Neuromuscular Electrical Stimulation and Therapeutic Exercise on Functional Capacity and Quality of Life in Patients with Chronic Heart Failure
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Abstract
Background: Heart failure (HF) is one of the most common cardiovascular diseases that considered as a progressive and debilitating disorder. One of the main problems in these patients is frequent hospitalizations due to the exacerbation of symptoms. Therefore, the aim of this study is to investigate the simultaneous effect of muscle electrical stimulation and exercise therapy on quality of life and functional capacity in hospitalized patients with chronic heart failure.
Material and Methods: The present study included 40 hospitalized patients with chronic heart failure among the volunteers and randomly divided into two groups of 20 patients. The first group underwent cardiac rehabilitation based on resistance training along with muscle electrical stimulation (RT+ES). The second group received only resistance training program (RT). Resistance training consisted of performing three leg presses, cuff presses, and triceps movements with Traband. Functional capacity and quality of life evaluated before and after intervention.
Results: Quality of Life Index in the RT+ES increased more than RT (P≤0.05). Although the functional capacity in both groups had increased relative to the pre-test (P≤0.05). However, there were no meaningful differences between the two groups (P≥0.05).
Conclusion: Resistance training with electrical stimulation during hospitalization improves the quality of life and functional capacity of patients with chronic heart failure.
1. Nouwen L, Timmers L. The difference between low and moderate intense resistance training, combined with aerobic endurance training, on exercise tolerance and functional capacity in patients with heart failure. 2021.
2. Metra M, Tomasoni D, Adamo M, Bayes‐Genis A, Filippatos G, Abdelhamid M, et al. Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2023;25(6):776-91.
3. Adamo M, Gardner RS, McDonagh TA, Metra M. The ‘Ten Commandments’ of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Oxford University Press; 2022.
4. Triposkiadis F, Xanthopoulos A, Parissis J, Butler J, Farmakis D. Pathogenesis of chronic heart failure: cardiovascular aging, risk factors, comorbidities, and disease modifiers. Heart failure reviews. 2022;27(1):337-44.
5. Tomasoni D, Adamo M, Lombardi CM, Metra M. Highlights in heart failure. ESC heart failure. 2019;6(6):1105-27.
6. Heo S, Lennie TA, Okoli C, Moser DK. Quality of life in patients with heart failure: ask the patients. Heart & lung. 2009;38(2):100-8.
7. CORVERA TT, Doering LV, Aqulino C. The role of physical functioning and depression in quality of life in patients with heart failure. 2003.
8. Heo S, Moser DK, Pressler SJ, Dunbar SB, Kim J, Ounpraseuth S, et al. Dose-dependent relationship of physical and depressive symptoms with health-related quality of life in patients with heart failure. European journal of cardiovascular nursing. 2013;12(5):454-60.
9. Squeo MR, Di Giacinto B, Perrone MA, Santini M, Sette ML, Fabrizi E, et al. Efficacy and Safety of a Combined Aerobic, Strength and Flexibility Exercise Training Program in Patients with Implantable Cardiac Devices. Journal of cardiovascular development and disease. 2022;9(6):182.
10. Soer R, van der Schans CP, Geertzen JH, Groothoff JW, Brouwer S, Dijkstra PU, et al. Normative values for a functional capacity evaluation. Archives of physical medicine and rehabilitation. 2009;90(10):1785-94.
11. Arshi B, Geurts S, Tilly MJ, van den Berg M, Kors JA, Rizopoulos D, et al. Heart rate variability is associated with left ventricular systolic, diastolic function and incident heart failure in the general population. BMC medicine. 2022;20(1):91.
12. Jeong S-W, Kim S-H, Kang S-H, Kim H-J, Yoon C-H, Youn T-J, et al. Mortality reduction with physical activity in patients with and without cardiovascular disease. European heart journal. 2019;40(43):3547-55.
