Muscle electrical stimulation improves neurovascular control and exercise tolerance in hospitalised advanced heart failure patients

Groehs, Raphaela V; Antunes‐Correa, Lígia M.; Nobre, Thais S.; Alves, Maria-Janieire N. N.; Rondon, Maria Urbana Pinto Brandão; Barreto, Antônio Carlos; Negräo, Carlos Eduardo

doi:10.1177/2047487316654025

Cited by 32 publications

(28 citation statements)

References 35 publications

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“…Leg blood flow (LBF) was measured by venous occlusion plethysmography as previously described . Briefly, the left leg was elevated above heart level to ensure adequate venous drainage.…”

Section: Methodsmentioning

confidence: 99%

“…Leg blood flow Leg blood flow (LBF) was measured by venous occlusion plethysmography as previously described. 40 Briefly, the left leg was elevated above heart level to ensure adequate venous drainage. A mercury-filled silastic tube attached to a low-pressure transducer was placed around the calf and connected to plethysmography (Hokanson-AI-6, USA).…”

Section: Measures and Proceduresmentioning

confidence: 99%

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Effects of aerobic and inspiratory training on skeletal muscle microRNA‐1 and downstream‐associated pathways in patients with heart failure

Antunes‐Correa

Trevizan

Bacurau

et al. 2019

J cachexia sarcopenia muscle

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Background The exercise intolerance in chronic heart failure with reduced ejection fraction (HFrEF) is mostly attributed to alterations in skeletal muscle. However, the mechanisms underlying the skeletal myopathy in patients with HFrEF are not completely understood. We hypothesized that (i) aerobic exercise training (AET) and inspiratory muscle training (IMT) would change skeletal muscle microRNA‐1 expression and downstream‐associated pathways in patients with HFrEF and (ii) AET and IMT would increase leg blood flow (LBF), functional capacity, and quality of life in these patients. Methods Patients age 35 to 70 years, left ventricular ejection fraction (LVEF) ≤40%, New York Heart Association functional classes II–III, were randomized into control, IMT, and AET groups. Skeletal muscle changes were examined by vastus lateralis biopsy. LBF was measured by venous occlusion plethysmography, functional capacity by cardiopulmonary exercise test, and quality of life by Minnesota Living with Heart Failure Questionnaire. All patients were evaluated at baseline and after 4 months. Results Thirty‐three patients finished the study protocol: control (n = 10; LVEF = 25 ± 1%; six males), IMT (n = 11; LVEF = 31 ± 2%; three males), and AET (n = 12; LVEF = 26 ± 2%; seven males). AET, but not IMT, increased the expression of microRNA‐1 (P = 0.02; percent changes = 53 ± 17%), decreased the expression of PTEN (P = 0.003; percent changes = −15 ± 0.03%), and tended to increase the p‐AKTser473/AKT ratio (P = 0.06). In addition, AET decreased HDAC4 expression (P = 0.03; percent changes = −40 ± 19%) and upregulated follistatin (P = 0.01; percent changes = 174 ± 58%), MEF2C (P = 0.05; percent changes = 34 ± 15%), and MyoD expression (P = 0.05; percent changes = 47 ± 18%). AET also increased muscle cross‐sectional area (P = 0.01). AET and IMT increased LBF, functional capacity, and quality of life. Further analyses showed a significant correlation between percent changes in microRNA‐1 and percent changes in follistatin mRNA (P = 0.001, rho = 0.58) and between percent changes in follistatin mRNA and percent changes in peak VO2 (P = 0.004, rho = 0.51). Conclusions AET upregulates microRNA‐1 levels and decreases the protein expression of PTEN, which reduces the inhibitory action on the PI3K‐AKT pathway that regulates the skeletal muscle tropism. The increased levels of microRNA‐1 also decreased HDAC4 and increased MEF2c, MyoD, and follistatin expression, improving skeletal muscle regeneration. These changes associated with the increase in muscle cross‐sectional area and LBF contribute to the attenuation in skeletal myopathy, and the improvement in functional capacity and quality of life in patients with HFrEF. IMT caused no changes in microRNA‐1 and in the downstream‐associated pathway. The increased functional capacity provoked by IMT seems to be associated with amelioration in the respiratory function instead of changes in skeletal muscle. http://ClinicalTrials.gov (Identifier: NCT01747395)

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“…Leg blood flow (LBF) was measured by venous occlusion plethysmography as previously described . Briefly, the left leg was elevated above heart level to ensure adequate venous drainage.…”

