title: Exercise-resembling effects of periodic somatosensory stimulation in heart failure.
abstract: BACKGROUND
  The mechanism of the beneficial effects of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure (CHF) is largely unexplained. In our here-presented hypothesis-generating study we propose that part of these effects is mediated by the exercise-accompanying somatosensory nerve traffic. To demonstrate this, we compared the effects of periodic electrical somatosensory stimulation in patients with CHF with the effects of exercise training and with usual care.
  
  
  METHODS
  In a randomized controlled study we measured, in CHF patients, changes in blood pressure, baroreflex sensitivity (BRS), neurohormones, exercise capacity and quality of life (QOL) in response to periodic somatosensory stimulation in the form of 2 Hz transcutaneous electrical nerve stimulation (TENS) at both feet, in response to conventional exercise training (EXTR) and, as control (CTRL), in patients with usual care only.
  
  
  RESULTS
  Group sizes were N=31 (TENS group), N=25 (EXTR group) and N=30 (CTRL group), respectively. Practically all improvements in BRS, neurohormone concentrations, exercise capacity and QOL in the TENS group were comparable to, or sometimes even better than in the EXTR group. These improvements were not observed in the CTRL group.
  
  
  CONCLUSIONS
  This study demonstrates that periodic electrical somatosensory stimulation is as effective as exercise training in improving BRS, neurohormone concentrations, exercise capacity and QOL in CHF patients. These results encourage exploration of exercise modalities that concentrate on rhythm rather than on effort, with the purpose to normalize autonomic derangement and neurohumoral activation in CHF.
authors: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands.
authors: Maaike G J
authors: MG
authors: Gademan
authors: Henk J
authors: HJ
authors: van Exel
authors: Hedde
authors: H
authors: van de Vooren
authors: Joris C W
authors: JC
authors: Haest
authors: Johannes
authors: J
authors: van Pelt
authors: Arnoud
authors: A
authors: van der Laarse
authors: Suzanne C
authors: SC
authors: Cannegieter
authors: Carolien M H B
authors: CM
authors: Lucas
authors: Soeresh
authors: S
authors: Somer
authors: Harriette F
authors: HF
authors: Verwey
authors: Martin J
authors: MJ
authors: Schalij
authors: Ernst E
authors: EE
authors: van der Wall
authors: Cees A
authors: CA
authors: Swenne
mesh_terms: D000368:Aged; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*
keywords: Autonomic nervous system; Baroreflex sensitivity; Exercise training; Heart failure; Neurohumoral activation; Somatosensory stimulation