13. Piotrowicz E, Baranowski R, Piotrowska M, Zieliński T, Piotrowicz R. Variable effects of physical training of heart rate variability, heart rate recovery, and heart rate turbulence in chronic heart failure. Pacing and Clinical Electrophysiology. 2009;32:S113-S5.
14. Volterrani M, Caminiti G, Perrone MA, Cerrito A, Franchini A, Manzi V, et al. Effects of concurrent, within-session, aerobic and resistance exercise training on functional capacity and muscle performance in elderly male patients with chronic heart failure. Journal of clinical medicine. 2023;12(3):750.
15. Khadanga S, Savage PD, Ades PA. Resistance training for older adults in cardiac rehabilitation. Clinics in geriatric medicine. 2019;35(4):459.
16. Filipovic A, Kleinöder H, Dörmann U, Mester J. Electromyostimulation—a systematic review of the influence of training regimens and stimulation parameters on effectiveness in electromyostimulation training of selected strength parameters. The Journal of Strength & Conditioning Research. 2011;25(11):3218-38.
17. Moritani T. Electrical muscle stimulation: application and potential role in aging society. Journal of Electromyography and Kinesiology. 2021;61:102598.
18. Borzuola R, Laudani L, Labanca L, Macaluso A. Superimposing neuromuscular electrical stimulation onto voluntary contractions to improve muscle strength and mass: A systematic review. European Journal of Sport Science. 2023;23(8):1547-59.
19. Poltavskaya M, Sviridenko V, Giverts I, Patchenskaya I, Kozlovskaya I, Tomilovskaya E, et al. In-hospital electrical muscle stimulation for patients early after heart failure decompensation: results from a prospective randomised controlled pilot trial. Open Heart. 2022;9(2).
20. Caruso F, Arena R, Phillips S, Bonjorno Jr J, Mendes R, Arakelian V, et al. Resistance exercise training improves heart rate variability and muscle performance: a randomized controlled trial in coronary artery disease patients. Eur J Phys Rehabil Med. 2015;51(3):281-9.
21. Ennis S, McGregor G, Shave R, McDonnell B, Thompson A, Banerjee P, et al. Low frequency electrical muscle stimulation and endothelial function in advanced heart failure patients. ESC heart failure. 2018;5(4):727-31.
22. Iliou MC, Vergès-Patois B, Pavy B, Charles-Nelson A, Monpère C, Richard R, et al. Effects of combined exercise training and electromyostimulation treatments in chronic heart failure: A prospective multicentre study. European journal of preventive cardiology. 2017;24(12):1274-82.
23. Kucio C, Stastny P, Leszczyńska-Bolewska B, Engelmann M, Kucio E, Uhlir P, et al. Exercise‐based cardiac rehabilitation with and without neuromuscular electrical stimulation and its effect on exercise tolerance and life quality of persons with chronic heart failure. Journal of human kinetics. 2018;65:151.
24. Andrade DC, Arce‐Alvarez A, Parada F, Uribe S, Gordillo P, Dupre A, et al. Acute effects of high‐intensity interval training session and endurance exercise on pulmonary function and cardiorespiratory coupling. Physiological reports. 2020;8(15):e14455.
25. Myers J. Principles of exercise prescription for patients with chronic heart failure. Heart failure reviews. 2008;13:61-8.
26. Kobat MA, Karasu M. Valsalva and modified valsalva maneuver. Journal of Clinical Medicine of Kazakhstan. 2020(3 (57)):6-10.
27. Pilannejad S, Naimi SS, Okhovatian F, Attarbashi Moghadam B, Jamalian SA, Akbarzadeh Bagheban A. The effect of the first phase of cardiac rehabilitation on quality of life and functional capacity of patients with heart failure. Scientific Journal of Rehabilitation Medicine. 2017;6(2):82-90.
