Electrical Stimulation of Muscles

Neuromuscular Electrical Stimulation (NMES) Increases Walking Distance

In a December 14, 2015, on-line article in the Lancet Respiratory Journal, doctors at King’s College in London reported their findings of electrical stimulation of muscles as a home-based exercise program. (Lancet Respir Med. 2015 Dec 14. pii: S2213-2600(15)00503-2. doi: 10.1016/S2213-2600(15)00503-2). The Reason for the Study: Some individuals with advanced COPD are too short of breath to begin an exercise program. In addition,
White pads are placed on the quadricep muscle. The wires are connected to a machine that provides electrical stimulation.

White pads are placed on the quadricep muscle. The wires are connected to a machine that provides electrical stimulation.

their leg and arm muscles may be weak as a result of physical inactivity (called deconditioning). The weakness may occur over a long time period or be a result of a COPD exacerbation that limits activities What was the Study?: Adults with COPD who had (1) lung function less than 50% of predicted and (2) incapacitating breathlessness were studied over a 6 week period. 25 received NMES and 27 received placebo (sham or ineffective therapy). The distance walked in 6 minutes after 6 weeks was the main outcome. NMES was self-administered at home every day for 30 minutes to each quadriceps muscle (large muscle in front of thigh). A battery powered unit was used to produce a controlled contraction of the muscle. For the placebo group, a low intensity of stimulation was used and individuals could detect the electrical stimulus, but it was too low to cause actual muscle contraction (shortening). Main Findings: The change the 6 minute walking distance over 6 weeks was + 30 meters in the NMES group and – 6 meters in the placebo group. This difference was considered significant. Two participants, one from each group, had persistent redness of the skin over the muscle. Conclusions: The authors concluded that NMES improves the ability to walk farther  in those with severe COPD who are very breathless by strengthening the quadriceps muscle of the legs. They suggest that the use of NMES may be considered for those with severe COPD who are unable to participate in pulmonary rehabilitation. My Comment: This is an interesting study particularly for those who are so short of breath that it is difficulty to do very much. It is reasonable to me that someone with severe COPD could receive NMES for 6 weeks and than transition to a standard pulmonary rehabilitation program. Where is NMES available?  Electrical muscle stimulation is used commonly for athletes before and/or after knee surgery especially for repair of the anterior cruciate ligament (ACL). The equipment is typically available and can be performed by a physical therapist (PT) or  by a physiatrist (a doctor who specializes in rehabilitation and treats injuries or illnesses that affect how you move). You should ask your health care provider about a possible referral to one of these specialties. Since the use of NMES is considered as a new treatment for those with COPD who have major weakness of the muscles, you may wish to bring information about the study for the appointment.    

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.