Effects of neuromuscular electrical stimulation during hemodialysis on peripheral muscle strength and exercise capacity: a randomized clinical trial

Publication date: Available online 16 January 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ana Karla Vieira Brüggemann, Carolina Luana Mello, Tarcila Dal Pont, Deborah de Camargo Hizume Kunzler, Daniel Fernandes Martins, Franciane Bobinski, Wellington Pereira Yamaguti, Elaine Paulin
ObjectiveTo evaluate the effects of neuromuscular electrical stimulation of high and low frequency and intensity, performed during hemodialysis (HD), on physical function and inflammation markers in patients with chronic kidney disease (CKD).DesignRandomized clinical trialSettingHemodialysis clinic.Participants51 CKD patients were randomized into blocks of four by means of opaque envelopes. They were divided into a group of high frequency and intensity neuromuscular electrical stimulation (HG) and a group of low frequency and intensity neuromuscular electrical stimulation (LG).InterventionHG was submitted to neuromuscular electrical stimulation with 50Hz and medium intensity of 72.90mA, and LG used 5Hz and medium intensity of 13.85mA, 3 times per week for one hour, during 12 sessions.Main Outcome MeasuresPeripheral muscle strength, exercise capacity, levels of muscle trophism marker [growth factor similar to insulin type 1 (IGF-1)] and levels of pro- inflammatory [tumor necrosis factor (TNF-alpha)] and anti-inflammatory [Interleukin 10 – (IL-10)] cytokines.ResultsHG showed significant increase in right peripheral muscle strength (155.35±65.32Nm versus 161.60±68.73Nm; p=0.01) and left peripheral muscle strength (156.60±66.51Nm versus 164.10±69.76Nm, p=0.02) after training, which did not occur with LG for both right muscle strength (109.40±32.08Nm versus 112.65±38.44Nm, p=0.50) and left muscle strength (113.65±37.79Nm versus 116.15±43.01Nm; p=0.61). The distance of the 6-minute walk test (6MWTD) increased in both groups: HG (435.55±95.81m versus 457.25±90.64m; p=0.02) and LG (403.80±90.56m versus 428.90±87.42m, p=0.007). The groups did not differ in peripheral muscle strength and in the 6MWTD after the training protocol. In HG, a correlation was observed between initial and final values for 6MWTD and muscle strength. In LG, correlations occurred only between the 6MWTD and the initial muscle strength. Only LG increased levels of IGF-1 (252.38±156.35pg/ml versus 336.97±207.34 pg/ml; p=0.03) and only HG reduced levels of IL-10 (7.26±1.81 pg/ml versus 6.32±1.54 pg/ml; p=0.03). The groups showed no differences in the TNF-alpha concentrations.ConclusionCKD patients on HD improve exercise capacity after peripheral neuromuscular electrical stimulation of high and low frequency and intensity. However, the benefits on muscle and inflammatory outcomes seem to be specific for the adopted strategy.



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