Impact of mild-to-moderate exacerbations on outcomes of neuromuscular electrical stimulation (NMES) in patients with COPD.

Autor: Meys R; Department of Research and Development, CIRO, Horn, the Netherlands. Electronic address: roymeys@ciro-horn.nl., Sillen MJ; Department of Physiotherapy, CIRO, Horn, the Netherlands., Franssen FME; Department of Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands., Stoffels AAF; Department of Research and Development, CIRO, Horn, the Netherlands; Department of Pulmonary Diseases, Radboud UMC Dekkerswald, Nijmegen, the Netherlands; Department of Pulmonology, Merem Pulmonary Rehabilitation Centre, Hilversum, the Netherlands., Wouters EFM; Department of Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands., van Hees HWH; Department of Pulmonary Diseases, Radboud UMC Dekkerswald, Nijmegen, the Netherlands., van den Borst B; Department of Pulmonary Diseases, Radboud UMC Dekkerswald, Nijmegen, the Netherlands., Klijn PH; Department of Pulmonology, Merem Pulmonary Rehabilitation Centre, Hilversum, the Netherlands; Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands., Spruit MA; Department of Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
Jazyk: angličtina
Zdroj: Respiratory medicine [Respir Med] 2020 Jan; Vol. 161, pp. 105851. Date of Electronic Publication: 2019 Nov 28.
DOI: 10.1016/j.rmed.2019.105851
Abstrakt: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common among patients attending pulmonary rehabilitation (PR) and may compromise its outcomes. Neuromuscular electrical stimulation (NMES) seems one of the few exercise modalities that can actually be continued during AECOPD, due to its low burden on the impaired respiratory and cardiovascular system. However, the quality of evidence is low. The purpose of this study was to assess the impact of mild-to-moderate AECOPD on adherence/outcomes of a high-frequency (HF) or low-frequency (LF) NMES training program, as part of inpatient PR, in severely dyspneic, weakened individuals with COPD. 62 patients who received NMES as the sole supervised muscle training modality during an 8-week PR program (HF-NMES: n = 33; LF-NMES: n = 29) were analyzed retrospectively. 48.4% experienced ≥1 AECOPD during PR and were classified as exacerbators. Exacerbators completed 75 NMES sessions (interquartile range: 73-78) and were able to increase training intensity with 24 mA (15-39), while non-exacerbators completed 76 sessions (73-79) and increased training intensity with 35 mA (22-50), with no between-group differences (p = 0.474 and p = 0.065, respectively). The median change in 6-min walking distance, cycle endurance time, and isokinetic quadriceps strength and endurance did not differ between the exacerbation and non-exacerbation group. To conclude, the occurrence of mild-to-moderate AECOPD during a PR program primarily focused on NMES, does not affect adherence, intensity, and clinical outcomes in patients with severe COPD. Continuing NMES seems a feasible way to potentially counteract exacerbation-related lower-limb muscle dysfunction and improve outcomes of PR, with HF-NMES being the preferential muscle training modality.
Competing Interests: Declaration of competing interest FMEF reports grants and personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from GlaxoSmithKline, grants and personal fees from Novartis, personal fees from TEVA, outside the submitted work; MAS reports grants from Lung Foundation Netherlands, during the conduct of the main study; EFMW reports grants from the Weijerhorst foundation Netherlands, during the conduct of the main study. RM, MJS, AAFS, HWHH, BB and PHK have nothing to disclose.
(Copyright © 2019 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: