Effectiveness of neuromuscular electrical stimulation training combined with exercise on patient-reported outcomes measures in people with knee osteoarthritis: A systematic review and meta-analysis.

OBJECTIVE: This study examined the effectiveness of neuromuscular electrical stimulation (NMES) added to the exercise or superimposed on voluntary contractions on patient-reported outcomes measures (PROMs) in people with knee osteoarthritis (OA). METHODS: This systematic review was described according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) were obtained from a systematic literature search in five electronic databases (PubMed, PEDro, LILACS, EMBASE, and SPORTDiscus) in April 2022. We described the effects of intervention according to each PROMs (scores for Pain; Self-reported functional ability; Symptoms (hear clicking, swelling, catching, restricted range of motion, and stiffness); Daily living function; Sports function; and Quality of life) and used a random-effect model to examine the impact of NMES plus exercise on pain compared with exercise in people with knee OA. RESULTS: Six RCTs (n = 367) were included. In the qualitative synthesis, the systematic literature analysis showed improvement in pain after NMES plus exercise compared with exercise alone in three studies. The other three studies revealed no difference between groups in pain, although similar improvement after treatments. In the meta-analysis, NMES at a specific joint angle combined with exercise was not superior to exercise alone in pain management (standardized mean difference = -0.33, 95% CI = -1.05 to 0.39, p = 0.37). There was no additional effect of NMES on exercise on self-reported functional ability, stiffness, and physical function compared with exercise alone. In only one study, symptoms, activities of daily living, sports function, and quality of life improved after whole-body electrostimulation combined with exercise. CONCLUSION: This review found insufficient evidence for the effectiveness of NMES combined with exercise in treating knee OA considering PROMs. While pain relief was observed in some studies, more high-quality clinical trials are needed to support the use of NMES added to the exercise in clinical practice. Electrical stimulation in a whole-body configuration combined with exercise shows promise as an alternative treatment option.

Cardiometabolic, functional, and psychosocial effects of a remotely supervised home-based exercise program in individuals with type 2 diabetes (RED study): study protocol for a randomized clinical trial.

BACKGROUND: Type 2 diabetes mellitus (T2D) is a serious global health problem, and exercise is considered an essential non-pharmacological tool in T2D prevention and treatment. During periods of social isolation experienced by the COVID-19 pandemic, home-based exercise programs were strongly recommended as a strategy to facilitate exercise practice and reduce the negative impacts of social isolation. Remotely supervised exercise stands out as an easily accessible strategy after the pandemic, as it is a tool that aims to facilitate access to exercise by this population. The purpose of the RED study is to verify the effects of a remotely supervised home-based exercise program compared to a control group on cardiometabolic, functional, and psychosocial outcomes in patients with T2D. METHODS: Participants are randomized into the control group (CG) and the intervention group (IG). Participants allocated to the CG receive recommendations for the practice of physical activity based on information from chapters of the Physical Activity Guide for the Brazilian Population, while the IG will perform a 12-week home-based exercise program supervised remotely by video call. The intervention has a weekly frequency of two sessions per week on non-consecutive days during the first 6 weeks and three sessions per week on non-consecutive days for the remaining 6 weeks. The RED study has HbA1c as the primary outcome, and the participants' cardiometabolic, functional, and psychosocial parameters are assessed at baseline (week 0) and post-intervention (week 13). DISCUSSION: Expected results of the proposed study will provide the knowledge base of health professionals and deliver more evidence for a growing area, i.e., home-based exercise and T2D. Additionally, this protocol aims to verify and demonstrate whether this program can be accessible and effective for different health outcomes in patients with T2D. TRIAL REGISTRATION: The RED study protocol was prospectively registered at ClinicalTrials.gov (NCT05362071). Date registered April 6, 2022. https://clinicaltrials.gov/ct2/show/NCT05362071 .

Estimulação elétrica funcional associada ao treinamento combinado pós-CRM: ensaio clínico randomizado / Estimulación eléctrica funcional asociada con el entrenamiento combinado post-CABG: ensayo clínico aleatorizado / Functional electrical stimulation associated with combined post-CABG training: a randomized clinical trial

