Subjects then initiate passive electrical muscle stimulation (EMS) delivered by a commercially available FDA approved neuromuscular stimulator (EMPI 300PV or its replacement, EMPI Continuum device obtained from EMPI, Inc., St Paul MN) 3 times a week to the quadriceps muscle groups (15 minutes on each side, 30 minutes total) while on hemodialysis. The duration of training will last for 4 months. Subjects will be monitored at regular intervals during the training to make sure they are doing the training correctly and they are not experiencing any problems.

use of passive electrical muscle stimulation on quadriceps muscle 3 times a week for patients in dialysis

Muscle strength was measured using a belt-stabilized hand held dynamometer (BSHHD) using a validated technique. Briefly, isometric knee extension strength (torque) was measured with patients seated on an elevated chair and their knees bent at about 90o of flexion (i.e., the legs hanging vertical). Patients are stabilized to the chair with straps around proximal thighs and waist. A dynamometer-stabilizing belt is passed around a bar secured behind the back legs of the chair and over a calibrated hand-held dynamometer that was placed against the anterior leg of the patient just proximal to the malleoli. The patient is asked to perform three leg extensions with the leg separated by 30 seconds of rest. The first effort is sub-maximal to get the patient accustom to the procedure. Then two full strength efforts are performed and used for calculation of average peak force (newtons, N) generated. The test is performed sequentially on both legs at each measurement session.

Advanced body composition analysis will be performed by DXA scan to measure regional fat and lean mass before starting EMS training and again after 2 and 4 months of EMS training. Specific areas of interest will be in determining whether EMS training produces the expected changes in thigh fat and muscle mass. The test is performed in the CRU at the University of Iowa using a Discovery A DXA scanner with the latest software version package (Hologic Inc., Bedford, MA). The advanced body composition analysis software package measures total regional body composition (cm2) using a validated technique that produces comparable results to a CT scan with less cost and radiation exposure.The total radiation dose is less than one tenth that of a standard CXR and equivalent to one-day exposure to natural background radiation. Patients will be asked to report to the CRU dressed metal-free (no zippers, jewelry, piercings, underwire bra, etc.). Each study will take approximately 30 minutes.

This was a longitudinal cohort study where all patients were entered into one study group receiving electrical muscle stimulation 3x/week for 30 minutes each session for a total of 16 weeks followed by a 4 week post-EMS study visit.

Muscle strength was measured using a belt-stabilized hand held dynamometer (BSHHD) using a validated technique. Briefly, isometric knee extension strength (torque) was measured with patients seated on an elevated chair and their knees bent at about 90o of flexion (i.e., the legs hanging vertical). Patients are stabilized to the chair with straps around proximal thighs and waist. A dynamometer-stabilizing belt is passed around a bar secured behind the back legs of the chair and over a calibrated hand-held dynamometer that was placed against the anterior leg of the patient just proximal to the malleoli. The patient is asked to perform three leg extensions with the leg separated by 30 seconds of rest. The first effort is sub-maximal to get the patient accustom to the procedure. Then two full strength efforts are performed and used for calculation of average peak force (newtons, N) generated. The test is performed sequentially on both legs at each measurement session.

Longitudinal prospective study of the effect of electrical muscle stimulation (EMS) on muscle strength.

This is a longitudinal pilot study of electrical muscle stimulation (EMS training) on outcomes measures such as quadriceps strength. All participants under go the same protocol of EMS training. EMS is provided sequentially for 15 minutes to both the right and left quadriceps muscle groups three times a week while on hemodialysis. EMS is delivered to the quadriceps muscle groups using a neuromuscular electrical stimulator (using either the EMPI 300PV or its replacement, the Continuum device, EMPI, Inc). The device generates electrical impulses that are delivered to nerves stimulating the muscles through electrodes applied to the skin surface. Patients are taught how to place the adherent electrode pads over the quadriceps muscles on the upper thigh a few inches below the anterior iliac crest and just above the patella bilaterally. The patient will feel contraction of the muscles and may feel mild shortness of breath and tingling of the skin but otherwise is expected to tolerate the stimulation well. The first intervention will be observed through the entire treatment. If the patient feels excessively fatigued or other untoward signs the stimulator will be turned off until they feel better and then restarted to achieve the full treatment time.