Intradialytic neuromuscular electrical stimulation with optional virtual reality distraction improves not only muscle strength and functional capacity but also serum albumin level in haemodialysis patients: a pilot randomized clinical trial.
Albumin
Haemodialysis
Muscle strength
Neuromuscular electrical stimulation
Sarcopenia
Virtual reality
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
23 08 2023
23 08 2023
Historique:
received:
06
04
2023
accepted:
26
07
2023
medline:
24
8
2023
pubmed:
23
8
2023
entrez:
23
8
2023
Statut:
epublish
Résumé
Sarcopenia is highly prevalent in haemodialysis (HD) patients and linked to a poor prognosis regarding comorbidities and premature mortality. Previous studies assessed the effects of neuromuscular electrical stimulation in haemodialysis patients. This study adds to the relevance of neuromuscular electrical stimulation (NMES) applications combined with a virtual reality (VR) distraction to increase intensity, dosage, and efficiency of NMES and slow sarcopenia progression in HD patients. We conducted a 12-week multicenter prospective randomised controlled trial. The patients were randomly assigned to one of the three groups: neuromuscular electrical stimulation with or without combined virtual reality distraction or control group. The final analysis included 32 haemodialysis patients (mean age of 68 ± 10 years, 26 men). Interaction effects between groups and time (12 weeks) were significant regarding serum albumin levels (p = 0.008) and left quadriceps femoris muscle (QFM) force (p = 0.026). Both endpoints were increased in the NMES compared to the CO group at the end of the intervention. The NMES group increased serum albumin levels significantly after 12 weeks. The main effect of time was an increase in mean right QFM force between beginning and end of the intervention (p = 0.021). Functional capacity improved after 12 weeks in the NMES and NMES + VR but not in the control group, with a significant difference between the three groups (p = 0.022). Weight and body mass index increased in the NMES and NMES + VR groups, albeit not significantly. The effects of VR distraction on NMES efficiency were inconclusive. Intradialytic NMES increases serum albumin level, functional capacity, muscle strength in lower limb and in tendency weight and body mass index of HD patients. Effects on VR distraction are inconclusive. Large-scaled follow-up studies on integrated sports programs with NMES and active training in combination with VR as distraction and motivation accelerator are needed. German Clinical Trial Register: DRKS00029276 (Retrospectively registered: 30/06/2022).
Sections du résumé
BACKGROUND
Sarcopenia is highly prevalent in haemodialysis (HD) patients and linked to a poor prognosis regarding comorbidities and premature mortality. Previous studies assessed the effects of neuromuscular electrical stimulation in haemodialysis patients. This study adds to the relevance of neuromuscular electrical stimulation (NMES) applications combined with a virtual reality (VR) distraction to increase intensity, dosage, and efficiency of NMES and slow sarcopenia progression in HD patients.
METHODS
We conducted a 12-week multicenter prospective randomised controlled trial. The patients were randomly assigned to one of the three groups: neuromuscular electrical stimulation with or without combined virtual reality distraction or control group.
RESULTS
The final analysis included 32 haemodialysis patients (mean age of 68 ± 10 years, 26 men). Interaction effects between groups and time (12 weeks) were significant regarding serum albumin levels (p = 0.008) and left quadriceps femoris muscle (QFM) force (p = 0.026). Both endpoints were increased in the NMES compared to the CO group at the end of the intervention. The NMES group increased serum albumin levels significantly after 12 weeks. The main effect of time was an increase in mean right QFM force between beginning and end of the intervention (p = 0.021). Functional capacity improved after 12 weeks in the NMES and NMES + VR but not in the control group, with a significant difference between the three groups (p = 0.022). Weight and body mass index increased in the NMES and NMES + VR groups, albeit not significantly. The effects of VR distraction on NMES efficiency were inconclusive.
CONCLUSION
Intradialytic NMES increases serum albumin level, functional capacity, muscle strength in lower limb and in tendency weight and body mass index of HD patients. Effects on VR distraction are inconclusive. Large-scaled follow-up studies on integrated sports programs with NMES and active training in combination with VR as distraction and motivation accelerator are needed.
TRIAL REGISTRATION
German Clinical Trial Register: DRKS00029276 (Retrospectively registered: 30/06/2022).