RESUMO Os efeitos da adição da estimulação elétrica funcional (EEF) ao treinamento aeróbico e resistido (treino combinado) de curto prazo em pacientes submetidos à cirurgia de revascularização do miocárdio (CRM) ainda não foram estabelecidos. O objetivo do presente estudo é avaliar o impacto da adição da EEF ao treino combinado no fluxo arterial periférico, na capacidade funcional e na qualidade de vida de pacientes pós-CRM participantes de um programa de reabilitação cardíaca - Fase II. Trata-se de um ensaio clínico randomizado, duplo cego, composto por 17 pacientes (54,8±10,5 anos, 12 homens) randomizados ou em grupo intervenção (GI, n=8,) submetido à EEF no músculo quadríceps associada ao treino combinado, ou em grupo sham (GS, n=9), que realizou a EEF sham em associação ao treino combinado. Os desfechos avaliados foram: fluxo arterial periférico (índice tornozelo-braquial), capacidade funcional (distância percorrida no teste de caminhada de seis minutos - DTC6M) e qualidade de vida (questionário MacNew). Na comparação entre os grupos, o aumento do índice tornozelo-braquial (GI: 0,14±0,08 mmHg vs. GC: 0,05±0,04 mmHg; p=0,020) e do escore do domínio global do questionário MacNew (GI: 1,1±0,3 pontos vs. GC: 0,6±0,4 pontos; p=0,020) foi maior no GI. Entretanto, não foi observada diferença entre os grupos para a DTC6M (GI: 130,9±73,7 m vs. GS: 73,7±32,6 m; p=0,072). A adição da EEF, durante curto período, potencializou os efeitos do exercício aeróbico e resistido sobre o fluxo arterial periférico e a qualidade de vida em pacientes pós CRM em Fase II da reabilitação cardíaca.

RESUMEN Aún no se han establecido los efectos de agregar estimulación eléctrica funcional (EPS) cortoplacista al entrenamiento aeróbico y de resistencia (entrenamiento combinado) en pacientes sometidos a cirugía de injerto de derivación de las arterias coronarias (CABG). El objetivo del presente estudio fue evaluar el impacto de la adición de EPS al entrenamiento combinado sobre el flujo arterial periférico, la capacidad funcional y la calidad de vida de los pacientes post-CABG que participan en un programa de rehabilitación cardíaca de Fase II. Este es un ensayo clínico aleatorizado, doble ciego, compuesto por 17 pacientes (54,8±10,5 años, 12 hombres) aleatorizados en un grupo de intervención (GI, n=8) sometidos a EEF en el músculo cuádriceps asociado a entrenamiento combinado o en grupo simulado (GS, n=9), que realizó el simulacro de EEF en asociación con el entrenamiento combinado. Los resultados evaluados fueron: flujo arterial periférico (índice tobillo braquial), capacidad funcional (distancia recorrida en la prueba de caminata de seis minutos - 6MWT) y calidad de vida (cuestionario MacNew). Al comparar los grupos, el aumento del índice tobillo braquial (GI: 0,14±0,08 mmHg vs. GC: 0,05±0,04 mmHg; p=0,020) y la puntuación para el dominio global del cuestionario MacNew (GI: 1,1±0,3 puntos vs. GC: 0,6±0,4 puntos; p=0,020) fueron mayores en el GI. Sin embargo, no hubo diferencias entre los grupos en la 6MWT (GI: 130,9±73,7 m vs. GS: 73,7±32,6 m; p=0,072). La adición de EEF, durante un período corto, potenció los efectos del ejercicio aeróbico y de resistencia sobre el flujo arterial periférico y la calidad de vida en pacientes post-CABG en la Fase II de rehabilitación cardíaca.

ABSTRACT The effects of adding functional electrical stimulation (FES) to short-term aerobic and resistance exercise (combined training) in patients undergoing coronary artery bypass graft (CABG) surgery have not yet been established. This study aims to evaluate the effect of adding FES to combined training on peripheral arterial flow, functional capacity and quality of life of post-CABG patients participating in a cardiac rehabilitation program - Phase II. This is a randomized, double-blind, clinical trial, composed of 17 patients (54.8±10.5 years old, 12 men) randomized or in an intervention group (IG, n=8,) submitted to FES in the quadriceps muscle associated with combined training, or in a sham group (SG, n=9), which performed the FES sham in association with the combined training. The evaluated outcomes were: peripheral arterial flow (ankle-brachial index), functional capacity (distance covered in the six-minute walk test - 6MWT) and quality of life (MacNew questionnaire). In the comparison between the groups, the increase in the ankle-brachial index (IG: 0.14±0.08mmHg vs. CG: 0.05±0.04mmHg; p=0.020) and the score of the global MacNew questionnaire (IG: 1.1±0.3 points vs. CG: 0.6±0.4 points; p=0.020) was higher in the IG. However, no difference was observed between the groups for the 6MWT (IG: 130.9±73.7m vs SG: 73.7±32.6m; p=0.072). The addition of FES, during a short period, potentiated the effects of aerobic and resistance exercise on peripheral arterial flow and quality of life in patients after CABG in Phase II of cardiac rehabilitation.

