Chest

Chest

Volume 129, Issue 6, June 2006, Pages 1540-1548
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Original Research
Improvement in Quadriceps Strength and Dyspnea in Daily Tasks After 1 Month of Electrical Stimulation in Severely Deconditioned and Malnourished COPD

https://doi.org/10.1378/chest.129.6.1540Get rights and content

Study objectives

Low body weight in COPD patients is associated with worsening dyspnea, reduced leg strength, and poor prognosis. Classical rehabilitation strategies are then limited by reduced exercise tolerance. Thus, we proposed to evaluate whether electrostimulation (ES) was a beneficial technique in the rehabilitation programs for severely deconditioned COPD patients after an acute exacerbation.

Design

Randomized, controlled study.

Setting

Pulmonary rehabilitation center.

Patients

Seventeen patients with severe COPD (mean [ ± SD] FEV1, 30 ± 3% predicted) and low body mass index (BMI) [18 ± 2.5 kg/m2].

Methods

Patients were randomly assigned either to usual rehabilitation (UR) alone or to a UR-plus-ES program for 4 weeks. Quadriceps muscle strength, total muscle mass (MM), exercise capacity, and health-related quality of life were measured before and after rehabilitation.

Results

The training with ES plus UR induced a significant twofold improvement in the mean number of maximal voluntary contraction (MVC) compared to UR alone (97 ± 71 vs 36 ± 34 contractions, respectively; p = 0.03) and resulted in a more significant improvement in dyspnea when performing daily tasks (decrease in the dyspnea domain score of the 28-item Maugeri Foundation Respiratory Failure questionnaire, −1.7 ± 1.0 vs −0.2 ± 1.2 points, respectively; p = 0.05). There was also a significant increase in walking distance (63 ± 40 m; p = 0.01) and BMI (0.6 ± 0.5 kg/m2; p = 0.02) after training in the ES + UR group. A significant relationship was found between changes in MVC and changes in MM after training in the ES + UR group (r = 0.94; p = 0.03).

Conclusions

The combination of ES and UR was associated with greater improvement in quadriceps strength and dyspnea during the performance of daily tasks than UR alone in severely disabled COPD patients with low BMI. In this population, ES has been revealed as a useful procedure, complementing the usual pulmonary rehabilitation.

Section snippets

Subjects

The following procedures were performed in accordance with the standards of the Committee on Human Experimentation at our institution, which approved the study. The criteria for participation in the study were as follows: (1) experiencing severe bronchial obstruction (ie, COPD and/or bronchiectasis) but with no evidence of cardiovascular, renal, or hepatic diseases; (2) FEV1 ≤ 50% predicted with an FEV1/FVC ratio of < 70%; (3) disability and malnutrition as established by a BMI of < 22 kg/m2;

Patients Studied

As a whole group (n = 17), patients exhibited severe chronic bronchial obstruction (mean FEV1, 30 ± 3% predicted) and severe disability and malnutrition considering their very low mean BMI (18 ± 2.5 kg/m2) [Table 1]. Both groups showed a marked decrease in muscle strength (ES + UR group, 24 ± 18% predicted; UR group, 22 ± 11% predicted26), MM (ES + UR group 49 ± 14% predicted; UR group, 58 ± 8% predicted30), and 6 min-walking distance (ES + UR group, 42 ± 14% predicted; UR group, 39 ± 21%

Discussion

This study sought to evaluate whether ES was a useful additive strategy to UR (ie, ALM) in severely deconditioned COPD patients with low BMIs who were unable to perform cycle ergometry. Our results showed that ES was feasible to perform and was well-tolerated by these patients. The main result of this study was that the combination of ES and UR enabled improvements in quadriceps muscle strength and dyspnea in the performance of daily tasks to a greater extent than UR alone.

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml)

    This research was supported by grants from the Association pour le Traitement, la Rééducation et la Réadaptation des Insuffisants Respiratoires (ATRIR), “Bourse André Dion,” Nyons, France.

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    Copyright © 2006 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.