/18/2022] Open
Abstract
QUESTIONS Does neuromuscular electrical stimulation (NMES) applied during haemodialysis sessions improve functional capacity in people with end-stage renal disease? Does NMES used in this way also improve muscle strength, muscle mass/architecture, psychological outcomes, cardiovascular outcomes and biochemical variables? Does it have any adverse effects? DESIGN Systematic review of randomised controlled trials with meta-analysis. PubMed, Web of Science, Scopus and SPORTDiscus were searched from inception to 15 October 2019. PARTICIPANTS Patients receiving haemodialysis for end-stage renal disease. INTERVENTION NMES administered during haemodialysis sessions versus control. OUTCOMES MEASURES Functional capacity, muscle strength, muscle mass, psychological outcomes, cardiovascular outcomes, biochemical variables and adverse events. DATA ANALYSIS Data were meta-analysed where possible and results were expressed as the pooled mean difference between groups with a 95% confidence interval. RESULTS Eight studies (221 patients) were included in the analysis. Overall, the methodological quality of the studies was fair to good. NMES improved functional capacity as assessed by the 6-minute walk distance test (MD 31 m, 95% CI 13 to 49) and peak workload attained in incremental exercise (MD 12.5 W, 95% CI 3.2 to 21.9). NMES increased knee extensor muscle strength (MD 3.5 kg, 95% CI 2.3 to 4.7) and handgrip strength (MD 2.4 kg, 95% CI 0.4 to 4.4). Muscle mass/architecture was not substantially affected. NMES was estimated to be beneficial for several domains of quality of life in several studies, although most of these estimates were imprecise. No benefits were found for cardiovascular outcomes. The available data did not establish any clear effects on cardiovascular outcomes or biochemical variables (dialysis efficiency, urea and creatinine). No major NMES-related adverse events were observed. CONCLUSIONS NMES is safe, practical and effective for improving functional capacity and muscle strength in haemodialysis patients. Further research is needed to confirm the clinical relevance of these findings. REGISTRATION PROSPERO CRD42018107323.
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Affiliation(s)
- Pedro L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain; Department of Sport and Health, Spanish Agency for Health Protection in Sport (AEPSAD), Madrid, Spain
| | - Javier S Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Laboratory, Research Institute of the Hospital 12 de Octubre ("imas12"), Madrid, Spain
| | - Pedro de la Villa
- Department of Systems Biology, University of Alcalá, Madrid, Spain; i+HeALTH, Department of Health Sciences, European University Miguel de Cervantes, Valladolid, Spain
| | - Alejandro Santos-Lozano
- Hypertension Unit and Cardiorenal Translational Laboratory, Research Institute of the Hospital 12 de Octubre ("imas12"), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; Hypertension Unit and Cardiorenal Translational Laboratory, Research Institute of the Hospital 12 de Octubre ("imas12"), Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
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Affiliation(s)
- Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra-Public University of Navarra, Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Ageing, Instituto de Salud Carlos III, Madrid, Spain
| | - John E Morley
- Saint Louis University School of Medicine, St Louis, MO, USA
| | - Alejandro Lucia
- CIBER of Frailty and Healthy Ageing, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid and Research Institute of the Hospital 12 de Octubre (i+12), Madrid, Spain
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Valenzuela PL, Castillo-García A, Morales JS, Izquierdo M, Serra-Rexach JA, Santos-Lozano A, Lucia A. Physical Exercise in the Oldest Old. Compr Physiol 2019; 9:1281-1304. [PMID: 31688965 DOI: 10.1002/cphy.c190002] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Societies are progressively aging, with the oldest old (i.e., those aged >80-85 years) being the most rapidly expanding population segment. However, advanced aging comes at a price, as it is associated with an increased incidence of the so-called age-related conditions, including a greater risk for loss of functional independence. How to combat sarcopenia, frailty, and overall intrinsic capacity decline in the elderly is a major challenge for modern medicine, and exercise appears to be a potential solution. In this article, we first summarize the physiological mechanisms underlying the age-related deterioration in intrinsic capacity, particularly regarding those phenotypes related to functional decline. The main methods available for the physical assessment of the oldest old are then described, and finally the multisystem benefits that exercise (or "exercise mimetics" in those situations in which volitional exercise is not feasible) can provide to this population segment are reviewed. In summary, lifetime physical exercise can help to attenuate the loss of many of the properties affected by aging, especially when the latter is accompanied by an inactive lifestyle and benefits can also be obtained in frail individuals who start exercising at an advanced age. Multicomponent programs combining mainly aerobic and resistance training should be included in the oldest old, particularly during disuse situations such as hospitalization. However, evidence is still needed to support the effectiveness of passive physical strategies including neuromuscular electrical stimulation or vibration for the prevention of disuse-induced negative adaptations in those oldest old people who are unable to do physical exercise. © 2019 American Physiological Society. Compr Physiol 9:1281-1304, 2019.
