Short-term Effects Of Neuromuscular Electrical Stimulation Therapy On Undernourished Older Women

Bed rest is one of the risk factors for muscle atrophy and weakness in older individuals. Moreover, poor nutritional status accelerates muscle atrophy and weakness; thus, older patients in a low-nutrient state have difficulty standing and walking even after short-term (approximately a week) bed rest. Neuromuscular electrical stimulation (NMES), which induces muscle contraction by electrical stimulation, can be used in bed and is expected to prevent muscle atrophy and weakness even in critically ill patients. PURPOSE: To determine whether combining NMES and exercise therapy could prevent muscle atrophy and weakness in undernourished older women requiring one week of bed rest. METHODS: Hospitalized women aged 65 years or older with serum albumin levels of 3.5 g/dL or less and requiring one week of bed rest due to a compression fracture of the thoracolumbar spine participated in this study. They were randomly divided into an exercise therapy (80 min of exercise therapy, n = 9) or exercise therapy + NMES group (20 min of exercise therapy and 60 min of NMES on the quadriceps and gastrocnemius muscles, n = 7). The exercise therapy and NMES were performed in bed daily for a week. RESULTS: The muscle thickness was similar in the exercise group before and after the intervention (quadriceps: 1.0 ± 0.3 vs. 0.8 ± 0.3 cm, gastrocnemius: 0.8 ± 0.2 vs. 0.7 ± 0.2 cm), while a significant increase was observed in the exercise + NMES group (quadriceps: 1.0 ± 0.3 vs. 1.2 ± 0.3 cm, gastrocnemius: 0.8 ± 0.2 vs. 1.2 ± 0.2 cm, p < 0.05). Similarly, muscle strength was unchanged in the exercise group (quadriceps: 0.1 ± 0.05 vs. 0.1 ± 0.05 kgf/kg, gastrocnemius: 0.1 ± 0.06 vs. 0.1 ± 0.05 kgf/kg) but increased in the exercise + NMES group (quadriceps: 0.1 ± 0.02 vs. 0.2 ± 0.1 kgf/kg, gastrocnemius: 0.1 ± 0.05 vs. 0.2 ± 0.05 kgf/kg, p < 0.05). In contrast, echo intensity was increased in the exercise group (quadriceps: 65.7 ± 11.6 vs. 81.4 ± 21.6 px, gastrocnemius: 67.4 ± 19.2 vs 86.5 ± 20.9 px, p < 0.05) whereas these were maintained in the exercise + NMES group (quadriceps: 65.7 ± 11.6 vs. 81.4 ± 21.6 px, gastrocnemius: 67.4 ± 19.2 vs. 86.5 ± 20.9 px). CONCLUSION: Exercise therapy + NMES prevents muscle atrophy and muscle weakness after one week of bed rest.