Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD.
OBJECTIVE
Low body weight in COPD patients is associated with worsening dyspnea, reduced leg strength, and poor prognosis. Classical rehabilitation strategies are then limited by reduced exercise tolerance. Thus, we proposed to evaluate whether electrostimulation (ES) was a beneficial technique in the rehabilitation programs for severely deconditioned COPD patients after an acute exacerbation.


METHODS
Randomized, controlled study.


METHODS
Pulmonary rehabilitation center.


METHODS
Seventeen patients with severe COPD (mean [ +/- SD] FEV(1), 30 +/- 3% predicted) and low body mass index (BMI) [18 +/- 2.5 kg/m(2)].


METHODS
Patients were randomly assigned either to usual rehabilitation (UR) alone or to a UR-plus-ES program for 4 weeks. Quadriceps muscle strength, total muscle mass (MM), exercise capacity, and health-related quality of life were measured before and after rehabilitation.


RESULTS
The training with ES plus UR induced a significant twofold improvement in the mean number of maximal voluntary contraction (MVC) compared to UR alone (97 +/- 71 vs 36 +/- 34 contractions, respectively; p = 0.03) and resulted in a more significant improvement in dyspnea when performing daily tasks (decrease in the dyspnea domain score of the 28-item Maugeri Foundation Respiratory Failure questionnaire, -1.7 +/- 1.0 vs -0.2 +/- 1.2 points, respectively; p = 0.05). There was also a significant increase in walking distance (63 +/- 40 m; p = 0.01) and BMI (0.6 +/- 0.5 kg/m(2); p = 0.02) after training in the ES + UR group. A significant relationship was found between changes in MVC and changes in MM after training in the ES + UR group (r = 0.94; p = 0.03).


CONCLUSIONS
The combination of ES and UR was associated with greater improvement in quadriceps strength and dyspnea during the performance of daily tasks than UR alone in severely disabled COPD patients with low BMI. In this population, ES has been revealed as a useful procedure, complementing the usual pulmonary rehabilitation.
Vivodtzev
Isabelle
I
Lung function and Exercise Laboratory, Hospital A Michallon, Grenoble, France.
Pépin
Jean-Louis
JL
Vottero
Gabrielle
G
Mayer
Valerie
V
Porsin
Bernard
B
Lévy
Patrick
P
Wuyam
Bernard
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control; D004599:Electric Stimulation Therapy; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D052097:Quadriceps Muscle / Q000503:physiopathology*; D011788:Quality of Life