• Marie C Valenza, Irene Torres-Sánchez, Laura López-López, Irene Cabrera-Martos, Araceli Ortiz-Rubio, and Gerald Valenza-Demet.
• Department of Physical Therapy, School of Health Sciences, University of Granada, Granada, Spain.
• Eur J Phys Rehabil Med. 2018 Jun 1; 54 (3): 323-332.

BackgroundChronic obstructive pulmonary disease (COPD) patients experience a sustained deterioration of several capacities. Those with severe COPD undergo a considerable decline in their physical and functional capacities, but pulmonary rehabilitation (PR) is used to reduce the weakness of such patients. To date, neuromuscular electrical stimulation (NMES) has been used in acute COPD patients but NMES superimposed onto voluntary muscular contraction has not been tested in COPD patients.AimThe aim of this study was to evaluate the effects of superimposed NMES on the cardiorespiratory performance and functionality of severe COPD patients undergoing a home-based rehabilitation program.DesignThis was a randomized controlled clinical trial.PopulationA total of 36 stable severe COPD patients were included in this study and were randomly divided into two groups: an intervention group and a control group.SettingThe study was conducted as a home-based program.MethodsThe control group received standard medical treatment. The intervention group additionally underwent an individualized physical therapy program. The intervention consisted of a pulmonary rehabilitation (PR) protocol for 8 weeks (2 h/week). The protocol was carried out as follows: 10 minutes of controlled breathing training; 30 minutes of NMES superimposed onto voluntary muscular contraction; and 5 minutes of relaxation/cool-down. The outcome measures were cardiorespiratory performance measured using the 6-Minute Walk Test in the treadmill and functionality assessed with the functional independence measure.ResultsIn the intervention group, significant improvements were observed after the treatment in cardiorespiratory performance and functionality (P<0.05), while the control group did not show any significant changes (P>0.05). The between-group analysis showed significant differences in cardiorespiratory performance and functionality (P<0.05).ConclusionsAn 8-week individualized home-based PR program including controlled breathing training, aerobic exercise with elastic bands, and NMES superimposed onto voluntary muscle contraction significantly improves cardiorespiratory performance and functionality in stable COPD patients.Clinical Rehabilitation ImpactA home-based pulmonary rehabilitation program including controlled breathing training, and NMES superimposed onto voluntary muscle contraction significantly improves cardiorespiratory performance and functionality in stable COPD patients.

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