Identifiants
pubmed: 37608265
doi: 10.1186/s12882-023-03283-2
pii: 10.1186/s12882-023-03283-2
pmc: PMC10464068
doi:
Substances chimiques
Serum Albumin
0
Types de publication
Randomized Controlled Trial
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
246Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, et al. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney Int. 2019;96:1048–50. https://doi.org/10.1016/j.kint.2019.07.012 .
doi: 10.1016/j.kint.2019.07.012
pubmed: 31582227
Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385:1975–82. https://doi.org/10.1016/S0140-6736(14)61601-9 .
doi: 10.1016/S0140-6736(14)61601-9
pubmed: 25777665
Hämodialyse BJ. In: Kuhlmann U, Böhler J, Luft FC, Kunzendorf U, Alscher MD, editors. Nephrologie: Pathophysiologie, Klinik, Nierenersatzverfahren. Stuttgart, New York: Georg Thieme Verlag; 2015. p. 671–711.
Ferrari U, Drey M. Die aktuelle Sarkopenie-Definition. DMW (1946). 2020;145:1315–9. https://doi.org/10.1055/a-0986-2818 .
doi: 10.1055/a-0986-2818
Mori K, Nishide K, Okuno S, Shoji T. Impact of diabetes on sarcopenia and mortality in patients undergoing hemodialysis. BMC Nephrol. 2019;20:105.
doi: 10.1186/s12882-019-1271-8
pubmed: 30922266
pmcid: 6437886
Slee A, McKeaveney C, Adamson G, Devenport A, Farrington K, et al. Estimating the Prevalence of Muscle Wasting, Weakness, and Sarcopenia in Hemodialysis Patients. J Ren Nutr. 2020;30:313–21. https://doi.org/10.1053/j.jrn.2019.09.004 .
doi: 10.1053/j.jrn.2019.09.004
pubmed: 31734056
Shu X, Lin T, Wang H, Zhao Y, Jiang T, et al. Diagnosis, prevalence, and mortality of sarcopenia in dialysis patients: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13:145–58. https://doi.org/10.1002/jcsm.12890 .
doi: 10.1002/jcsm.12890
pubmed: 34989172
pmcid: 8818609
Wathanavasin W, Banjongjit A, Avihingsanon Y, Praditpornsilpa K, Tungsanga K, et al. Prevalence of sarcopenia and its impact on cardiovascular events and mortality among dialysis patients: a systematic review and meta-analysis. Nutrients. 2022;14:4077. https://doi.org/10.3390/nu14194077 .
doi: 10.3390/nu14194077
pubmed: 36235729
pmcid: 9572026
Schaap LA, van Schoor NM, Lips P, Visser M. Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures: the longitudinal aging study Amsterdam. J Gerontol A Biol Sci Med Sci. 2018;73:1199–204. https://doi.org/10.1093/gerona/glx245 .
doi: 10.1093/gerona/glx245
pubmed: 29300839
Bischoff-Ferrari HA, Orav JE, Kanis JA, Rizzoli R, Schlögl M, et al. Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int. 2015;26:2793–802. https://doi.org/10.1007/s00198-015-3194-y .
doi: 10.1007/s00198-015-3194-y
pubmed: 26068298
Chang K-V, Hsu T-H, Wu WT, Huang KC, Han DS. Is sarcopenia associated with depression? A systematic review and meta-analysis of observational studies. Age Ageing. 2017;46:738–46. https://doi.org/10.1093/ageing/afx094 .
doi: 10.1093/ageing/afx094
pubmed: 28633395
Bahat G, İlhan B. Sarcopenia and the cardiometabolic syndrome: a narrative review. Eur Geriatr Med. 2016;7:220–3. https://doi.org/10.1016/j.eurger.2015.12.012 .
doi: 10.1016/j.eurger.2015.12.012
Morley J E; Abbatecola A M; Argiles J M; Baracos V; Bauer J, et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc. 2011;12 :403–09. https://doi.org/10.1016/j.jamda.2011.04.014 .
Mori K. Maintenance of skeletal muscle to counteract sarcopenia in patients with advanced chronic kidney disease and especially those undergoing hemodialysis. Nutrients. 2021;13:1538. https://doi.org/10.3390/nu13051538 .
doi: 10.3390/nu13051538
pubmed: 34063269
pmcid: 8147474
Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, et al. A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease. Kidney Int. 2088;73:391–8. https://doi.org/10.1038/sj.ki.5002585 .
doi: 10.1038/sj.ki.5002585
Velasquez M T, Andrews S C, Raj DS. Protein Energy Metabolism in Chronic Kidney Disease. Chro Ren Dis. 2020;225–48. https://doi.org/10.1016/B978-0-12-815876-0.00016-4 .
