title: Comparison of muscle functional electrical stimulation to conventional bicycle exercise on endothelium and functional status indices in patients with heart failure.
abstract: The aim of this prospective, open-label, cohort study was to compare the effect of muscle functional electrical stimulation (FES) on endothelial function to that of conventional bicycle training. Eligible patients were those with New York Heart Association class II or III heart failure symptoms and ejection fractions ≤ 0.35. Two physical conditioning programs were delivered: FES of the muscles of the lower limbs and bicycle training, each lasting for 6 weeks, with a 6-week washout period between them. Brachial artery flow-mediated dilation (FMD) and other parameters were assessed before and after FES and the bicycle training program. FES resulted in a significant improvement in FMD, which increased from 5.9 ± 0.5% to 7.7 ± 0.5% (95% confidence interval for the difference 1.5% to 2.3%, p < 0.001). Bicycle training also resulted in a substantial improvement of endothelial function. FMD increased from 6.2 ± 0.4% to 9.2 ± 0.4% (95% confidence interval for the difference 2.5% to 3.5%, p < 0.001). FES was associated with a 41% relative increase in FMD, compared to 57% with bicycle exercise (95% confidence interval for the difference between the relative changes 1.2% to 30.5%, p = 0.034). This resulted in attaining a significantly higher FMD value after bicycle training compared to FES (9.2 ± 0.4% vs 7.7 ± 0.5%, p < 0.001). In conclusion, the effect of muscle FES in patients with heart failure on endothelial function, although not equivalent to that of conventional exercise, is substantial. Muscle FES protocols may prove very useful in the treatment of patients with heart failure who cannot or will not adhere to conventional exercise programs.
authors.affiliation: Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital G. Gennimatas, Athens, Greece.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raisakis
authors.forename: Charalampos
authors.initials: C
authors.lastname: Kossyvakis
authors.forename: Andreas
authors.initials: A
authors.lastname: Kaoukis
authors.forename: Metaxia
authors.initials: M
authors.lastname: Driva
authors.forename: Loukas
authors.initials: L
authors.lastname: Pappas
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Panagopoulou
authors.forename: Olga
authors.initials: O
authors.lastname: Ntzouvara
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karavidas
authors.forename: Vlasios
authors.initials: V
authors.lastname: Pyrgakis
authors.forename: Ilias
authors.initials: I
authors.lastname: Rentoukas
authors.forename: Constadina
authors.initials: C
authors.lastname: Aggeli
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000328:Adult; D000368:Aged; D001916:Brachial Artery / Q000503:physiopathology; D018592:Cross-Over Studies; D004599:Electric Stimulation Therapy / Q000379:methods*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D011446:Prospective Studies; D016896:Treatment Outcome; D014664:Vasodilation / Q000502:physiology*