Effects of neuromuscular electrical stimulation during hemodialysis on muscle strength, functional capacity and postural balance in patients with end-stage renal disease: a randomized controlled trial

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BACKGROUND: Hemodialysis patients (HD) have a limited physical capacity and this often means low adherence to rehabilitation programs based on conventional exercise. This study investigated the effectiveness of neuromuscular electrical stimulation (NMES) during HD therapy on muscle strength, functional capacity and postural balance in HD patients. METHODS: Twenty-two HD patients were randomly assigned to a control group (CG) or a neuromuscular electrical stimulation training group (NSTG). The NSTG underwent NMES on the quadriceps muscle during HD sessions for 12 weeks, three times per week (40 min per session. Center of pressure (COP) displacement in the mediolateral direction (COPx), in the anteroposterior direction (COPy), and the COP area (COP area) were recorded using a stabilometric platform. Timed Up and Go test (TUG) and Sit to Stand (STS30) tests, 6-minute walking test (6MWT), and the maximal voluntary contraction (MVC) were measured before and after the intervention in both groups. RESULTS: There was a significant increase in MVC (+ 24.5%; P < 0.01), 6MWT (+ 9.8%; P < 0.05) and STS30 (+ 25.6%; P < 0.01) performance in the NSTG following the NMES intervention period. A significant reduction was observed in TUG (-11.8%; P < 0.01), COPx(-20.1%; P < 0.05) and COPy (-24.7%; P < 0.01) following the intervention period only in the NSTG. However, no significant changes were observed in the CG following the intervention period. CONCLUSION: This study supports the effectiveness of intradialytic NMES to improve muscular strength, functional capacity and postural balance in HD patients. Given the limited implementation of exercise programs in dialysis clinical practice, NMES during HD sessions offers a novel therapeutic alternative to enhance physical condition and quality of life in these patients. TRIAL REGISTRATION: Pan African Clinical Trial Registry Identifer: PACTR202206634181851 Registered on 21/06/2022. Registered trial name: Beneficial Effect of Intradialytic Electrical Muscle Stimulation in Hemodialysis Patients.

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