28. Fini EM, Ahmadizad S. Effect of Resistance Exercise and Training and Principles of prescribing it for Cardiovascular Patients. Journal of Shahid Sadoughi University of Medical Sciences. 2021.
29. Braith RW, Beck DT. Resistance exercise: training adaptations and developing a safe exercise prescription. Heart failure reviews. 2008;13:69-79.
30. Parissis J, Farmakis D, Karavidas A, Arapi S, Filippatos G, Lekakis J. Functional electrical stimulation of lower limb muscles as an alternative mode of exercise training in chronic heart failure: practical considerations and proposed algorithm. European journal of heart failure. 2015;17(12):1228-30.
31. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Quality of life research. 2005;14:875-82.
32. Gary RA, Paul S, Corwin E, Butts B, Miller AH, Hepburn K, et al. Exercise and cognitive training intervention improves self-care, quality of life and functional capacity in persons with heart failure. Journal of Applied Gerontology. 2022;41(2):486-95.
33. Gomes-Neto M, Duraes AR, Conceição LSR, Roever L, Silva CM, Alves IGN, et al. Effect of combined aerobic and resistance training on peak oxygen consumption, muscle strength and health-related quality of life in patients with heart failure with reduced left ventricular ejection fraction: a systematic review and meta-analysis. International journal of cardiology. 2019;293:165-75.
34. German CA, Brubaker PH, Nelson MB, Fanning J, Ye F, Kitzman DW. Relationships between objectively measured physical activity, exercise capacity, and quality of life in older patients with obese heart failure and preserved ejection fraction. Journal of cardiac failure. 2021;27(6):635-41.
35. Sloan RA, Sawada SS, Martin CK, Church T, Blair SN. Associations between cardiorespiratory fitness and health-related quality of life. Health and quality of life outcomes. 2009;7:1-5.
36. Reddy YN, Rikhi A, Obokata M, Shah SJ, Lewis GD, AbouEzzedine OF, et al. Quality of life in heart failure with preserved ejection fraction: importance of obesity, functional capacity, and physical inactivity. European journal of heart failure. 2020;22(6):1009-18.
37. Buendía F, Almenar L, Martínez-Dolz L, Sánchez-Lázaro I, Navarro J, Agüero J, et al., editors. Relationship between functional capacity and quality of life in heart transplant patients. Transplantation proceedings; 2011: Elsevier.
38. Häkkinen A, Rinne M, Vasankari T, Santtila M, Häkkinen K, Kyröläinen H. Association of physical fitness with health-related quality of life in Finnish young men. Health and quality of life outcomes. 2010;8:1-8.
2. Metra M, Tomasoni D, Adamo M, Bayes‐Genis A, Filippatos G, Abdelhamid M, et al. Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2023;25(6):776-91.
3. Adamo M, Gardner RS, McDonagh TA, Metra M. The ‘Ten Commandments’ of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Oxford University Press; 2022.
4. Triposkiadis F, Xanthopoulos A, Parissis J, Butler J, Farmakis D. Pathogenesis of chronic heart failure: cardiovascular aging, risk factors, comorbidities, and disease modifiers. Heart failure reviews. 2022;27(1):337-44.
5. Tomasoni D, Adamo M, Lombardi CM, Metra M. Highlights in heart failure. ESC heart failure. 2019;6(6):1105-27.
6. Heo S, Lennie TA, Okoli C, Moser DK. Quality of life in patients with heart failure: ask the patients. Heart & lung. 2009;38(2):100-8.
7. CORVERA TT, Doering LV, Aqulino C. The role of physical functioning and depression in quality of life in patients with heart failure. 2003.
8. Heo S, Moser DK, Pressler SJ, Dunbar SB, Kim J, Ounpraseuth S, et al. Dose-dependent relationship of physical and depressive symptoms with health-related quality of life in patients with heart failure. European journal of cardiovascular nursing. 2013;12(5):454-60.
