[Electromyostimulation (EMS) in cardiac patients. Will EMS training be helpful in secondary prevention?].
BACKGROUND
Current guidelines concerning the treatment of patients with chronic congestive heart failure (CHF) include ergospirometry-directed dynamic exercises on a daily basis. Several prospective, randomized trials have confirmed its positive influence on clinical symptoms and prognosis of the disease. Patients with stable coronary artery disease (CAD) can benefit from a 27% reduction of mortality, as shown in meta-analyses of several studies. By contrast, patients with CHF have traditionally been discouraged from physical activities, which may have had detrimental consequences. They became even less able to participate in daily activities that in turn hastened the disease-driven atrophies of skeletal muscles. On the other hand, well-adjusted endurance training at 50-70% of maximum oxygen uptake was shown to improve overall fitness. In a recent metaanalysis, the mortality of patients with CHF was reduced by 35% by sports, and the rate of hospitalizations dropped by 28%. It is a well-perceived clinical problem that successful treatment is not possible without intensive guidance and a close therapeutic relationship. Being left in their routine situation and circumstances, the majority of patients cannot cope with the day-to-day challenge of an independent, active lifestyle. Among the primary reasons not to sustain physical activity are mental, psychological or social barriers.


METHODS
The authors have begun, in a cohort of patients with CHF, a prospective pilot study to investigate the impact of, and attitude to, electromyostimulation (EMS). Unique features of this treatment include its passive nature that remains independent of mental attitude.


RESULTS
An up to 96% increase of peak oxygen uptake at the anaerobic threshold could be shown (pre- vs. posttraining phase, VO(2at) 19.39 [+/- 5.3] ml/kg vs. 24.25 [+/- 6.34] ml/kg). The diastolic blood pressure decreased significantly. A 14% gain in muscle volume was observed, while overall body weight remained unchanged. All patients kept up the training until the conclusion of the study and found their overall fitness to be considerably improved.


CONCLUSIONS
The results may indicate the enormous potential of EMS for the treatment of patients within the cardiologic arena, especially those with CHF.
Fritzsche
Dirk
D
Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen. dfritzsche@hdz-nrw.de
Fruend
Andreas
A
Schenk
Sören
S
Mellwig
Klaus-Peter
KP
Kleinöder
Heinz
H
Gummert
Jan
J
Horstkotte
Dieter
D
D000328:Adult; D000368:Aged; D015308:Anaerobic Threshold / Q000502:physiology; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality / Q000534:rehabilitation*; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D017060:Patient Satisfaction; D010809:Physical Fitness / Q000502:physiology; D010865:Pilot Projects; D011446:Prospective Studies; D004561:Transcutaneous Electric Nerve Stimulation / Q000295:instrumentation*
D010100:Oxygen