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Feasibility and effects of intra-dialytic low-frequency electrical muscle stimulation and cycle training: A pilot randomized controlled trial

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Author
McGregor, Gordon
Ennis, Stuart
Powell, Richard
Hamborg, Thomas
Raymond, Neil
Owen, William
Aldridge, Nicholas
Evans, Gail
Goodby, Josie
Hewins, Sue
Banerjee, Prithwish
Krishnan, Nithya
Ting, Stephen
Zehnder, Daniel
Date
2018-07-11
Acceptance date
2018-06-22
Type
Article
Publisher
PLoS
ISSN
1932-6203
Metadata
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Abstract
Background and objectives: Exercise capacity is reduced in chronic kidney failure (CKF). Intra-dialytic cycling is beneficial, but comorbidity and fatigue can prevent this type of training. Low–frequency electrical muscle stimulation (LF-EMS) of the quadriceps and hamstrings elicits a cardiovascular training stimulus and may be a suitable alternative. The main objectives of this trial were to assess the feasibility and efficacy of intra-dialytic LF-EMS vs. cycling Design, setting, participants, and measurements: Assessor blind, parallel group, randomized controlled pilot study with sixty-four stable patients on maintenance hemodialysis. Participants were randomized to 10 weeks of 1) intra-dialytic cycling, 2) intra-dialytic LF-EMS, or 3) non-exercise control. Exercise was performed for up to one hour three times per week. Cycling workload was set at 40–60% oxygen uptake (VO2) reserve, and LF-EMS at maximum tolerable intensity. The control group did not complete any intra-dialytic exercise. Feasibility of intra-dialytic LF-EMS and cycling was the primary outcome, assessed by monitoring recruitment, retention and tolerability. At baseline and 10 weeks, secondary outcomes including cardio-respiratory reserve, muscle strength, and cardio-arterial structure and function were assessed. Results: Fifty-one (of 64 randomized) participants completed the study (LF-EMS = 17 [77%], cycling = 16 [80%], control = 18 [82%]). Intra-dialytic LF-EMS and cycling were feasible and well tolerated (9% and 5% intolerance respectively, P = 0.9). At 10-weeks, cardio-respiratory reserve (VO2 peak) (Difference vs. control: LF-EMS +2.0 [95% CI, 0.3 to 3.7] ml.kg-1.min-1, P = 0.02, and cycling +3.0 [95% CI, 1.2 to 4.7] ml.kg-1.min-1, P = 0.001) and leg strength (Difference vs. control: LF-EMS, +94 [95% CI, 35.6 to 152.3] N, P = 0.002 and cycling, +65.1 [95% CI, 6.4 to 123.8] N, P = 0.002) were improved. Arterial structure and function were unaffected. Conclusions: Ten weeks of intra-dialytic LF-EMS or cycling improved cardio-respiratory reserve and muscular strength. For patients who are unable or unwilling to cycle during dialysis, LF-EMS is a feasible alternative.
Journal/conference proceeding
PLoS ONE;
Citation
McGregor, G., Ennis, S., Powell, R., Hamborg, T., Raymond, N.T., Owen, W., Aldridge, N., Evans, G., Goodby, J., Hewins, S. and Banerjee, P. (2018) 'Feasibility and effects of intra-dialytic low-frequency electrical muscle stimulation and cycle training: A pilot randomized controlled trial', PloS one, 13(7), p.e0200354. DOI: 10.1371/journal.pone.0200354.
URI
http://hdl.handle.net/10369/10453
DOI
https://doi.org/10.1371/journal.pone.0200354
Description
Article published in PLoS ONE on 11 July 2018, available open access at: https://doi.org/10.1371/journal.pone.0200354.
Rights
https://creativecommons.org/licenses/by/4.0/
Sponsorship
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
Funded by West Midlands Comprehensive Local Research Network
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  • Sport Research Groups [1088]

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