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The Use of Neuromuscular Electrical Stimulation to Reverse Muscle Atrophy in Patients With Rheumatoid Arthritis

This study has been completed.
Information provided by (Responsible Party):
University of Pittsburgh Identifier:
First received: June 18, 2009
Last updated: September 9, 2014
Last verified: September 2014
This study will be a small randomized clinical trial to test the effectiveness of neuromuscular electrical stimulation (NMES) to improve physical function and reverse muscle atrophy in patients with rheumatoid arthritis (RA). The investigators will also determine the mechanism by which NMES affects muscle hypertrophy and physical function. The proposed study will be the first step in demonstrating that NMES training is an effective alternative to highly intense volitional exercises (VE) in individuals with RA. After baseline testing, 60 individuals with RA will be randomly assigned to a 16-week NMES program or highly intense VE program. Both programs will be applied based on the best current clinical evidence. Subjects will be re-assessed after intervention. Groups will be compared for differences in performance-based and self-reported lower extremity function, muscle volume, muscle strength, proportion and area of type I and II muscle fibers, fat content, and muscle oxidative capacity from pre- to post-intervention. Changes in physical function, muscle volume, and muscle strength will be correlated with proportion and area of type I and II muscle fibers, fat content, and markers of muscle oxidative capacity.

Condition Intervention
Rheumatoid Arthritis
Other: Neuromuscular electrical stimulation
Other: Volitional exercises

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Use of Neuromuscular Electrical Stimulation to Reverse Muscle Atrophy in Patients With Rheumatoid Arthritis

Resource links provided by NLM:

Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
  • Short Physical Performance Battery [ Time Frame: 4 months ]

Secondary Outcome Measures:
  • Muscle volume [ Time Frame: 4 months ]

Enrollment: 64
Study Start Date: June 2009
Study Completion Date: February 2014
Primary Completion Date: December 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Neuromuscular electrical stimulation
NMES will be used as in clinical practice based on an evidence-based approach. NMES will be applied at the participant's maximum tolerance. Participants will receive 3 treatments/week for 12 weeks with at least 48h between training sessions.
Other: Neuromuscular electrical stimulation
Strength of the quadriceps muscles will be tested at the beginning of each session. During administration of the NMES participant will sit with the knees bent at 70 degrees. The force sensing pad will be secured to the ankle joint. Two electrodes will be placed on the thigh muscle; one near the hip and the other near the knee joint. The intensity of NMES will be increased gradually according with tolerance. During each treatment 15 electrically elicited muscle contractions will be administered to each thigh. Each contraction will last 14 sec followed by 1min rest.
Other Name: Electrical Stimulation
Active Comparator: Volitional exercises
VE will be used as in clinical practice based on an evidence-based approach. VE program will be the one shown to positively affect muscle hypertrophy and will follow the resistance training principles. Participants will receive 3 treatments/week for 12 weeks with at least 48h between training sessions
Other: Volitional exercises
The training will include bilateral exercises using resistance equipment (Leg Extension and Leg Press machines). Each resistance exercise will have: (a) dynamic muscle action at moderate repetition velocity (1-2 s concentric, 1-2 s eccentric, 2-3 s interval); (b) 3 sets of 8 repetitions with a load corresponding to 80% of one repetition maximum(1-RM); (c) 2-min rest period between sets and exercises.
Other Name: Strength training


Ages Eligible for Study:   21 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • English-speaking
  • Age 21 or older
  • Diagnosed with RA for at least 5 years according to the criteria of the American College of Rheumatology
  • Independent ambulator

Exclusion Criteria:

  • History of cardiovascular disease or uncontrolled hypertension (above 140/90 mmHg);
  • History of a quadriceps tendon or patellar tendon rupture;
  • History of previous adverse reaction associated with electrical stimulation treatment;
  • Surgery to the dominant lower extremities within the past 6 months.
  • History of a neurological disorder that may affect lower extremity function, such as cerebrovascular accident or neuropathy, parkinson's disease, multiple sclerosis, etc.;
  • History of muscle disease such as muscular dystrophy;
  • Change in medication regimen (excluding NSAID change) during the month prior to treatment;
  • Current use of cholesterol-lowering medication;
  • History of malignancy during the last 5 years, excluding skin cancers other than melanoma;
  • Current or anticipated pregnancy;
  • Less than 70º of passive knee flexion;
  • Are not willing to undergo needle biopsy.
  • Participated in progressive resistance training or NMES training in the prior year;
  • Prior adverse effects with local anesthesia.
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Please refer to this study by its identifier: NCT00924625

United States, Pennsylvania
Physical Therapy Department
Pittsburgh, Pennsylvania, United States, 15260
Sponsors and Collaborators
University of Pittsburgh
Principal Investigator: Sara R Piva, PT, PhD University of Pittsburgh
  More Information

Responsible Party: University of Pittsburgh Identifier: NCT00924625     History of Changes
Other Study ID Numbers: K01HD058035-01 ( US NIH Grant/Contract Award Number )
Study First Received: June 18, 2009
Last Updated: September 9, 2014

Additional relevant MeSH terms:
Arthritis, Rheumatoid
Muscular Atrophy
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases
Connective Tissue Diseases
Autoimmune Diseases
Immune System Diseases
Pathological Conditions, Anatomical
Neuromuscular Manifestations
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms processed this record on May 22, 2017