Stenvinkel P, Heimbürger O, Lindholm B. Wasting, but not malnutrition, predicts cardiovascular mortality in end-stage renal disease. Nephrol Dial Transplant. 2004;19:2181–3. https://doi.org/10.1093/ndt/gfh296 .
doi: 10.1093/ndt/gfh296
pubmed: 15238625
Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013;23:77–90. https://doi.org/10.1053/j.jrn.2013.01.001 .
doi: 10.1053/j.jrn.2013.01.001
pubmed: 23428357
Hanna RM, Ghobry L, Wassef O, Rhee CM, Kalantar-Zadeh K. A practical approach to nutrition, protein-energy wasting, sarcopenia, and cachexia in patients with chronic kidney disease. Blood Purif. 2020;49:202–11. https://doi.org/10.1159/000504240 .
doi: 10.1159/000504240
pubmed: 31851983
Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani C, et al. Global prevalence of protein-energy wasting in kidney disease: a meta-analysis of contemporary observational studies from the international society of renal nutrition and metabolism. J Ren Nutr. 2018;28:380–92. https://doi.org/10.1053/j.jrn.2018.08.006 .
doi: 10.1053/j.jrn.2018.08.006
pubmed: 30348259
Chen C, Zhang , Zhou Z, Liu , Li C, et al. Impact of serum albumin level and variability on short-term cardiovascular-related and all-cause mortality in patients on maintenance hemodialysis. Medicine (Baltimore). 2021;100:e27666. https://doi.org/10.1097/md.0000000000027666 .
Klantar-Zadeh K, Kilpatrick RD, Kuwae N, McAllister CJ, Alcorn H, et al. Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and population-attributable fraction. Nephrol Dial Transplant. 2005;20:1880–8. https://doi.org/10.1093/ndt/gfh941 .
doi: 10.1093/ndt/gfh941
Johansen KL, Chertow GM, Ng AV, Mulligan K, Carey S, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int. 2000;57:2564–70. https://doi.org/10.1046/j.1523-1755.2000.00116.x .
doi: 10.1046/j.1523-1755.2000.00116.x
pubmed: 10844626
Zelle DM, Klaassen G, van Adrichem E, Bakker SJL, Corpeleijn E, et al. Physical inactivity: a risk factor and target for intervention in renal care. Nat Rev Nephrol. 2017;13:152–68. https://doi.org/10.1038/nrneph.2016.187 .
doi: 10.1038/nrneph.2016.187
pubmed: 28138130
Avesani CM, Trolonge S, Deléaval P, Baria F, Mafra D, et al. Physical activity and energy expenditure in haemodialysis patients: an international survey. NDT. 2012;27:2430–4. https://doi.org/10.1093/ndt/gfr692 .
doi: 10.1093/ndt/gfr692
pubmed: 22172727
Bündchen DC, Sousa H, Afreixo V, Frontini R, Ribeiro O, et al. Intradialytic exercise in end-stage renal disease: An umbrella review of systematic reviews and/or meta-analytical studies. Clin Rehabil. 2021;35:812–28. https://doi.org/10.1177/0269215520986784 .
doi: 10.1177/0269215520986784
pubmed: 33530715
Ferrari F, Helal L, Dipp T, Soares D, Soldatelli A, et al. Intradialytic training in patients with end-stage renal disease: a systematic review and meta-analysis of randomized clinical trials assessing the effects of five different training interventions. J Nephrol. 2020;33:251–66. https://doi.org/10.1007/s40620-019-00687-y .
doi: 10.1007/s40620-019-00687-y
pubmed: 31865607
Wilund KR, Viana JL, Perez LM. A critical review of exercise training in hemodialysis patients: personalized activity prescriptions are needed. Exerc Sport Sci Rev. 2020;48:28–39. https://doi.org/10.1249/jes.0000000000000209 .
doi: 10.1249/jes.0000000000000209
pubmed: 31453844
pmcid: 6910960
Wilund KR, Thompson SV, João L, Wang AYM. Physical activity and health in chronic kidney disease. Contrib Nephrol. 2021;199:43–55. https://doi.org/10.1159/000517696 .
doi: 10.1159/000517696
pubmed: 34343989
Valenzuela PL, Morales JS, Ruilope LM, De la Villa P, Santos-Lozano A, et al. Intradialytic neuromuscular electrical stimulation improves functional capacity and muscle strength in people receiving haemodialysis: a systematic review. J Physiother. 2020;66:89–96. https://doi.org/10.1016/j.jphys.2020.03.006 .
doi: 10.1016/j.jphys.2020.03.006
pubmed: 32291224
Schardong J, Stein C, Plentz DM, R. Neuromuscular electrical stimulation in chronic kidney failure: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2020;101:700–11. https://doi.org/10.1016/j.apmr.2019.11.008 .