9. Squeo MR, Di Giacinto B, Perrone MA, Santini M, Sette ML, Fabrizi E, et al. Efficacy and Safety of a Combined Aerobic, Strength and Flexibility Exercise Training Program in Patients with Implantable Cardiac Devices. Journal of cardiovascular development and disease. 2022;9(6):182.
10. Soer R, van der Schans CP, Geertzen JH, Groothoff JW, Brouwer S, Dijkstra PU, et al. Normative values for a functional capacity evaluation. Archives of physical medicine and rehabilitation. 2009;90(10):1785-94.
11. Arshi B, Geurts S, Tilly MJ, van den Berg M, Kors JA, Rizopoulos D, et al. Heart rate variability is associated with left ventricular systolic, diastolic function and incident heart failure in the general population. BMC medicine. 2022;20(1):91.
12. Jeong S-W, Kim S-H, Kang S-H, Kim H-J, Yoon C-H, Youn T-J, et al. Mortality reduction with physical activity in patients with and without cardiovascular disease. European heart journal. 2019;40(43):3547-55.
13. Piotrowicz E, Baranowski R, Piotrowska M, Zieliński T, Piotrowicz R. Variable effects of physical training of heart rate variability, heart rate recovery, and heart rate turbulence in chronic heart failure. Pacing and Clinical Electrophysiology. 2009;32:S113-S5.
14. Volterrani M, Caminiti G, Perrone MA, Cerrito A, Franchini A, Manzi V, et al. Effects of concurrent, within-session, aerobic and resistance exercise training on functional capacity and muscle performance in elderly male patients with chronic heart failure. Journal of clinical medicine. 2023;12(3):750.
15. Khadanga S, Savage PD, Ades PA. Resistance training for older adults in cardiac rehabilitation. Clinics in geriatric medicine. 2019;35(4):459.
16. Filipovic A, Kleinöder H, Dörmann U, Mester J. Electromyostimulation—a systematic review of the influence of training regimens and stimulation parameters on effectiveness in electromyostimulation training of selected strength parameters. The Journal of Strength & Conditioning Research. 2011;25(11):3218-38.
17. Moritani T. Electrical muscle stimulation: application and potential role in aging society. Journal of Electromyography and Kinesiology. 2021;61:102598.
18. Borzuola R, Laudani L, Labanca L, Macaluso A. Superimposing neuromuscular electrical stimulation onto voluntary contractions to improve muscle strength and mass: A systematic review. European Journal of Sport Science. 2023;23(8):1547-59.
19. Poltavskaya M, Sviridenko V, Giverts I, Patchenskaya I, Kozlovskaya I, Tomilovskaya E, et al. In-hospital electrical muscle stimulation for patients early after heart failure decompensation: results from a prospective randomised controlled pilot trial. Open Heart. 2022;9(2).
20. Caruso F, Arena R, Phillips S, Bonjorno Jr J, Mendes R, Arakelian V, et al. Resistance exercise training improves heart rate variability and muscle performance: a randomized controlled trial in coronary artery disease patients. Eur J Phys Rehabil Med. 2015;51(3):281-9.
21. Ennis S, McGregor G, Shave R, McDonnell B, Thompson A, Banerjee P, et al. Low frequency electrical muscle stimulation and endothelial function in advanced heart failure patients. ESC heart failure. 2018;5(4):727-31.
22. Iliou MC, Vergès-Patois B, Pavy B, Charles-Nelson A, Monpère C, Richard R, et al. Effects of combined exercise training and electromyostimulation treatments in chronic heart failure: A prospective multicentre study. European journal of preventive cardiology. 2017;24(12):1274-82.
23. Kucio C, Stastny P, Leszczyńska-Bolewska B, Engelmann M, Kucio E, Uhlir P, et al. Exercise‐based cardiac rehabilitation with and without neuromuscular electrical stimulation and its effect on exercise tolerance and life quality of persons with chronic heart failure. Journal of human kinetics. 2018;65:151.
