Effects of Neuromuscular Electrical Stimulation on Physiologic and Functional Measurements in Patients With Heart Failure A SYSTEMATIC REVIEW WITH META-ANALYSIS

BACKGROUND: Neuromuscular electrical stimulation (NMES) is potentially attractive as a method of training in heart failure (HF) and could be performed in patients unable to participate in standard exercise training. PURPOSE: To examine the effects of NMES on physiologic and functional measurements in patients with HF. METHODS: MEDLINE, Cochrane, EMBASE, Scielo, and PEDro were searched from the earliest date available to July 2014. Two independent reviewers screened the titles and abstracts and selected randomized controlled trials, examining the effects of NMES versus exercise and/or of NMES versus control on physiologic and functional measurements in patients with HF. Two independent reviewers screened the randomized controlled trials. The PEDro score was used to evaluate methodological quality. Weighted mean differences and 95% CI were calculated. RESULTS: Thirteen studies met the study criteria. Neuromuscular electrical stimulation resulted in improvement in peak oxygen uptake ((V) over dotO(2)) (4.86 mL.kg(-1).min(-1); 95% CI, 2.81-6.91), 6-minute walk test (6MWT) distance (63.54 m; 95% CI, 35.81-91.27), muscle strength (30.74 N; 95% CI, 3.67-57.81), flow-mediated dilatation (2.67%; 95% CI, 0.86-4.49), depressive symptoms (-3.86; 95% CI, -6.46 to -1.25), and global quality of life (0.89; 95% CI, 0.55-1.24). Nonsignificant differences in ((V) over dotO(2)) peak, 6MWT, and quality of life were found for participants in the exercise group compared with NMES. CONCLUSIONS: Neuromuscular electrical stimulation improved peak (V) over dotO(2), 6MWT distance, quality of life, muscle strength, endothelial function, and depressive symptoms in patients with HF and could be considered for inclusion in cardiac rehabilitation for selected patients.