Benefits of neuromuscular electrical stimulation prior to endurance training in patients with cystic fibrosis and severe pulmonary dysfunction.
BACKGROUND
We investigated the effect of neuromuscular electrical stimulation (NMES) training prior to endurance training in patients with cystic fibrosis (CF) and severe pulmonary obstruction.


METHODS
Fourteen patients with CF (FEV(1) = 35% ± 11% predicted) were prospectively randomized to either a 6-week NMES training program (n = 7) or a 6-week control period (n = 7) both followed by ergocycle (ERGO) training (8 weeks) (NMES + ERGO and control + ERGO groups). Measurements were pulmonary function, mid-thigh circumference, quadriceps strength, 6-min walk distance, maximal exercise capacity on a cycloergometer, plasma biomarkers, insulin resistance (homeostasis model assessment indexes), and quality of life (CF questionnaire for adults and teenagers > 14 years of age [CFQ14 + ], Baseline Dyspnea Index-Transition Dyspnea Index).


RESULTS
NMES + ERGO training greatly improved mid-thigh circumference ( + 2.6 ± 0.9 cm vs - 0.4 ± 1.4 cm), quadriceps strength ( + 6 ± 5 kg vs - 2 ± 2 kg), and BMI ( + 0.6 ± 0.6 kg/m(2) vs - 0.5 ± 0.7 kg/m(2) ) compared with control + ERGO training ( P < .05). No differences between groups were found in exercise-induced changes in 6-min walk distance and maximal exercise capacity. However, dyspnea after the 6-minute walk test, the fasting glucose/insulin ratio (calculated as an index of insulin resistance), and physical function and health perception domains of the CFQ14 + improved after NMES + ERGO training compared with control + ERGO training ( P < .05). Significant correlations were found between changes in mid-thigh circumference and muscle strength, ventilation requirements during exercise, insulin sensibility, and the physical function section of CFQ14 + ( P < .05).


CONCLUSIONS
NMES training performed prior to endurance training is useful for strengthening peripheral muscles, which in turn may augment gains in body weight and quality of life, further reductions in ventilation requirements during exercise, and retard insulin resistance in patients with CF with severe pulmonary obstruction.
HP2 Laboratory, Université Joseph Fourier, Institut national de la santé et de la recherche médicale (Inserm) U1042, Grenoble; Locomotion Rehabilitation and Physiology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble. Electronic address: IVivodtzev@chu-grenoble.fr.
Isabelle
I
Vivodtzev
HP2 Laboratory, Université Joseph Fourier, Institut national de la santé et de la recherche médicale (Inserm) U1042, Grenoble; Locomotion Rehabilitation and Physiology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble.
Nicolas
N
Decorte
HP2 Laboratory, Université Joseph Fourier, Institut national de la santé et de la recherche médicale (Inserm) U1042, Grenoble; Locomotion Rehabilitation and Physiology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble.
Bernard
B
Wuyam
Inserm Clinical Research Center CIC03, Centre Hospitalier Universitaire de Grenoble, Grenoble.
Nicolas
N
Gonnet
Cystic Fibrosis Center for Adults, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon.
Isabelle
I
Durieu
HP2 Laboratory, Université Joseph Fourier, Institut national de la santé et de la recherche médicale (Inserm) U1042, Grenoble; Locomotion Rehabilitation and Physiology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble.
Patrick
P
Levy
HP2 Laboratory, Université Joseph Fourier, Institut national de la santé et de la recherche médicale (Inserm) U1042, Grenoble; Inserm Clinical Research Center CIC03, Centre Hospitalier Universitaire de Grenoble, Grenoble.
Jean-Luc
JL
Cracowski
HP2 Laboratory, Université Joseph Fourier, Institut national de la santé et de la recherche médicale (Inserm) U1042, Grenoble; Inserm Clinical Research Center CIC03, Centre Hospitalier Universitaire de Grenoble, Grenoble; Cystic Fibrosis Center for Adults, Pulmonology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Claire
C
Cracowski
D000328:Adult; D001835:Body Weight; D003550:Cystic Fibrosis / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy; D005080:Exercise Test; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008168:Lung / Q000503:physiopathology; D008173:Lung Diseases, Obstructive / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010807:Physical Endurance / Q000502:physiology*; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D016896:Treatment Outcome