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Affiliation(s)
- Pedro L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain.,Department of Sport and Health, Spanish Agency for Health Protection in Sport (AEPSAD), Madrid, Spain
| | | | - Javier S Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Mikel Izquierdo
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Department of Health Sciences, Public University of Navarra, Navarrabiomed, Idisna, Pamplona, Spain
| | - José A Serra-Rexach
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Department of Geriatric, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain and Research Institute Hospital 12 de Octubre (ì+12'), Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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14
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Physical strategies to prevent disuse-induced functional decline in the elderly. Ageing Res Rev 2018; 47:80-88. [PMID: 30031068 DOI: 10.1016/j.arr.2018.07.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/08/2018] [Accepted: 07/09/2018] [Indexed: 01/07/2023]
Abstract
Disuse situations can have serious adverse health consequences in the elderly, including mainly functional impairment with subsequent increase in the risk of falls or morbimortality. The present review provides clinicians and care givers with detailed and practical information on the feasibility and effectiveness of physical strategies that are currently available to prevent or attenuate the functional decline that occurs secondarily to disuse situations in the elderly, notably in the hospital setting. In this context, active approaches such as resistance exercises and maximal voluntary contractions, which can be performed both isometrically and dynamically, are feasible during most immobilization situations including in hospitalized old people and represent powerful tools for the prevention of muscle atrophy. Aerobic exercise should also be prescribed whenever possible to reduce the loss of cardiovascular capacity associated with disuse periods. Other feasible strategies for patients who are unwilling or unable to perform volitional exercise comprise neuromuscular electrical stimulation, vibration, and blood flow restriction. However, they should ideally be applied synchronously with voluntary exercise to obtain synergistic benefits.
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15
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Paillard T. Muscle plasticity of aged subjects in response to electrical stimulation training and inversion and/or limitation of the sarcopenic process. Ageing Res Rev 2018; 46:1-13. [PMID: 29742451 DOI: 10.1016/j.arr.2018.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 12/30/2022]
Abstract
This review addresses the possible structural and functional adaptations of the muscle function to neuromuscular electrical stimulation (NMES) training in frail and/or aged (without advanced chronic disease) subjects. Evidence suggests that the sarcopenic process and its structural and functional effects would be limited and/or reversed through NMES training using excito-motor currents (or direct currents). From a structural viewpoint, NMES helps reduce muscle atrophy. From a functional viewpoint, NMES enables the improvement of motor output (i.e., muscle strength), gait, balance and activities of daily living which enhances the quality of life of aged subjects. Muscle plasticity of aged subjects in response to NMES training turns out to be undeniable, although many mechanisms are not yet explained and deserve to be explore further. Mechanistic explanations as well as conceptual models are proposed to explain how muscle plasticity operates in aged subjects through NMES training. NMES could be seen as a clinically applicable training technique, safe and efficient among aged subjects and could be used more often as part of prevention of sarcopenia. Therapists and physical conditioners/trainers could exploit this new knowledge in their professional practice to improve life conditions (including the risk of fall) of frail and/or aged subjects.
