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  1. Elizabeth Batalla-Duran
  1. Correspondence to Dr Elizabeth Batalla-Duran, Torbay Hospital, Lawes Bridge, ST5 Respiratory, Torquay TQ2 7AA, UK; ebatalla-duran{at}

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Skeletal muscle bulk improves exercise capacity in COPD patients, and exercises to increase muscle mass are part of pulmonary rehabilitation. This randomised, double-blind, placebo-controlled trial in the Lancet (doi:10.1016/S2213-2600(15)00503-2) looked at the effect of neuromuscular electrical stimulation (NMES) to the quadriceps on exercise capacity in patients with severe COPD (FEV1 <50%, MRC score ≥4). Fifty-two patients were assigned to receive either active or placebo NMES over 6 weeks. Change in 6 min walk test distance (the primary end point) was greater in the active group than the placebo group, with a mean change of 35.7 m (95% CI 10.5 to 60.9) (p=0.005). Patients receiving the NMES also reported greater ease in carrying out activities of daily living. Unfortunately, the effect waned 6 weeks after the intervention was stopped. The findings of this study could prove beneficial in the management of patients unable to undergo conventional pulmonary rehabilitation, as NMES can be carried out in the home environment, independently, and is well tolerated. However, the practicalities of recurrent neuromuscular stimulation would have to be overcome to maintain the effect.

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