Efeitos do exercício passivo precoce em cicloergômetro na espessura muscular do quadríceps femoral de pacientes críticos: estudo-piloto randomizado controlado / Efectos del ejercicio pasivo precoz en cicloergómetro en el espesor muscular del cuádriceps femoral de pacientes críticos: un estudio piloto aleatorizado controlado / Effects of early passive cycling exercise on quadriceps femoris thickness in critically ill patients: a controlled randomized pilot study

RESUMO O objetivo deste estudo foi avaliar os efeitos do exercício passivo precoce em cicloergômetro na espessura muscular (EM) do quadríceps femoral (EMQ) de pacientes críticos admitidos em uma Unidade de Terapia Intensiva (UTI) de um hospital universitário terciário. O método utilizado foi um estudo-piloto randomizado controlado conduzido em uma amostra de 24 pacientes (51±18,11 anos, 16 do sexo masculino), com 24 a 48 horas de ventilação mecânica (VM), aleatoriamente divididos em dois grupos: grupo-controle (n=12), que recebeu a fisioterapia convencional; e grupo-intervenção (n=12), que recebeu o exercício passivo em cicloergômetro, uma vez ao dia, durante o período de sete dias do protocolo, em adição à fisioterapia convencional. A EMQ foi mensurada através da ultrassonografia. A primeira medida ultrassonográfica foi realizada entre as primeiras 48 horas de VM e a segunda ao término do protocolo. Não houve diferenças significativas na EMQ esquerda (27,29±5,86mm vs. 25,95±10,89mm; p=0,558) e direita (24,96±5,59mm vs 25,9±9,21mm; p=0,682) do grupo-controle e na EMQ esquerda (27,2±7,38mm vs 29,57±7,89mm; p=0,299) e direita (26,67±8,16mm vs 28,65±8,04mm; p=0,381) do grupo-intervenção. Na comparação entre os grupos, não houve alterações significativas em relação à EMQ esquerda (3,61±1,07mm; p=0,248) e a EMQ direita (2,75±0,85mm; p=0,738). Os resultados deste estudo-piloto demonstraram que a aplicação precoce do exercício passivo em cicloergômetro não promoveu mudanças significativas na espessura da camada muscular avaliada. No entanto, nossos achados sinalizam que a fisioterapia convencional foi capaz de preservar a EMQ de pacientes críticos admitidos em UTI.

RESUMEN El presente estudio tuvo como objetivo evaluar los efectos del ejercicio pasivo precoz en cicloergómetro en el espesor muscular (EM) del cuádriceps femoral (EMC) de pacientes críticos ingresados en una Unidad de Cuidados Intensivos (UCI) de un hospital universitario terciario. Se utilizó como método un estudio piloto aleatorizado controlado con una muestra de 24 pacientes (51±18,11 años, 16 varones), con 24 a 48 horas de ventilación mecánica (VM), quienes fueron divididos aleatoriamente en dos grupos: grupo de control (n=12), que recibió fisioterapia convencional; y grupo intervención (n=12), que recibió el ejercicio pasivo en cicloergómetro una vez al día durante el período de protocolo de siete días, además de la fisioterapia convencional. El EMC se midió por ecografía. La primera medición ecográfica se realizó entre las primeras 48 horas de VM, y la segunda al final del protocolo. No hubo diferencias significativas en el EMC izquierdo (27,29±5,86 mm vs. 25,95±10,89mm; p=0,558) y derecho (24,96±5,59mm vs 25,9±9,21mm; p=0,682) del grupo de control; y en el EMC izquierdo (27,2±7,38mm vs 29,57±7,89mm; p=0,299) y derecho (26,67±8,16mm vs 28,65±8,04mm; p=0,381) del grupo intervención. En la comparación entre grupos, no hubo cambios significativos en el EMC izquierdo (3,61±1,07 mm; p=0,248) y en el EMC derecho (2,75±0,85 mm, p=0,738). Los resultados de este estudio piloto demostraron que la aplicación precoz del ejercicio pasivo en cicloergómetro no promovió cambios significativos en el espesor de la capa muscular evaluada. Sin embargo, nuestros hallazgos indican que la fisioterapia convencional pudo preservar el EMC de pacientes críticos ingresados en la UCI.

