1. By Gabriel Ausfresser University of Rhode Island BME 482

2.  Introduction ◦ What is Chronic Heart Failure (CHF)? ◦ What is Electrical Muscle Stimulation (EMS)?  How does EMS relate to CHF?  Research Experiment ◦ Hypothesis ◦ Methods ◦ Results  Conclusions  References

3.  What is Chronic Heart Failure (CHF)? ◦ Heart cannot pump sufficient blood and oxygen to body ◦ Results of CHF include  Enlargement of Heart  More heart muscle mass  Faster heart rate ◦ Symptoms  Shortness of Breath  Fatigue  Weight Gain  Ankle Swelling  Coughing  Exercise Intolerance

4.  CHF Statistics ◦ 5.8 million people in U.S. have heart failure ◦ 670,000 people are diagnosed every year in U.S. ◦ In 2006, CHF contributed to 282,754 deaths

6.  What is Electrical Muscle Stimulation (EMS)? ◦ Technique of inducing a muscle contraction ◦ Uses an electrical impulse from a device  Impulses mimic action potentials from Central Nervous System ◦ Signals travel down a wire to an electrode  Attached to skin in close proximity to muscle that needs stimulating

7.  Uses for EMS? ◦ Electrotherapy  Prevent atrophy after injury ◦ Muscle Strength Training  Targets a specific muscle to train  Used by athletes ◦ Weight Loss?  Proven that EMS does not burn as many calories as a full-body workout  EMS devices are regulated by the FDA

9.  Proven that exercise prolongs life of patients with CHF ◦ Allows for more activity throughout the day ◦ Unfortunately, most patients with CHF have other conditions  Make conventional exercise very difficult  Most patients will not have the desire to exercise  EMS can be used to exercise patients with CHF right from their homes ◦ This seems more desirable for CHF patients

10.  Doctors Banerjee, P., Caulfield, B., Crowe, L., and Clark, A. conducted an experiment in 2009 ◦ Hypothesis:  A home-based EMS training program can effectively improve the health of CHF patients similar to standard exercise programs.

11.  10 Patients ◦ Left ventricular systolic dysfunction with New York Heart Association Class II-III  18 Week Training Program ◦ 1 st 8 weeks  EMS training – at least one hour a day for 5 days  10 Electrodes placed on legs via tight shorts  9 Volts, rhythmic pulses at 4 Hz, maximum current 300 mA  Stimulation of quadriceps, hamstrings, gluteal, and calf muscles

13.  Next two weeks ◦ “Washout period”  No training at all, minimal activity  Last 8 weeks ◦ “Control period”  Returned to habitual activity  After 1 st 8 weeks and after the last 8 weeks, a series of physical tests were taken by the patients ◦ Peak oxygen consumption, treadmill walking time, 6-minute walking distance, quadriceps strength, and BMI

14. Before any training After EMS training period After control period Peak Oxygen Consumption 1.7 L/min1.8 L/min1.7 L/min Treadmill walking time 9 minutes10.68 minutes9.38 minutes 6-minute walking distance 415 meters455 meters394 meters Quadriceps strength 377.9 Newtons404.9 Newtons363.4 Newtons BMI27.9 kg/m^227.5 kg/m^227.7 kg/m^2

15.  Based on the results: ◦ Treadmill walking time increased ◦ Peak O 2 levels increased ◦ 6-minute walking distance increased ◦ Quad strength increased ◦ BMI decreased  The results are seen after any type of exercise by anyone

16.  EMS successfully increased strength of legs, increased endurance, and lowered the BMI of the patients with CHF  These results will keep the patient healthier and prolong the life of the patient with CHF  The patient can get an efficient workout without leaving her/his house.  Patients who have no motivation for exercise will be able to use EMS training with ease  Only in research phase, but EMS is a possible alternative to strenuous exercise in the future

17.  Banerjee, P., Caulfield, B., Crowe, L., & Clark, A. (2009). Prolonged electrical muscle stimulation exercise improves strength, peak VO2, and exercise capacity in patients with stable chronic heart failure. Journal of Cardiac Failure, 15(4), 319-326. Retrieved from CINAHL database.  http://en.wikipedia.org/wiki/Electro_Muscular_Stimulation  http://www.americanheart.org/presenter.jhtml?identifier= 337  http://en.wikipedia.org/wiki/Heart_failure  http://www.cdc.gov/dhdsp/library/fs_heart_failure.htm  http://www.brownchiro.com/physicaltherapy.htm  http://www.nhlbi.nih.gov/.../HF_SignsAndSymptoms.html  http://www.topnews.in/health/physicians-uncertain- therapeutic-approaches-heart-failure-patients-21018