Abstract
Both aerobic training (AT) and electromyostimulation (EMS) of leg muscles improve exercise tolerance in patients suffering from chronic heart failure (CHF). It was speculated that combination of both methods might have an additive effect. This study was performed to evaluate the effects of a combination of AT and EMS in rehabilitation (RHB) of CHF patients. Patients (n=71; age 59 ± 10.2 yrs, NYHA II/III, EF 32 ± 7.1%) were randomized into 3 groups: a) group AT, b) group EMS, and c) group AT+EMS. AT protocol included standard activity on bicycle 3x a week at the level of individual anaerobic threshold. EMS (10 Hz, mode 20s "on"/20s "off") was applied to leg extensors for 2 h/day. Total time of given type of RHB was 12 weeks. Data analysis revealed statistically significant improvements of patients in all experimental groups (averaged difference after 12 weeks of exercise as related to initial value: ∆VO2peak: +12.9%, ∆VO2AT: +9.3%, ∆Wpeak: +22.7%). No statistically significant difference among experimental groups was found. Quality of life (Minnesota Living with Heart Failure - MLHF) global score was significantly improved in all 3 groups: AT (∆MLHF: -27.9%; P=0.001), AT+EMS (∆MLHF: -29.1%; P=0.002), and EMS (∆MLHF: -16.6%; P=0.008). MLHF score in EMS group showed the smallest time-related improvement compared to AT and AT+EMS groups, and this difference in improvement between the groups was statistically significant (P=0.021). No significant difference was found between the two types of exercise training.and nor did, their combination have any significant additional improvement.
Highlights
Congestive chronic heart failure (CHF) is a frequent, gradually progressing and life-threatening disease occurring in 2% of the adult population in developed countries
There were no reports of muscle pains, dyspnea, nausea or dermatological problems caused by the electrodes
Muscular contractions evoked by EMS have similar acute effects on the neuromuscular system as voluntary muscular contractions (VMC), but during VMC motor units (MU) are activated synchronously in the direction from small to large depending on the intensity of physical workload[47]
Summary
Congestive chronic heart failure (CHF) is a frequent, gradually progressing and life-threatening disease occurring in 2% of the adult population in developed countries. Current treatment of heart failure (CHF) encompasses appropriate pharmacotherapy and meticulous education consisting in changing patient’s life style and performing adequate physical activity[9] These measures are inseparably related to cardiovascular rehabilitation (RHB), which effectively contributes to optimizing the entire treatment. EMS and voluntary muscular contractions (VMC) during bicycle training are two different methods of activating muscle fibers They both cause a number of acute changes at the level of the neuromuscular system (exercise training on bicycle is a dynamic exercise, while EMS is a rather static exercise). It can be presumed that using the combination of both types of exercise may lead to cumulative adaptation in the given muscle, as well as to higher overall efficiency This presumption is confirmed by a few studies on the combination of EMS and VMC, in the area of muscle rehabilitation and regeneration after surgery[15,16]. The main purpose of this study was to evaluate the effects of the combination of standard aerobic training (AT) and the low-frequency EMS in the rehabilitation of patients with CHF of moderate grade
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