COMPARING THE EFFECTS of NMES and ENDURANCE TRAINING IN PATIENTS WITH SEVERE COPD PATIENTS

COMPARING THE EFFECTS of NMES and COMPARING THE EFFECTS of NMES and ENDURANCE TRAINING IN PATIENTS WITH ENDURANCE TRAINING IN PATIENTS WITH

SEVERE COPD PATIENTSSEVERE COPD PATIENTS

Pınar ERGÜN MD, Dicle KAYMAZ MD, Ebru ÇANAK , Neşe DEMİRCİ

Atatürk Chest Disease and Chest Surgery Center

PULMONARY REHABLİTATION and ULMONARY REHABLİTATION and HOME CARE UNITHOME CARE UNIT

Exercise training in COPDExercise training in COPD

• Improves endurance • Muscle strength,• Exercise capacity,• HRQOL,• Dyspnea,• Scores of Anxiety-Depression

However, physical training of very severe patients with intense breathlessness at rest or on minimum exertion, can be particularly difficult.

Neuromuscular electrical stimulation

(NMES)

Muscle strength and endurans,

Peripheral muscle capillary/fibre ratio,

fibre cross-sectional area

the number of type I and type II fibres,improve oxidative potential of the muscle.

Journal of Cardiopulmonary Rehabilitation and Prevention 2008;28:79-91

Chest 2006;129;1540-48

Respiratory Medicine 2007;101:1236-43

AIM;AIM;

To compaire the level of improvement of NMES and endurance training in patients with severe COPD

exercise capacity muscle strengthdyspnea health related quality of lifephsycohological statusbody composition

METOD; METOD;

Patients: 50 COPD

GOLD Stage IV PR Programme:Multidisciplinary, outpatient

Exercise training: NMES and Endurance

METOD;METOD;

DYSPNEA : MRC, BORG scale CRDQ dyspnea domaineExercise capacity: SWT ESWT

Peripheral muscle strength: Manuel muscle test

HRQOL: SGRQ

Phsycohological status: HAD skalası

Body composition : BMI, FFM,FFMI

STUDY DESIGN

DEĞERLENDİRME

50 olgu

EVALUTİON

50 patient

RANDOMISATION

NMES

25 patient, 20 session

Endurance

25 patient, 10 week

OUTCOME EVALUATION

n= 23

OUTCOME EVALUATİON

n= 25

Drop outs

2 patient

NMES Protocol;NMES Protocol;NMES SESSION;Bilateral,Quadriceps; 9X5cm,Deltoid; 5X5cm surfaca electrodesDuration: 15min- 2day / Wk- 20 session.First 2 Wk : Duty cicle:200-380µs, Stimulation frequency: 55 Hz.Following sessions: Duty cicle:220- 400 µs, Stimulation frequency: 60Hz.

ENDURANCE TRAINING;ENDURANCE TRAINING;

•2 days in week , survised, 10 week

•15 min cycling ; 15 min cycling ;

%50 Peak W

•15 min treadmill; 15 min treadmill;

%85 Peak VO2

Parameters NMES

(n=25)

ENDURANCES

(n=25)

