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Title: Exercise training by neuromuscular stimulation in chronic heart failure
Author: LeMaitre, John P.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2008
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Methods: Studies 1-3 randomise stable patients to conventional bicycle training (Bike) or neuromuscular stimulation (NMS) of quadriceps and gastrocnemius leg muscles. A 6-week training programme is undertaken with functional performance assessed by 6-minute walk (6MW), quadriceps strength and fatigue testing, cardiopulmonary exercise testing and quality of life scoring. Body composition is assessed further in study 2 using dual-energy X-ray absorptionometry. Inflammatory markers are assessed before and after training in study 3. Study 4 is a controlled trial of NMS and Bike training including stable (S-CHF) and recently decompensated (RD-CHF) patients, with performance testing before and after a period of training. Study 5 explores the characteristics of a large group of CHF patients admitted to hospital with heart failure and compares the characteristics of these patients with those included in the exercise training trial described in study 4 and also with those patients included in a recent meta-analysis of exercise training trials. Results: Improvements in 6MW, treadmill exercise time, quadriceps strength and fatigue were observed following both Bike and NMS training for stable patients in study 1. In study 2, a significant improvement in peak VO2 following bike training but not NMS was observed when corrected for lean muscle mass. No change in body composition following training was observed. Pro-inflammatory state was attenuated following conventional training with a significant fall in sTNFαr2 in the Bike group only. NMS training resulted in significant improvement in NT-pro BNP when compared with controls and Bike patients in study 4. Overall, exercise training appeared to be effective when RD-CHF patients were included. Study 5 demonstrated that only 6.7% of the screened population was suitable for inclusion in the exercise training trial in study 4. Eligible patients were younger, more likely to be male, had fewer comorbidities and were on more optimal CHF medication than the non-eligible patients despite similar symptoms. The characteristics of the eligible patients were similar to those included in the large meta-analysis. Conclusions: NMS exercise training appears safe and effective in stable CHF patients, although it differs from Bike training in its effects on markers of inflammation. Body composition did not change following training despite functional improvements, implying qualitative changes in peripheral muscle. RD-CHF patients may benefit from training but recruitment into a trial of exercise training is difficult. NMS is more easily delivered than Bike training and it may be a useful alternative or bridging therapy for those who cannot exercise conventionally.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available