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Original Research: COPD |

Functional and Muscular Effects of Neuromuscular Electrical Stimulation in Patients With Severe COPDNeuromuscular Electrical Stimulation in COPD: A Randomized Clinical Trial

Isabelle Vivodtzev, PhD; Richard Debigaré, PhD; Philippe Gagnon, MSc; Vincent Mainguy, MSc; Didier Saey, PhD; Annie Dubé, PhD; Marie-Ève Paré, MSc; Marthe Bélanger, BSc; François Maltais, MD
Author and Funding Information

From the Centre de Recherche (Drs Vivodtzev, Debigaré, Saey, Dubé, and Maltais, Messrs Gagnon and Mainguy and Mss Paré and Bélanger) Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada; and Inserm U 1042 (Dr Vivodtzev), HP2 Laboratory, Joseph Fourier University, Grenoble University Hospital, Grenoble, France.

Correspondence to: François Maltais, MD, Centre de Recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, G1V 4G5, Canada; e-mail: Francois.Maltais@med.ulaval.ca


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).


© 2012 American College of Chest Physicians


Chest. 2012;141(3):716-725. doi:10.1378/chest.11-0839
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Background:  The mechanisms through which neuromuscular electrical stimulation (NMES) training may improve limb muscle function and exercise tolerance in COPD are poorly understood. We investigated the functional and muscular effects of NMES in advanced COPD.

Methods:  Twenty of 22 patients with COPD were randomly assigned to NMES (n = 12) or sham (n = 8) training in a double-blind controlled study. NMES was performed on quadriceps and calf muscles, at home, 5 days per week for 6 weeks. Quadriceps and calf muscle cross-sectional area (CSA), quadriceps force and endurance, and the shuttle-walking distance with cardiorespiratory measurements were assessed before and after training. Quadriceps biopsy specimens were obtained to explore the insulin-like growth factor-1/AKT signaling pathway (70-kDa ribosomal S6 kinase [p70S6K] , atrogin-1).

Results:  NMES training improved muscle CSA (P < .05), force, and endurance (P < .03) when compared with sham training. Phosphorylated p70S6K levels (anabolism) were increased after NMES as compared with sham (P = .03), whereas atrogin-1 levels (catabolism) were reduced (P = .01). Changes in quadriceps strength and ventilation during walking contributed independently to variations in walking distance after training (r = 0.77, P < .001). Gains in walking distance were related to the ability to tolerate increasing current intensities during training (r = 0.95, P < .001).

Conclusions:  In patients with severe COPD, NMES improved muscle CSA. This was associated with a more favorable muscle anabolic to catabolic balance. Improvement in walking distance after NMES training was associated with gains in muscle strength, reduced ventilation during walking, and the ability to tolerate higher stimulation intensity.

Trial registry:  ClinicalTrials.gov; No.: NCT00874965; URL: www.clinicaltrials.gov

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