doi: 10.1016/j.apmr.2019.11.008
pubmed: 31877308
Zampieri S, Mosole S, Löfler S, Fruhmann H, Burggraf S, et al. Physical exercise in Aging: Nine weeks of leg press or electrical stimulation training in 70 years old sedentary elderly people. Eur J Transl Myol. 2015;25:237–42. https://doi.org/10.4081/ejtm.2015.5374 .
doi: 10.4081/ejtm.2015.5374
pubmed: 26913162
pmcid: 4748981
Omonaiye O, Smyth W, Nagle C. Impact of virtual reality interventions on haemodialysis patients: A scoping review. J Ren Care. 2021;47:193–207. https://doi.org/10.1111/jorc.12362 .
doi: 10.1111/jorc.12362
pubmed: 33491276
Simó V-E, Jiménez AJ, Oliveira JC, Guzmán FM, Nicolás MF, et al. Efficacy of neuromuscular electrostimulation intervention to improve physical function in haemodialysis patients. Int Urol Nephrol. 2015;47:1709–17. https://doi.org/10.1007/s11255-015-1072-3 .
doi: 10.1007/s11255-015-1072-3
pubmed: 26253828
Heidland A, Fazeli G, Klassen A, Sebekova K, Hennemann H, et al. Neuromuscular electrostimulation techniques: historical aspects and current possibilities in treatment of pain and muscle waisting. Clin Nephrol. 2013;79(suppl 1):S12-23. https://doi.org/10.5414/CNX77S106 .
doi: 10.5414/CNX77S106
pubmed: 23249528
Insausti-Delgado A, López-Larraz E, Omedes J, Ramos-Murguialday A. Intensity and Dose of Neuromuscular Electrical Stimulation Influence Sensorimotor Cortical Excitability. Front Neurosci. 2021;14.
doi: 10.3389/fnins.2020.593360
pubmed: 33519355
pmcid: 7845652
Wiederhold BK, Soomro A, Riva G, Wiederhold MD. Future directions: advances and implications of virtual environments designed for pain management. Cyberpsychol Behav Soc Netw. 2014;17:414–22. https://doi.org/10.1089/cyber.2014.0197 .
doi: 10.1089/cyber.2014.0197
pubmed: 24892206
pmcid: 4043364
Kipping B, Rodger S, Miller K, Kimble RM. Virtual reality for acute pain reduction in adolescents undergoing burn wound care: a prospective randomized controlled trial. Burns. 2012;38:650–7. https://doi.org/10.1016/j.burns.2011.11.010 .
doi: 10.1016/j.burns.2011.11.010
pubmed: 22348801
Haahr M, Haahr S. RANDOM.ORG - True Random Number Service. https://www.random.org/ . Accessed 12 Dec 2022.
HOGGAN SCIENTIFIC LLC: Muscle testing postions. https://hogganscientific.com/wp-content/uploads/2019/06/HogganScientific-MuscleTestingPositions-11x17-Poster.pdf (2020). Accessed 24 Jun 2023.
Bohannon RW, Crouch R. 1-Minute Sit-to-Stand Test: systematic review of procedures, performance, and clinimetric properties. J Cardiopulm Rehabil Prev. 2019;39:2–8. https://doi.org/10.1097/hcr.0000000000000336 .
doi: 10.1097/hcr.0000000000000336
pubmed: 30489442
Kaysen G A. Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy?. 2003;87:92–8. https://doi.org/10.1046/j.1523-1755.64.s87.14.x .
Schomacher J. Gütekriterien der visuellen Analogskala zur Schmerzbewertung. Physioscience. 2008;4:125–33. https://doi.org/10.1055/s-2008-1027685 .
Simó VE, Carneiro J, Moreno F, Garriga S, Pou M, et al. The effect of neuromuscular electrical stimulation on muscle strength, functional capacity and body composition in haemodialysis patients. Nefrologia. 2017;37:68–77. https://doi.org/10.1016/j.nefro.2016.05.010 .
doi: 10.1016/j.nefro.2016.05.010
Schardong J, Dipp T, Bozzeto CB, Godoy da Silva M, Baldissera GL, et al. Effects of Intradialytic Neuromuscular Electrical Stimulation on Strength and Muscle Architecture in Patients With Chronic Kidney Failure Randomized Clinical Trial. Artif Organs. 2017;41:1049–58. https://doi.org/10.1111/aor.12886 .
