Feasibility and effects of intra-dialytic low-frequency electrical muscle stimulation and cycle training: A pilot randomized controlled trial

Abstract

Background and objectivesExercise capacity is reduced in chronic kidney failure (CKF). Intra-dialytic cycling is beneficial, but comorbidity and fatigue can prevent this type of training. Low–frequency electrical muscle stimulation (LF-EMS) of the quadriceps and hamstrings elicits a cardiovascular training stimulus and may be a suitable alternative. The main objectives of this trial were to assess the feasibility and efficacy of intra-dialytic LF-EMS vs. cyclingDesign, setting, participants, and measurementsAssessor blind, parallel group, randomized controlled pilot study with sixty-four stable patients on maintenance hemodialysis. Participants were randomized to 10 weeks of 1) intra-dialytic cycling, 2) intra-dialytic LF-EMS, or 3) non-exercise control. Exercise was performed for up to one hour three times per week. Cycling workload was set at 40–60% oxygen uptake (VO2) reserve, and LF-EMS at maximum tolerable intensity. The control group did not complete any intra-dialytic exercise. Feasibility of intra-dialytic LF-EMS and cycling was the primary outcome, assessed by monitoring recruitment, retention and tolerability. At baseline and 10 weeks, secondary outcomes including cardio-respiratory reserve, muscle strength, and cardio-arterial structure and function were assessed.ResultsFifty-one (of 64 randomized) participants completed the study (LF-EMS = 17 [77%], cycling = 16 [80%], control = 18 [82%]). Intra-dialytic LF-EMS and cycling were feasible and well tolerated (9% and 5% intolerance respectively, P = 0.9). At 10-weeks, cardio-respiratory reserve (VO2 peak) (Difference vs. control: LF-EMS +2.0 [95% CI, 0.3 to 3.7] ml.kg-1.min-1, P = 0.02, and cycling +3.0 [95% CI, 1.2 to 4.7] ml.kg-1.min-1, P = 0.001) and leg strength (Difference vs. control: LF-EMS, +94 [95% CI, 35.6 to 152.3] N, P = 0.002 and cycling, +65.1 [95% CI, 6.4 to 123.8] N, P = 0.002) were improved. Arterial structure and function were unaffected.ConclusionsTen weeks of intra-dialytic LF-EMS or cycling improved cardio-respiratory reserve and muscular strength. For patients who are unable or unwilling to cycle during dialysis, LF-EMS is a feasible alternative.

Home‐based training using neuromuscular electrical stimulation in patients on continuous ambulatory peritoneal dialysis: A pilot study

“…Resulting VO 2peak improvement is fully comparable to standard RHB trainings . These findings were verified recently in several studies proving therapeutic effectiveness of NMES in hemodialyzed patients . Based on our current knowledge, NMES has not been applied as a RHB method in patients on chronic ambulatory peritoneal dialysis (CAPD).…”

“…[24][25][26][27] These findings were verified recently in several studies proving therapeutic effectiveness of NMES in hemodialyzed patients. [28][29][30][31][32] Based on our current knowledge, NMES has not been applied as a RHB method in patients on chronic ambulatory peritoneal dialysis (CAPD). With respect to previously published data and to our own experience proving NMES therapeutic potential, we assume that a RHB program based on electrical stimulation of leg muscles might positively affect functional performance as well as QoL in CAPD patients.…”

Cardiovascular Functional Changes in Chronic Kidney Disease: Integrative Physiology, Pathophysiology and Applications of Cardiopulmonary Exercise Testing

“…Additionally, the development of restrictive lung disease has been associated with progressive CKD (Mukai et al, 2018). Underlying these systemic target organ changes are widespread ultrastructural and molecular alterations that contribute to subclinical disease early in the course of CKD and may not be readily detected with conventional resting imaging studies (Ting et al, 2015;Kim et al, 2018;McGregor et al, 2018).…”

Influências Bioecológicas Da Prática Da Natação Na Vida De Uma Pessoa Com Deficiência Acometida Por Ave: Um Estudo De Caso

“…al. 2018;MCGREGOR et. al., 2018), a atuação conjunta do educador físico com o fisioterapeuta e fisiologistas não pode ser ignorada nesses casos, pois o educador físico cuida de toda a parte de treinamento desportivo do atleta com aplicação de protocolos de exercícios padronizados e aprovados pela equipe funcional no geral (MCGREGOR et.…”

“…2018;MCGREGOR et. al., 2018), a atuação conjunta do educador físico com o fisioterapeuta e fisiologistas não pode ser ignorada nesses casos, pois o educador físico cuida de toda a parte de treinamento desportivo do atleta com aplicação de protocolos de exercícios padronizados e aprovados pela equipe funcional no geral (MCGREGOR et. al., 2018), já o profissional fisioterapeuta é responsável pela análise do desenvolvimento funcional do atleta, prevenção e manejo de possíveis lesões instaladas e trabalho de percepção corporal, além de viabilizar o atleta para o exercício sem presença de dor incapacitante (NOGUEIRA et.…”