Quick Overview
Scientists in Athens tested whether electrical muscle stimulation could slow muscle loss in critically ill patients who could not exercise. A randomised hospital study used ultrasound to measure the rectus femoris and vastus intermedius on day two and again one week later. Both groups lost muscle. The stimulation group lost less. Right thigh size fell about 8% and 12.5% with daily sessions, versus about 13.9% and 21.5% with usual care. Those gaps were significant. Published in Critical Care by a University of Athens team, the evidence is strongest for very sick, bed-bound patients, and it hints at benefit for others who cannot train. The full post has the settings, both-leg numbers, and limits.
We always provide direct links to the original research at the end of every article so you can review the evidence yourself.
Sick patients lost less thigh muscle when doctors used daily electrical muscle stimulation.
In a busy Athens intensive care unit, doctors saw a problem they could not ignore. Very sick patients were losing muscle fast. Some could not move. Some could not even stay awake. Sepsis, organ failure, and bed rest were all working against them.
So the team asked a simple question. Could gentle electrical pulses help protect muscle when normal exercise was impossible?
The study was run at Evangelismos Hospital. That hospital works with the National and Kapodistrian University of Athens. Greece has one of the oldest medical traditions in the world. The paper was published in 2009 in Critical Care, a peer-reviewed intensive care journal from BioMed Central. The trial was registered at clinicaltrials.gov as NCT00882830.
Lead author Vasiliki Gerovasili worked with Serafim Nanas and colleagues. They studied adults with an APACHE II score of 13 or higher. That score means serious illness. Patients were randomly placed into two groups. One group received daily electrical muscle stimulation. The other received usual care only.
Forty-nine patients were assigned. Twenty-six could be fully measured. Thirteen were in each group. Ages averaged about 59 years. Most needed mechanical ventilation. Reasons for admission included sepsis, trauma, and neurologic illness.
Stimulation started on day two after admission. It continued through day nine. It was applied to both legs. The targets were the quadriceps and the peroneus longus. Each session lasted 55 minutes. That included five minutes of warm-up and five minutes of recovery.
The signal was 45 hertz. Each pulse lasted 400 microseconds. Muscles worked for 12 seconds. They rested for six seconds. Current was raised until a contraction could be seen. Average strength was about 38 milliamps on the thigh. About 37 milliamps was used on the lower leg. Patients did not need to join in. The machine did the work. About 81 percent of planned sessions were completed.
Muscle size was checked with ultrasound. Two operators were blinded to the group. They measured cross-sectional diameter of two front-thigh muscles. These were the rectus femoris and the vastus intermedius. Scans were taken on day two. They were repeated seven or eight days later. The probe site was marked so the second scan matched the first.
Both groups lost muscle. The stimulation group lost less.
On the right rectus femoris, diameter fell from 1.42 cm to 1.31 cm with stimulation. That was a drop of 0.11 cm, or 8 percent. In the control group it fell from 1.59 cm to 1.37 cm. That was a drop of 0.21 cm, or 13.9 percent. The difference was statistically significant.
On the right vastus intermedius, stimulation patients fell from 0.91 cm to 0.81 cm. That was 0.10 cm, or 12.5 percent. Control patients fell from 1.40 cm to 1.11 cm. That was 0.29 cm, or 21.5 percent. That gap was also significant.
The left leg told a similar story. Absolute loss in the left vastus intermedius was smaller with stimulation. The difference there was significant. Relative losses on the left favoured stimulation, but did not all reach significance.
The authors said electrical muscle stimulation was well tolerated. They said it seemed to preserve muscle mass in these critically ill patients. They were careful not to claim a cure. This paper did not measure strength or walking ability. Many patients were too sick to cooperate with those tests. Oedema also forced some people out of the scan analysis. The final sample was small. The authors said more research is needed on muscle function and critical illness polyneuromyopathy.
Even with those limits, the pattern was clear. In the first week of intensive care, thigh muscle can shrink quickly. Daily leg stimulation was linked with less shrinkage than usual care alone. The benefit showed up in patients who could not exercise on their own.
Earlier work, cited by the authors, had already explored stimulation in severe COPD and chronic heart failure. Those patients also struggle to train. A separate ICU metabolism study had hinted at less muscle breakdown. This Athens trial was the first here to track muscle size directly with ultrasound.
The finding speaks first to critically ill patients under hospital care. It may also interest other people who cannot do normal training. That includes severe lung disease, heart failure, and long bed rest. The study does not prove the same result in healthy people. It does show that muscle activation still mattered when movement was impossible.
