The Effect of Adding Neuromuscular Electrical Stimulation with Endurance and Resistance Training on Exercise Capacity and Balance in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

Abstract

This study investigated the effectiveness of adding neuromuscular electrical stimulation (NMES) to endurance training (ET) and resistance training (RT) on exercise tolerance and balance in COPD patients. 42 patients were assigned randomly to the ET + RT + NMES group (n = 22) or ET + RT group (n = 20). Two training programs were performed including 72 sessions. The center of pressure (CoP) displacement in the mediolateral direction (CoPML), in the anteroposterior direction (CoPAP), and the center of pressure velocity (CoPV) were recorded using a stabilometric platform with eyes open (EO) and eyes closed (EC). Time up and go and Berg Balance Scale tests, 6-minute walking test (6MWT), and the maximal voluntary contraction (MVC) were measured before and after the intervention. The walking distance, the dyspnea, and the heart rate were improved after the training period ( $p<0.001$ ) for both groups ( $p<0.05$ ). The ET + RT + NMES group showed better improvement than the ET + RT group in terms of 6MWD. CoPML, CoPAP, and CoPV were significantly ( $p<0.001$ ; $p<0.05$ ; $p<0.001$ , respectively) more improved in EO and EC conditions in the ET + RT + NMES group than the ET + RT group. BBS, TUG, and MVC values improved in both groups after the training ( $p<0.001$ ). The performances in TUG and MVC tests were significantly greater in the ET + RT + NMES group than those in the ET + RT group ( $p<0.01$ ; $p<0.001$ , respectively). Combining NMES, RT, and ET improves balance in patients with COPD.