Abstract
Neuromuscular electrical stimulation (NMES) has been shown to produce benefits in the muscle function of chronic obstructive pulmonary disease (COPD) patients. The definite effectiveness of NMES, applied in isolation or concurrently with conventional pulmonary rehabilitation (PR) or exercise training, remains unclear. This review was to determine the effects of NMES on exercise capacity, functional performance, symptoms, and health-related quality of life (HRQoL) in COPD patients. Electronic databases (PubMed, Embase, Web of Science, the Cochrane Library) were searched for relevant randomized controlled trials (RCTs). Two investigators independently screened the eligible studies up to February 2020 that used NMES as the intervention group. The outcome measures were 6-min walking distance (6MWD), peak rate of oxygen uptake (VO2 peak), St George’s Respiratory Questionnaire (SGRQ), and symptoms of dyspnoea and fatigue. Data were extracted using a predefined table and papers were appraised using Downs and Black tool. We analyzed 13 RCTs with 447 COPD patients. In the analysis of 6MWD, pooled estimates showed a significant increase in the NMES group, compared with the control group (mean difference (MD) = 27.05, 95% confidence interval (CI): 8.46–45.63, P<0.001). There were also improvements in symptoms of dyspnea or leg fatigue, and reduction in London Chest Activity of Daily Living (LCADL) scores. No statistically significant difference was observed in VO2 peak, peak power, and SGRQ. NMES could improve exercise capacity and reduce perceived sensation of dyspnea during exercise in patients with COPD, but not to be recommended as an effective alternative training modality in the rehabilitation of stable COPD patients.
Highlights
Chronic obstructive pulmonary disease (COPD) is a systemic disease that is characterized by incompletely reversible airflow obstruction [1]
Of the 23 randomized controlled trial (RCT) studies, 5 studies were excluded for the participants who were recruited during hospitalization for an exacerbation
The primary findings of the present study were that Neuromuscular electrical stimulation (NMES) promoted a significant increase in exercise tolerance measured with the 6-min walk test (6MWT), and such changes were accompanied by improvements in symptoms of dyspnoea and fatigue, increase in St George’s Respiratory Questionnaire (SGRQ) scores and reduction in London Chest Activity of Daily Living (LCADL) scores
Summary
Chronic obstructive pulmonary disease (COPD) is a systemic disease that is characterized by incompletely reversible airflow obstruction [1]. It is widely known that numerous COPD patients suffer from locomotor disorder and dysfunction [2]. As the most common extrapulmonary manifestation of COPD, progressive skeletal muscle impairment leads to decreased strength, endurance, exercise tolerance and in turn, a poor prognosis [3]. It has been well documented that pulmonary rehabilitation (PR) is safe and beneficial to increase exercise capacity and peak oxygen consumption [4]. As the most important component of the PR programs, physical exercise training is performed to improve the functional capacity in COPD patients. Numerous studies have confirmed that severe COPD patients cannot undergo physical training due to advanced heart failure or respiratory failure, which progressively impedes performance of physical
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