title: Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD).
abstract: BACKGROUND
  Passive training of specific locomotor muscle groups by means of neuromuscular electrical stimulation (NMES) might be better tolerated than whole body exercise in patients with severe chronic obstructive pulmonary disease (COPD). It was hypothesised that this novel strategy would be particularly effective in improving functional impairment and the consequent disability which characterises patients with end stage COPD.
  
  
  METHODS
  Fifteen patients with advanced COPD (nine men) were randomly assigned to either a home based 6 week quadriceps femoris NMES training programme (group 1, n=9, FEV(1)=38.0 (9.6)% of predicted) or a 6 week control period before receiving NMES (group 2, n=6, FEV(1)=39.5 (13.3)% of predicted). Knee extensor strength and endurance, whole body exercise capacity, and health related quality of life (Chronic Respiratory Disease Questionnaire, CRDQ) were assessed.
  
  
  RESULTS
  All patients were able to complete the NMES training programme successfully, even in the presence of exacerbations (n=4). Training was associated with significant improvements in muscle function, maximal and endurance exercise tolerance, and the dyspnoea domain of the CRDQ (p<0.05). Improvements in muscle performance and exercise capacity after NMES correlated well with a reduction in perception of leg effort corrected for exercise intensity (p<0.01).
  
  
  CONCLUSIONS
  For severely disabled COPD patients with incapacitating dyspnoea, short term electrical stimulation of selected lower limb muscles involved in ambulation can improve muscle strength and endurance, whole body exercise tolerance, and breathlessness during activities of daily living.
authors.affiliation: Department of Respiratory Medicine, Hairmyres Hospital, East Kilbride and Centre for Exercise Science and Medicine, Institute of Biomedical and Life Sciences (IBLS), University of Glasgow, Glasgow, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Neder
authors.forename: D
authors.initials: D
authors.lastname: Sword
authors.forename: S A
authors.initials: SA
authors.lastname: Ward
authors.forename: E
authors.initials: E
authors.lastname: Mackay
authors.forename: L M
authors.initials: LM
authors.lastname: Cochrane
authors.forename: C J
authors.initials: CJ
authors.lastname: Clark
mesh_terms: D000368:Aged; D001823:Body Composition; D004599:Electric Stimulation Therapy / Q000379:methods*; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D008297:Male; D010807:Physical Endurance / Q000502:physiology; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D014797:Vital Capacity / Q000502:physiology