Home-based neuromuscular electrical stimulation improves exercise tolerance and health-related quality of life in patients with COPD

BACKGROUND: This retrospective, observational study of a routine clinical practice reports the feasibility and efficiency of home-based pulmonary rehabilitation (PR), including transcutaneous neuromuscular electrical stimulation (NMES) or usual endurance physical exercise (UEPE), on exercise tolerance, anxiety/depression, and health-related quality of life (HRQoL) in patients with COPD. METHODS: Seventy-one patients with COPD participated in home-based PR with NMES (Group NMES [G(NMES)]), while 117 patients participated in home-based PR with the UEPEs (Group UEPE [G(UEPE)]). NMES was applied for 30 minutes twice a day, every day. The endurance exercises in G(UEPE) began with a minimum 10-minute session at least 5 days a week, with the goal being 30–45 minutes per session. Three upper and lower limb muscle strengthening exercises lasting 10–15 minutes were also proposed to both the groups for daily practice. Moreover, PR in both the groups included a weekly 90-minute session based on an educational needs assessment. The sessions comprised endurance physical exercise for G(UEPE), NMES for G(NMES), resumption of physical daily living activities, therapeutic patient education, and psychosocial support to facilitate health behavior changes. Before and after PR, functional mobility and physical exercise capacity, anxiety, depression, and HRQoL were evaluated at home. RESULTS: The study revealed that NMES significantly improved functional mobility (−18.8% in GNMES and −20.6% in G(UEPE)), exercise capacity (+20.8% in G(NMES) and +21.8% in G(UEPE)), depression (−15.8% in G(NMES) and −30.1% in G(UEPE)), and overall HRQoL (−7.0% in G(NMES) and −18.5% in G(UEPE)) in the patients with COPD, regardless of the group (G(NMES) or G(UEPE)) or severity of airflow obstruction. Moreover, no significant difference was observed between the groups with respect to these data (P>0.05). CONCLUSION: Home-based PR including self-monitored NMES seems feasible and effective for severely disabled COPD patients with severe exercise intolerance.