Feasibility and acceptability of whole-body electromyostimulation in pulmonary rehabilitation for patients with chronic respiratory disease: a pilot study protocol

BACKGROUND: Evidence on the effectiveness of electromyostimulation (EMS) has been reported in pulmonary rehabilitation, but the benefits have been limited in chronic obstructive pulmonary disease, and clinical trials in advanced idiopathic pulmonary fibrosis were not considered feasible. Recently, whole-body EMS (WB-EMS) has been developed and applied in the area of non-medical commercial application. To date, there are no reports on the application of medical WB-EMS for respiratory diseases. The aim of this study is to investigate the feasibility and acceptability of WB-EMS as an adjunct to pulmonary rehabilitation in patients with chronic respiratory disease. METHODS: This is a protocol for a pilot, single group, feasibility trial. The e-skin is an EMS suit that can simultaneously load the muscles of the entire body (Xenoma Inc., Tokyo, Japan). Participants will conduct one session per day, once a week for 4 weeks. They perform resistance exercise trainings during EMS under the supervision and guidance of a trained physiotherapist or respiratory physician as a trainer. A physiotherapist controls the HUB attached to the suit with a dedicated mobile application. Each setting of EMS is determined by each segment of electrical stimulation and meets the recommended regimen and guideline criteria for WB-EMS operation. Outcome measures will include Modified Medical Research Council Dyspnoea Scale, pulmonary function test, health-related quality of life, exercise tests including six-minute walk test and one-minute sit-to-stand-test, Barthel Index, muscle strength, body composition analysis, and blood tests such as muscle markers and renal function markers. To assess the feasibility and acceptability of the intervention, participant adherence, retention, and perceived burden will be evaluated. DISCUSSION: WB-EMS can stimulate both type I and type II muscle fibers and may help counteract preferential type II fiber atrophy frequently observed in CRD. This pilot study focuses on verifying the feasibility and acceptability of WB-EMS as an adjunct to pulmonary rehabilitation. By providing a physiologically distinct, time-efficient training modality that minimizes cardiopulmonary load, WB-EMS could become a promising rehabilitation option for patients with limited exercise tolerance. TRIAL REGISTRATION: UMIN-CTR, UMIN000057270. Retrospectively registered 12 March 2025.