Neuromuscular electrical stimulation after cardiovascular surgery mitigates muscle weakness in older individuals with diabetes - 07/03/22

Doi : 10.1016/j.rehab.2022.101659

Koya Takino ^a,^b, Masataka Kameshima ^c, Chikako Asai ^d, Itta Kawamura ^e, Shinji Tomita ^f, Hiroyuki Sato ^g, Akihiro Hirakawa ^g, Sumio Yamada ^h,^⁎
^a Department of Cardiac Rehabilitation, Gifu Heart Center. 4-14-4, Yabuta-minami, Gifu, Japan
^b Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine.
^c Department of Cardiac Rehabilitation, Nagoya Heart Center. 1-1-11, Sunadabashi, higasi-ku, Nagoya, Japan
^d Department of Cardiac Rehabilitation, Toyohashi Heart Center. 1-21, Gobudori, Oyamacho, Toyohasi, Japan
^e Department of Cardiology, Gifu Heart Center. 4-14-4, Yabuta-minami, Gifu, Japan
^f Department of Cardiovascular Surgery, Gifu Heart Center. 4-14-4, Yabuta-minami, Gifu, Japan
^g Division of Biostatistics and Data Science, Clinical Research Center. Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, JAPAN
^h Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Japan

^⁎Corresponding author: Sumio Yamada, PT, PhD, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, JapanDepartment of Integrated Health SciencesNagoya University Graduate School of Medicine 1-1-20 Daiko-MinamiNagoyaHigashi-kuJapan

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Highlights

•	A short course of neuromuscular electrical stimulation mitigated post-surgical muscle weakness in older persons with diabetes.
•	The effect of NMES on functional decline was greater in persons ≥ 75 years.
•	Mechanisms of NMES on PSMW may be mainly due to neural adaptation.

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Abstract

Background

: Cardiovascular surgery leads to postsurgical muscle weakness, probably because of muscle proteolysis and peripheral nerve dysfunction, which are augmented by aging and diabetes mellitus.

Objective

: We examined the effect of neuromuscular electrical stimulation (NMES) on postsurgical muscle weakness in older individuals with diabetes mellitus.

Methods

: We conducted a multicentre, randomized, controlled trial, and screened consecutive patients with diabetes who underwent cardiovascular surgery for eligibility (age ≥ 65 years). Those included were randomly assigned to the NMES or the sham group. The primary outcome was the percent change in isometric knee extension strength (%ΔIKES) from preoperative to postoperative day 7. Secondary outcomes were the percent change in usual (%ΔUWS), maximum walking speed (%ΔMWS), and grip strength (%ΔGS). A statistician who was blinded to group allocation used intention-to-treat analysis (student t test).

Results

: Of 1151 participants screened for eligibility, 180 (NMES, n=90; sham, n=90) were included in the primary analysis. %ΔIKES was significantly lower in the NMES than sham group (NMES: mean -2%, 95% confidence interval [CI] -6 to 1; sham: -13%, 95% CI -17 to -9, p < 0.001). Among the secondary outcomes, %ΔMWS was significantly lower and %ΔUWS and %ΔGS were lower, although not significantly, in the NMES than sham group.

Conclusions

: A short course of NMES (< 1 week) mitigated postsurgical muscle weakness and functional decline in older persons with diabetes mellitus. NMES could be recommended as a part of postsurgical rehabilitation in older people with diabetes mellitus, especially those with a low functional reserve.

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