O6.4 Neuromuscular electrical stimulation

Neuromuscular electrical stimulation (NMES) uses an intermittent electrical current to elicit a contraction of a superficial peripheral muscle.  The main aim of NMES is to improve muscle power or endurance.  In people with COPD, NMES is generally applied to the thigh muscles.  NMES is associated with a very low ventilatory load and thus dyspnoea in contrast to whole body exercise training.

The findings of a Cochrane Review (Hill 2018) showed that NMES applied in isolation improved peripheral muscle force (SMD 0.34, 95% CI 0.02 to 0.65, 6 trials, n=159) and endurance (SMD 1.36, 95% CI 0.59 to 2.12, 2 trials, n=35) and 6-minute walk distance (39.26m, 95% CI 16.31 to 62.22, 2 trials, n=76) [evidence level I]. These trials applied NMES over a 4 to 8-week period, 4 to 7 days a week and for sessions lasting 30-60 minutes applied once or twice daily.  The findings of studies that applied NMES in addition to conventional exercise training compared to conventional exercise training alone (6 trials) showed no additional gain in muscle performance.  The quality of the evidence in this review was rated as low.

The main clinical applications for NMES are for patients unable to engage in whole body exercise training, for example due to very severe dyspnoea including patients with an exacerbation and those awaiting transplantation.