Section: Methodsmentioning

confidence: 99%

Section: Measures and Proceduresmentioning

confidence: 99%

Effects of aerobic and inspiratory training on skeletal muscle microRNA‐1 and downstream‐associated pathways in patients with heart failure

Antunes‐Correa

Trevizan

Bacurau

et al. 2019

J cachexia sarcopenia muscle

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“…Exercise training is not recommended in unstable HF patients; Groehs et al 66. investigated the effects of muscle functional electrical stimulation on muscle sympathetic nerve activity, muscle blood flow, and exercise tolerance in hospitalized patients for stabilization of HF; functional electrical stimulation improves muscle sympathetic nerve activity, vasoconstriction, exercise tolerance, muscle strength, and QoL, suggesting this approach during hospitalization to treat decompensated HF.…”

Section: With Heart Failure Present: Exercise Improvement With Trainimentioning

confidence: 99%

Exercise and heart failure: an update

et al. 2017

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The present update is dedicated to the evolution of the interaction between heart failure (HF) and exercise and how the scientific community has handled it. Indeed, on the one hand, HF is a leading cause of morbidity and mortality with a stable prevalence from 1998 onward varying between 6.3% and 13.3%. On the other hand, exercise is seen as a diagnostic and prognostic tool as well as a therapeutic intervention in chronic HF. More precisely, the knowledge, the clinical application, and the research interest on the mutual interactions between exercise and HF have different phases in disease progression: Before HF onset (past): exercise provides protective benefit in preventing HF (primary prevention).With HF present: exercise improvement with training provides benefits in HF (secondary prevention).The prediction of future in HF patients: exercise impairment, as a leading characteristic of HF, is used as a prognostic factor.

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“…12 EMS is a novel intervention that shows beneficial effects on both physical function and exercise capacity. [14][15][16][17][18] Therefore, we postulated that EMS therapy would be effective in frail elderly AHF patients. In contrast, EMS therapy has some potential to adversely affect the patients.…”

Section: Resultsmentioning

confidence: 99%

“…It is necessary for AHF patients to achieve and maintain optimal physical function, and exercise therapy is required to maintain physical function in HF patients, especially in frail elderly subjects . EMS is a novel intervention that shows beneficial effects on both physical function and exercise capacity . Therefore, we postulated that EMS therapy would be effective in frail elderly AHF patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of Acute Phase Intensive Electrical Muscle Stimulation in Frail Elderly Patients With Acute Heart Failure (ACTIVE‐EMS): Rationale and protocol for a multicenter randomized controlled trial

Tanaka

Matsue

Yonezawa

et al. 2017

Clinical Cardiology

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In elderly patients with acute heart failure (AHF), clinical outcome is adversely affected by frailty. Although a number of potentially effective interventions for frailty have been reported, little is known about the effects of rehabilitation programs in frail elderly AHF patients. We postulated that addition of electrical muscle stimulation (EMS), which induces muscle contraction without requiring patient volition, to early rehabilitation would be efficacious in frail elderly AHF patients. The ACTIVE‐EMS (Effects of Acute Phase Intensive Electrical Muscle Stimulation in Frail Elderly Patients With AHF; UMIN000019551) trial is a multicenter, randomized controlled trial that will enroll 80 patients from 3 hospitals in Japan. AHF patients age ≥ 75 years positive for frailty, defined as Short Physical Performance Battery score 4 to 9, will be randomly assigned to receive early rehabilitation program only or EMS add‐on therapy for 2 weeks. The primary endpoint of the trial is the change in quadriceps isometric strength between baseline and 2 weeks, with changes in physical function and cognitive function, and clinical safety and feasibility of EMS therapy as secondary outcomes. ACTIVE‐EMS is the first randomized trial to evaluate the clinical effectiveness of adding EMS therapy to early rehabilitation in frail elderly AHF patients. The results of this study will provide insight for the development of appropriate rehabilitation programs for this high‐risk population.

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Muscle electrical stimulation improves neurovascular control and exercise tolerance in hospitalised advanced heart failure patients

Cited by 32 publications

References 35 publications

Effects of aerobic and inspiratory training on skeletal muscle microRNA‐1 and downstream‐associated pathways in patients with heart failure

Effects of aerobic and inspiratory training on skeletal muscle microRNA‐1 and downstream‐associated pathways in patients with heart failure

Exercise and heart failure: an update

Effects of Acute Phase Intensive Electrical Muscle Stimulation in Frail Elderly Patients With Acute Heart Failure (ACTIVE‐EMS): Rationale and protocol for a multicenter randomized controlled trial

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