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The use of neuromuscular electrical stimulation (NMES) for managing the complications of ageing related to reduced exercise participation. Maturitas 2018; 113:13-20. [DOI: 10.1016/j.maturitas.2018.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 12/17/2022]
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17
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Li Z, Wang XX, Liang YY, Chen SY, Sheng J, Ma SJ. Effects of the visual-feedback-based force platform training with functional electric stimulation on the balance and prevention of falls in older adults: a randomized controlled trial. PeerJ 2018; 6:e4244. [PMID: 29340245 PMCID: PMC5768172 DOI: 10.7717/peerj.4244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Force platform training with functional electric stimulation aimed at improving balance may be effective in fall prevention for older adults. Aim of the study is to evaluate the effects of the visual-feedback-based force platform balance training with functional electric stimulation on balance and fall prevention in older adults. METHODS A single-centre, unblinded, randomized controlled trial was conducted. One hundred and twenty older adults were randomly allocated to two groups: the control group (n = 60, one-leg standing balance exercise, 12 min/d) or the intervention group (n = 60, force platform training with functional electric stimulation, 12 min/d). The training was provided 15 days a month for 3 months by physical therapists. Medial-lateral and anterior-posterior maximal range of sway with eyes open and closed, the Berg Balance Scale, the Barthel Index, the Falls Efficacy scale-International were assessed at baseline and after the 3-month intervention. A fall diary was kept by each participant during the 6-month follow-up. RESULTS On comparing the two groups, the intervention group showed significantly decreased (p < 0.01) medial-lateral and anterior-posterior maximal range of sway with eyes open and closed. There was significantly higher improvement in the Berg Balance Scale (p < 0.05), the Barthel Index (p < 0.05) and the Falls Efficacy Scale-International (p < 0.05), along with significantly lesser number of injurious fallers (p < 0.05), number of fallers (p < 0.05), and fall rates (p < 0.05) during the 6-month follow-up in the intervention group. CONCLUSION This study showed that the visual feedback-based force platform training with functional electric stimulation improved balance and prevented falls in older adults.
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Affiliation(s)
- Zhen Li
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Geriatrics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiu-Xia Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan-Yi Liang
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Yan Chen
- Department of Geriatrics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Sheng
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shao-Jun Ma
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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18
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Maffiuletti NA, Gondin J, Place N, Stevens-Lapsley J, Vivodtzev I, Minetto MA. Clinical Use of Neuromuscular Electrical Stimulation for Neuromuscular Rehabilitation: What Are We Overlooking? Arch Phys Med Rehabil 2017; 99:806-812. [PMID: 29233625 DOI: 10.1016/j.apmr.2017.10.028] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/18/2017] [Accepted: 10/31/2017] [Indexed: 12/19/2022]
Abstract
The clinical success of neuromuscular electrical stimulation (NMES) for neuromuscular rehabilitation is greatly compromised by the poor consideration of different physiological and methodological issues that are not always obvious to the clinicians. Therefore, the aim of this narrative review is to reexamine some of these fundamental aspects of NMES using a tripartite model perspective. First, we contend that NMES does not actually bypass the central nervous system but results in a multitude of neurally mediated responses that contribute substantially to force generation and may engender neural adaptations. Second, we argue that too much emphasis is generally placed on externally controllable stimulation parameters while the major determinant of NMES effectiveness is the intrinsically determined muscle tension generated by the current (ie, evoked force). Third, we believe that a more systematic approach to NMES therapy is required in the clinic and this implies a better identification of the patient-specific impairment and of the potential "responders" to NMES therapy. On the basis of these considerations, we suggest that the crucial steps to ensure the clinical effectiveness of NMES treatment should consist of (1) identifying the neuromuscular impairment with clinical assessment and (2) implementing algorithm-based NMES therapy while (3) properly dosing the treatment with tension-controlled NMES and eventually amplifying its neural effects.
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Affiliation(s)
| | - Julien Gondin
- NeuroMyoGene Institute, University Claude Bernard Lyon 1, INSERM U1217, CNRS UMR 5310, Villeurbanne, France
| | - Nicolas Place
- Institute of Sport Sciences, Faculty of Biology Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
| | - Isabelle Vivodtzev
- INSERM U1042, HP2 Laboratory (Hypoxia: Pathophysiology), University Grenoble Alps, Grenoble, France
| | - Marco A Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
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