This was supervised hospital treatment. It is not a claim that a home device treats critical illness. It is a published randomised finding from a university hospital, in a proper journal, with numbers anyone can check. The paper is open access: Gerovasili and colleagues, Critical Care, 2009, volume 13, article R161.
This article is general information about published research. It is not personal medical advice. Electrical muscle stimulation in intensive care was delivered by clinicians. People with a pacemaker, pregnancy, epilepsy, or a medical condition should speak with a qualified health professional before any stimulation use.
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Research Summary
| Detail | What the study reports |
|---|---|
| Full title | Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study |
| Authors | Vasiliki Gerovasili, Konstantinos Stefanidis, Konstantinos Vitzilaios, Eleftherios Karatzanos, Panagiotis Politis, Apostolos Koroneos, Aikaterini Chatzimichail, Christina Routsi, Charis Roussos, and Serafim Nanas |
| Research centre | First Critical Care Department, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece; ultrasound support from the Second Department of Radiology, Attiko Hospital, Athens |
| Journal and date | Critical Care, volume 13, article R161; received 26 April 2009, accepted 8 October 2009, published 8 October 2009; open access under BioMed Central |
| Link to the original study | http://ccforum.com/content/13/5/R161 (DOI: 10.1186/cc8123) |
| Trial registration | clinicaltrials.gov NCT00882830 |
| Study design | Prospective randomised study with stratified randomisation by age and gender; patients with an APACHE II admission score of 13 or higher were assigned on day two to daily lower-limb electrical muscle stimulation or usual care |
| Who was studied | Critically ill adults, mean age 59 ± 21 years; final measured groups were about 59 and 56 years old, with similar illness severity (APACHE II about 19 vs 18, SOFA about 10 vs 8, SAPS 3 about 66 vs 61) |
| Main reasons for admission | Sepsis, trauma, neurologic illness including cerebrovascular events, and other causes; almost all patients were mechanically ventilated |
| How many patients | 247 ICU admissions were screened; 49 met the score threshold and were randomised (24 stimulation, 25 control); 26 completed both ultrasound scans (13 in each group) |
| Why some were not measured | Death or discharge before the second scan, oedema that blocked ultrasound, or a technical problem; these losses were spread across both groups |
| What was stimulated | Both legs, every day from day two to day nine, on the quadriceps and peroneus longus; rectangular electrodes 90 × 50 mm after shaving and skin cleaning |
| Session settings | Biphasic symmetric pulses at 45 Hz, 400 microsecond pulse duration, 12 seconds on and 6 seconds off, strong enough for a visible contraction (confirmed by palpation if needed) |
| Current and session length | Mean current about 38 ± 10 mA on the quadriceps (range 19–55) and 37 ± 11 mA on the peroneus longus (range 23–60); each session lasted 55 minutes, including 5 minutes warm-up and 5 minutes recovery; about 81 ± 26% of planned sessions were completed |
| How muscle was measured | Blinded ultrasound of cross-sectional diameter of rectus femoris and vastus intermedius, midway between the anterior superior iliac spine and the patella, on day two and again 7 or 8 days later; probe site was marked for repeat scanning |
| Right thigh result | Rectus femoris fell 0.11 ± 0.06 cm (8 ± 3.9%) with stimulation versus 0.21 ± 0.10 cm (13.9 ± 6.4%) in control; vastus intermedius fell 0.10 ± 0.05 cm (12.5 ± 7.4%) versus 0.29 ± 0.28 cm (21.5 ± 15.3%); both between-group gaps were significant |
| Left thigh result | Both muscles still shrank in both groups; absolute loss was smaller with stimulation, and the left vastus intermedius difference was significant (0.09 ± 0.05 cm versus 0.22 ± 0.26 cm); some left-side relative differences did not reach significance |
| Tolerance and main conclusion | Sessions were well tolerated and did not need patient effort; authors concluded stimulation seemed to preserve muscle mass, while saying effects on strength, muscle structure, and critical illness polyneuromyopathy still need further study |
| Limits stated by the authors | Small final sample, oedema excluded many patients so findings apply to those without oedema, and no strength or functional recovery data were collected because most patients could not cooperate |
| Support | Co-financed by the European Social Fund and the Greek Ministry of Development (GSRT) under a PENED project; ultrasound equipment support from the Thorax Foundation; authors reported no competing interests |
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