An investigation into the effects of neuromuscular electrical stimulation exercise
in type 2 diabetes: a case study.
Giggins OM, Coughlan GF, Caulfield BM, Crowe LM
Stim XDP Research Group, Institute for Sport and Health, University College Dublin, Dublin 4, Ireland.
e-mail: oonagh.giggins@ucd.ie
INTRODUCTION
Figure 1. Electrode Placement
Exercise is a vital component in the management and prevention of type 2
diabetes (T2D). Both the American College of Sports Medicine (ACSM) and the
American Diabetes Association (ADA) advocate exercise as a treatment method
for T2D [1, 2]. However, given the benefits of engaging in physical activity, many
T2D patients are often unable to partake in physical activity secondary to
complications of their diabetes or other musculoskeletal problems. Neuromuscular
electrical stimulation (NMES) exercise is a likely alternative for diabetic individuals
who face barriers to physical activity. NMES has received much attention in recent
years as a new form of inducing exercise. The ability of NMES to stimulate
innervated muscle has resulted in it’s use as a training tool for individuals without
neuromuscular pathology. Banerjee and colleagues showed that prolonged NMES
exercise in sedentary adults resulted in significant improvements in maximal
Table 1. Venous Blood Markers (VBMs)
aerobic capacity, muscle strength and capacity for physical activity [3]. The aim of
HbA1c (%)
Week 0
9.5
Week 8
8.5
METHODS
Fasting Plasma Glucose (mmol/L)
10.3
9.6
A 58 year old T2DM male (Height 1.77 metres (m), Weight 92.6 kilograms (kg),
Insulin (mIU/L)
6.23
7.00
2 Hour Post Load Plasma Glucose (mmol/L)
12.3
11.3
this case study was to investigate the use of NMES exercise in T2D.
Body Mass Index 29.56 kg/m2) was recruited for this study. Baseline tests (Week
0) included venous blood markers (VBMs), a DEXA scan to assess body
composition and an isokinetic dynamometry test to assess knee extensor and
flexor strength. A blood sample was drawn from a vein in the cubital fossa of the
Table 2. Body Composition
forearm after an overnight fast. A further blood sample was drawn 2 hours post
Week 0
Week 8
Total Mass (kg)
92.6
94.0
% Body Fat
31.9
31.6
Fat Free Mass (kg)
64.19
65.45
consumption of a 35 gram solution of glucose. The baseline tests were repeated at
the 8 week follow-up (Week 8). A specially designed hand held muscle stimulator
(NT2010, BioMedical Research Ltd, Galway, Ireland) was used to deliver impulses
through 8 electrodes (17 x 10.3 centimetres (cm)) applied bilaterally to the
proximal
and distal quadriceps and hamstring muscles via custom made neoprene
garments (Figure 1). The NMES exercise programme consisted of 6 phases at
frequency of 19 Hertz (Hz) and one final phase combining two independent group
Figure 2. Isokinetic and Isometric Torque
frequencies at 90 Hz and 3 Hz. The participant completed six 45 minute training
250
sessions per week for 8 weeks.
RESULTS
VBMs demonstrated improved glucose control after an 8 week NMES exercise
T
O
R
Q
U
E
programme (Table1). Glycated haemoglobin (HbA1c), which reflects the mean
plasma glucose concentration over the previous 2 to 3 months, reduced from 9.5%
at baseline to 8.5% the 8 week follow up. Reductions in fasting plasma glucose
200
150
Week 0
Week 8
100
N
M
50
and 2 hour post load glucose and an increase in insulin levels were measured at
0
week 8. A 0.3% reduction in body fat and an increase in lean muscle mass from
Isometric Q
Isokinetic Q
Isokinetic H
60.53 kg to 61.77 kg were observed (Table 2). Isokinetic and isometric torque also
increased from baseline to the 8 week follow up (Figure 2).
DISCUSSION AND CONCLUSION
This case study demonstrates that an 8 week NMES exercise programme resulted
in improved body composition and increased lower limb strength. The 8 week
NMES exercise programme resulted in clinically significant improvements in
REFERENCES
1. Sigal, R.J., et al., Physical Activity/Exercise and Type 2 Diabetes. Diabetes
Care, 2004. 27(10): p. 2518-2539.
2. Albright, A., et al., Exercise and Type 2 Diabetes. Medicine & Science in Sports
& Exercise, 2000. 32(7): p. 1345-1360.
3. Banerjee, P., et al., Prolonged electrical muscle stimulation exercise improves
strength and aerobic capacity in healthy sedentary adults. J Appl Physiol, 2005.
99(6): p. 2307-2311.
glycaemic control and glucose tolerance. These results present preliminary
evidence for the potential use of this type of EMS training in T2D. Studies with
larger participant numbers and intervention periods are required to investigate this
further.
ACKNOWLEDGEMENTS