doi: 10.1111/aor.12886
pubmed: 28621488
Schardong J, Brito V, Dipp T, Macagnan FE, Saffi J, Méa Plentz RD. Intradialytic neuromuscular electrical stimulation reduces DNA damage in chronic kidney failure patients: a randomized controlled trial. Biomarkers. 2018;23:495–501. https://doi.org/10.1080/1354750x.2018.1452049 .
doi: 10.1080/1354750x.2018.1452049
pubmed: 29529880
Roxo RS, Xavier VB, Miorin LA, Magalhães AO, Dos Dantos Sens YA, et al. Impact of neuromuscular electrical stimulation on functional capacity of patients with chronic kidney disease on hemodialysis. J Bras Nefrol. 2016;38:344–50. https://doi.org/10.5935/0101-2800.20160052 .
doi: 10.5935/0101-2800.20160052
pubmed: 27737393
Dobsak P, Homolka P, Svojanovsky J, Reichertova A, Soucek M, et al. Intra-dialytic electrostimulation of leg extensors may improve exercise tolerance and quality of life in hemodialyzed patients. Artif Organs. 2012;36:71–8. https://doi.org/10.1111/j.1525-1594.2011.01302.x .
doi: 10.1111/j.1525-1594.2011.01302.x
pubmed: 21848929
Suzuki T, Ikeda M, Minami M, Matayoshi Y, Nakao M, et al. Beneficial effect of intradialytic electrical muscle stimulation in hemodialysis patients: a randomized controlled trial. Artif Organs. 2018;42:899–910. https://doi.org/10.1111/aor.13161 .
doi: 10.1111/aor.13161
pubmed: 30069942
Miura M, Hirayama A, Oowada S, Nishida A, Saito C, et al. Effects of electrical stimulation on muscle power and biochemical markers during hemodialysis in elderly patients: a pilot randomized clinical trial. Ren Replace Ther. 2018;4:33. https://doi.org/10.1186/s41100-018-0174-7 .
doi: 10.1186/s41100-018-0174-7
Kopple JD, Zhu X, Lew NL, Lowrie EG. Body weight-for-height relationships predict mortality in maintenance hemodialysis patients. Kidney Int. 1999;46:1136–48. https://doi.org/10.1046/j.1523-1755.1999.00615.x .
doi: 10.1046/j.1523-1755.1999.00615.x
Johansen KL, Shubert T, Doyle J, Soher B, Sakkas GK, Kent-Braun JA. Muscle atrophy in patients receiving hemodialysis: Effects on muscle strength muscle quality and physical function. Kidney Int. 2003;63(1) 291-297. https://doi.org/10.1046/j.1523-1755.2003.00704.x .
Ward LC. Bioelectrical impedance analysis for body composition assessment: reflections on accuracy, clinical utility, and standardisation. Eur J Clin Nutr. 2019;73:194–9. https://doi.org/10.1038/s41430-018-0335-3 .
doi: 10.1038/s41430-018-0335-3
pubmed: 30297760
Patel MP, Kute VB, Prasad N, Agarwal SK. COVID 19 and Hemodialysis Anxiety. Indian J Nephrol. 2020;30:174–5.10.4103%2Fijn.IJN_203_20.
doi: 10.4103/ijn.IJN_203_20
pubmed: 33013065
pmcid: 7470204
Hoxha E, Suling A, Turner JE, Haubitz M, Floege J, et al. COVID-19 prevalence and mortality in chronic dialysis patients. Dtsch Arztebl Int. 2021;118:195–6. https://doi.org/10.3238/arztebl.m2021.0160 .
doi: 10.3238/arztebl.m2021.0160
pubmed: 34024314
pmcid: 8245864
Segura-Ortí E, García-Testal A. Intradialytic virtual reality exercise: Increasing physical activity through technology. Semin Dial. 2019;32:331–5. https://doi.org/10.1111/sdi.12788 .
doi: 10.1111/sdi.12788
pubmed: 30916415
Maynard LG, Menezes DL de, Lião NS, Mendonça de Jesus E, Andrade NLS, et al. Effects of Exercise Training Combined with Virtual Reality in Functionality and Health-Related Quality of Life of Patients on Hemodialysis. Games Health J. 2019;8:339–48. https://doi.org/10.1089/g4h.2018.0066 .
doi: 10.1089/g4h.2018.0066
pubmed: 31539293
Yangöz ŞT, Turan Kavradım S, Özer Z. The effects of virtual reality-based exercise in adults receiving haemodialysis treatment: A systematic review and meta-analysis of randomized controlled studies. Appl Psychol Health Well Being. 2022;1:1–36. https://doi.org/10.1111/aphw.12426 .
doi: 10.1111/aphw.12426