Year 63,25 ± 10,10 62,81± 7,18

Smoking 42,26 ± 30,83 44,98 ± 24,24

FVC % predicted 45,13 ± 12,99 49,40 ± 13,20

FEV1 % predicted 25,92 ± 7,26 27,33 ± 8,20

FEV1/FVC 51,08 ± 14,20 39,85 ± 6,84

MRC 4,30 ± 0,87 3,81 ± 0,83

CRDQ- Dyspnea 9,78 ± 2,90* 11,88 ± 3,82*

Eercise BORG 3,60 ±1,26 3,40 ± 0,88

BMI (kg/m2) 21,85 ± 5,83 22,40 ± 4,23

FFM (kg) 44,43 ±6,23** 49,47 ± 6,27* *

FFMI(kg/m2) 16,97 ± 1,90** 17,93 ± 1,94**

ISWT(m) 90,65 ± 87,72 158 ± 88,33

ESWT (min) 3,02 ± 5,51 4,53 ± 5,22

SGRQ-Total 69,40 ±16,23 60,00 ± 18,67

SGRQ-Symptom 68,99 ± 14,85 64,86 ± 17,77

SGRQ-Activity 87,47 ± 15,93 78,01±20,42

SGRQ-impact 58,93 ± 20,77 47,83 ± 23,03

HAD-Depression 10,08 ± 2,50 8,77 ± 2,51

HAD- Anxiety 9,39 ± 3,38 8,66 ± 3,17

Deltoid right /left 3,86 ± 0,75 / 3,82 ± 0,77 4,44 ± 0,75 / 4,44 ± 0,75

Quadriceps right / left 4,04 ± 0,82 / 4,04 ± 0,82 4,33 ± 0,6 / 4,33 ± 0,6

Tabel-1: Demographic characteristics

*p<0.05

**p<0.001

0

100

200

300

400

500

600

700

Başlangıç Son Başlangıç Son

nmes endurans

Exercise capacity: SWT

p<0.001p<0.001

Increases in exercise capacity for NMES and Endurance groups is simillar , there were not any statisticaly meaningfull differance in the gainings.

0

5

10

15

20

25

Başlangıç Son Başlangıç Son

nmes endurans

ENDURANCE CAPACITY; ENDURANS SHUTTLE WALK TESTENDURANCE CAPACITY; ENDURANS SHUTTLE WALK TEST

p<0.001

p<0.001

Increases in endurance for NMES and Endurance groups is simillar , there were not any statisticaly meaningfull differance in the gainings.

5

0

1

2

3

4

DeltoidRight Left

QuadricepsRight Left

NMES

Right Left Right Left Deltoid Quadriceps ENDURANCE

Before

After

PERIPHERAL MUSCLE SRENGTH; Manuel Muscle Test

P<0,01P>0,05

P<0,01 P P<0,05 P<0,01

There were statistically meaninfull increases in the muscle strengths of upper and lower extremities evaluated with manuel muscle test. The level of gainings were simillar for the two gruops (p>0,05).

0

5

10

15

20

25

b s b s b s b s b s b s b s b s

nmes endurans nmes endurans nmes endurans nmes endurans

Mrc Borg iş Borg egzersiz KSHA dispne

DYSPNEA SENSATIONDYSPNEA SENSATION

MRC ist

p<0,001p<0,05

p<0,001

There were imrovements in Dyspnea sensation in daily living acties for the two group though the dypsnea sensation scores in exercise did not reach a statistically meaningfull level. The level of gainings were simillar for the two gruops.

p>0,05

p>0,05

0102030405060708090

100n

mes

end

ura

ns

nm

es

end

ura

ns

nm

es

end

ura

ns

nm

es

end

ura

ns

toplam semptom aktivite impact

Başlangıç Son

HRQOL; SGRQHRQOL; SGRQ

etkilenim

p>0.05

p<0.001 p<0.001

p<0.001

p<0.001

Increases in HRQOL for NMES and Endurance groups except the symptom domain is simillar , there were not any statisticaly meaningfull differance in the gainings.

0

2

4

6

8

10

12

Başlangıç Son Başlangıç Son

nmes endurans

HAD anksiyete HAD depresyon

PHSYCOLOGIC STATUS; Anxiety/Depression; Anxiety/Depression

p<0.05 (p<0.001)

There meaningfull improvements in Phsycologic comorbidties that were evaluated with HAD for NMES and Endurance groups. The level of gainings were simillar for the two gruops.

21,2

21,4

21,6

21,8

22

22,2

22,4

22,6

22,8

23

Başlangıç Son

nmes

endurans

BMI

40

42

44

46

48

50

52

54

56

Başlangıç Son

nmes

endurans

FFM

14

16

18

20

Başlangıç Son

nmes

endurans

FFMI

BODY COMPOSITIONBODY COMPOSITION

BKİ Kg/m² YVK Kg YVKİ Kg/m²

There were not statitistically meaninfull changes in the body composition for the two groups.

DISCUSSION

• These results corralates with the literature which supports that NMES can be used as an effective treatment strategy in severe COPD

Journal of Cardiopulmonary Rehabilitation and Prevention 2008;28:79-91

Thorax 2002;57:333-37

Chest 2006;129;1540-48

Respiratory Medicine 2007;101:1236-43

CONCLUSION

The gainings for outcome parameters in NMES and Endurance programmes are simillar.

NMES can be used as an effective treatment strategy for peripheral muscle training in severe COPD patients.