ABSTRACT The objective of this study was to evaluate the effects of early passive cycling exercise on quadriceps femoris thickness (QFT) in critically ill patients admitted in the intensive care unit (ICU) of a tertiary care university hospital. A controlled randomized pilot study was conducted with a sample of 24 patients (51±18.11 years, 16 male), on mechanical ventilation (MV) from 24 to 48 hours, who were randomly divided into two groups: control group (n=12), receiving conventional physical therapy; and an intervention one (n=12), receiving passive cycle ergometer, once a day, throughout seven days of protocol, in addition to conventional physical therapy. The QFT was measured by ultrasonography. The first ultrasonographic measurement was performed within 48 hours after the start of MV, and the second at the end of the protocol. There were no significant differences in QFT of the left (27,29±5,86mm vs 25,95±10,89mm; p=0,558) and right (24,96±5,59mm vs 25,9±9,21mm; p=0,682) in the control group, and in QFT of the left (27,2±7,38mm vs 29,57±7,89mm; p=0,299) and right (26,67±8,16mm vs 28,65±8,04mm; p=0,381) in the intervention group. There were no significant between-groups differences for left QFT (3,61±1,07mm; p=0,248) and right QFT (2,75±0,85mm; p=0,738). The results of this pilot study demonstrate that application of early passive cycle ergometer exercises has not significantly change the muscle layer thickness. However, our findings indicate that conventional physical therapy is able to preserve the quadriceps femoris thickness in critically ill patients admitted in ICU.

Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial.

Objective: To evaluate the effects that passive cycling exercise, in combination with conventional physical therapy, have on peripheral muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital. Methods: This was a randomized clinical trial involving 38 patients (≥ 18 years of age) on mechanical ventilation who were randomly divided into two groups: control (n = 16), receiving conventional physical therapy; and intervention (n = 22), receiving conventional physical therapy and engaging in passive cycling exercise five days per week. The mean age of the patients was 46.42 ± 16.25 years, and 23 were male. The outcomes studied were peripheral muscle strength, as measured by the Medical Research Council scale, duration of mechanical ventilation, and length of hospital stay. Results: There was a significant increase in peripheral muscle strength (baseline vs. final) in both groups (control: 40.81 ± 7.68 vs. 45.00 ± 6.89; and intervention: 38.73 ± 11.11 vs. 47.18 ± 8.75; p < 0.001 for both). However, the range of increase in strength was higher in the intervention group than in the control group (8.45 ± 5.20 vs. 4.18 ± 2.63; p = 0.005). There were no significant differences between the groups in terms of duration of mechanical ventilation or length of hospital stay. Conclusions: The results suggest that the performance of continuous passive mobilization on a cyclical basis helps to recover peripheral muscle strength in ICU patients. (ClinicalTrials.gov Identifier: NCT01769846 [http://www.clinicaltrials.gov/]).

Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial / Efeito do exercício passivo em cicloergômetro na força muscular, tempo de ventilação mecânica e internação hospitalar em pacientes críticos: ensaio clínico randomizado

ABSTRACT Objective: To evaluate the effects that passive cycling exercise, in combination with conventional physical therapy, have on peripheral muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital. Methods: This was a randomized clinical trial involving 38 patients (≥ 18 years of age) on mechanical ventilation who were randomly divided into two groups: control (n = 16), receiving conventional physical therapy; and intervention (n = 22), receiving conventional physical therapy and engaging in passive cycling exercise five days per week. The mean age of the patients was 46.42 ± 16.25 years, and 23 were male. The outcomes studied were peripheral muscle strength, as measured by the Medical Research Council scale, duration of mechanical ventilation, and length of hospital stay. Results: There was a significant increase in peripheral muscle strength (baseline vs. final) in both groups (control: 40.81 ± 7.68 vs. 45.00 ± 6.89; and intervention: 38.73 ± 11.11 vs. 47.18 ± 8.75; p < 0.001 for both). However, the range of increase in strength was higher in the intervention group than in the control group (8.45 ± 5.20 vs. 4.18 ± 2.63; p = 0.005). There were no significant differences between the groups in terms of duration of mechanical ventilation or length of hospital stay. Conclusions: The results suggest that the performance of continuous passive mobilization on a cyclical basis helps to recover peripheral muscle strength in ICU patients. (ClinicalTrials.gov Identifier: NCT01769846 [http://www.clinicaltrials.gov/])