24. Andrade DC, Arce‐Alvarez A, Parada F, Uribe S, Gordillo P, Dupre A, et al. Acute effects of high‐intensity interval training session and endurance exercise on pulmonary function and cardiorespiratory coupling. Physiological reports. 2020;8(15):e14455.
25. Myers J. Principles of exercise prescription for patients with chronic heart failure. Heart failure reviews. 2008;13:61-8.
26. Kobat MA, Karasu M. Valsalva and modified valsalva maneuver. Journal of Clinical Medicine of Kazakhstan. 2020(3 (57)):6-10.
27. Pilannejad S, Naimi SS, Okhovatian F, Attarbashi Moghadam B, Jamalian SA, Akbarzadeh Bagheban A. The effect of the first phase of cardiac rehabilitation on quality of life and functional capacity of patients with heart failure. Scientific Journal of Rehabilitation Medicine. 2017;6(2):82-90.
28. Fini EM, Ahmadizad S. Effect of Resistance Exercise and Training and Principles of prescribing it for Cardiovascular Patients. Journal of Shahid Sadoughi University of Medical Sciences. 2021.
29. Braith RW, Beck DT. Resistance exercise: training adaptations and developing a safe exercise prescription. Heart failure reviews. 2008;13:69-79.
30. Parissis J, Farmakis D, Karavidas A, Arapi S, Filippatos G, Lekakis J. Functional electrical stimulation of lower limb muscles as an alternative mode of exercise training in chronic heart failure: practical considerations and proposed algorithm. European journal of heart failure. 2015;17(12):1228-30.
31. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Quality of life research. 2005;14:875-82.
32. Gary RA, Paul S, Corwin E, Butts B, Miller AH, Hepburn K, et al. Exercise and cognitive training intervention improves self-care, quality of life and functional capacity in persons with heart failure. Journal of Applied Gerontology. 2022;41(2):486-95.
33. Gomes-Neto M, Duraes AR, Conceição LSR, Roever L, Silva CM, Alves IGN, et al. Effect of combined aerobic and resistance training on peak oxygen consumption, muscle strength and health-related quality of life in patients with heart failure with reduced left ventricular ejection fraction: a systematic review and meta-analysis. International journal of cardiology. 2019;293:165-75.
34. German CA, Brubaker PH, Nelson MB, Fanning J, Ye F, Kitzman DW. Relationships between objectively measured physical activity, exercise capacity, and quality of life in older patients with obese heart failure and preserved ejection fraction. Journal of cardiac failure. 2021;27(6):635-41.
35. Sloan RA, Sawada SS, Martin CK, Church T, Blair SN. Associations between cardiorespiratory fitness and health-related quality of life. Health and quality of life outcomes. 2009;7:1-5.
36. Reddy YN, Rikhi A, Obokata M, Shah SJ, Lewis GD, AbouEzzedine OF, et al. Quality of life in heart failure with preserved ejection fraction: importance of obesity, functional capacity, and physical inactivity. European journal of heart failure. 2020;22(6):1009-18.
37. Buendía F, Almenar L, Martínez-Dolz L, Sánchez-Lázaro I, Navarro J, Agüero J, et al., editors. Relationship between functional capacity and quality of life in heart transplant patients. Transplantation proceedings; 2011: Elsevier.
38. Häkkinen A, Rinne M, Vasankari T, Santtila M, Häkkinen K, Kyröläinen H. Association of physical fitness with health-related quality of life in Finnish young men. Health and quality of life outcomes. 2010;8:1-8.
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Electrical stimulation; Exercise therapy; Heart failure; Quality of life | ||
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How to Cite
1.
Dezhbarar S, Naimi S, Rahbar S. Neuromuscular Electrical Stimulation and Therapeutic Exercise on Functional Capacity and Quality of Life in Patients with Chronic Heart Failure. jmr. 2025;(-).