RESUMO Objetivo: Avaliar os efeitos da realização de exercícios passivos com um cicloergômetro, associada à fisioterapia convencional, na força muscular periférica, no tempo de ventilação mecânica e no tempo de internação hospitalar em pacientes críticos internados em UTI de um hospital universitário terciário. Métodos: Ensaio clínico randomizado envolvendo 38 pacientes (idade > 18 anos) em ventilação mecânica e divididos aleatoriamente em grupo controle (n = 16), que realizou fisioterapia convencional, e grupo intervenção (n = 22) submetidos a fisioterapia convencional e exercícios passivos em cicloergômetro cinco vezes por semana. A média de idade dos pacientes foi de 46,42 ± 16,25 anos, e 23 eram homens. Os desfechos analisados foram força muscular periférica, mensurada pela escala Medical Research Council, tempo de ventilação mecânica e tempo de internação hospitalar. Resultados: Houve um aumento significativo da força muscular periférica (basal vs. final) tanto no grupo controle (40,81 ± 7,68 vs. 45,00 ± 6,89; p < 0,001) quanto no grupo intervenção (38,73 ± 11,11 vs. 47,18 ± 8,75; p < 0,001). Entretanto, a variação do aumento da força foi maior no grupo intervenção que no controle (8,45 ± 5,20 vs. 4,18 ± 2,63; p = 0,005). Não foram observadas diferenças significativas entre os grupos quanto ao tempo de ventilação mecânica e tempo de internação hospitalar. Conclusões: Os resultados sugerem que a realização de mobilização passiva contínua de forma cíclica auxilia na recuperação da força muscular periférica de pacientes internados em UTI. (ClinicalTrials.gov Identifier: NCT01769846 [http://www.clinicaltrials.gov/])

Impacto de la movilidad temprana en pacientes de terapia intensiva / Impact of early mobilization in intensive care patients

Introdução: Os (Los) pacientes internados em Unidade de Terapia Intensiva (UTI) estão expostos a fatores deletérios ao seu (están expuestos a factores nocivos para su) estado clínico. Apesar dos estudos demonstrarem que a mobilização precoce do (de que los estudios demostraron que la movilidad tempranadel) paciente promova uma diminuição dos efeitos deletérios do imobilismo (de la inmovilidad), proporcionando uma melhor evolução clínica, alguns profissionais da saúde ainda se mostram receososem (de la salud todavía muestran recelo a) mobilizar pacientes sob ventilação mecânica (VM) e acabampor restringir esses indivíduos à (y los reducen a la) inatividade. Objetivo: Avaliar o impacto e a segurançada (Evaluar el impacto y la seguridad de la) implementação de programas de mobilização precoce empacientes internados em UTI, através da sistematização das (de la sistematización de las) evidências científicas publicadas nos últimos dez anos (en los últimos diez años). Métodos: Realizou-se uma revisão sistemática de ensaios clínicos randomizados publicados em periódicos indexados nas bases de dados (indizados en las bases de datos) PubMed, PEDro, Science Direct, LILACS, usando os descritores IntensiveCare Unit and Early Mobilization and Rehabilitation. A qualidade metodológica dos estudos foi avaliada pela (de los estudios fue evaluada por la) Escala de Jaddad. Resultados: Foram encontrados 198 artigos potencialmente relevantes, sendo que destes, apenas 4 foram (de éstos, apenas cuatro fueron) selecionados por atenderem aos critérios de incluso (por cumplimentar los criterios de inclusión).

Patients in an Intensive Care Unit (ICU) are exposed to factors that are harmful to their clinical status. Al-though studies have shown that early mobilization of patients results in reduction of the harmful effects of immobility, providing better clinical outcomes, some health professionals are still not comfortable with mobilizing patients who are on mechanical ventilation (MV) and end up restricting such individu-als to inactivity. Objective: To assess the impact and safety of the implementation of early mobilization programs in ICU patients through the systematic review of scientific evidence published throughout the past ten years. Methods: A systematic review was carried out on randomized controlled trials published in journals indexed in the databases PubMed, PEDro, Science Direct and LILACS, applying the descriptors Intensive Care Unit and Early Mobilization and Rehabilitation. The methodological quality of the stud-ies was assessed by the Jaddad Scale. Results: 198 potentially relevant papers were found; only 4 that met the inclusion criteria were selected. Conclusion: Through this systematic review, it was possible to conclude that early mobilization programs are safe, improve the functional performance of patients in the ICU, reduce the incidence of delirium, and decrease the time of MV and hospital stays. However, it is important to note that the currently available level of evidence concerning the impact of early mobiliza-tion on relevant clinical outcomes, such as length of stay in ICU, hospital mortality and long-term survival is still low and limited, requiring, therefore, further prospective studies.