A new generation of neuromuscular electrical stimulation (NMES) devices can exercise aerobically at equivalent rates to voluntary exercise. Many with type 2 diabetes cannot or will not exercise sufficiently. The objective of this pilot investigation was to see (1) if it was an acceptable training modality for men with type 2 diabetes mellitus and (2) to assess effects on haemoglobin A1c levels.
Design, setting, participants and intervention
A case series of eight men with type 2 diabetes mellitus (aged 53±8; body mass index 32±5 5 kg/m2) trained with the NMES system for 1 h 6 times weekly for 8 weeks, unsupervised, at home. There were no other medication or lifestyle interventions. The aerobic NMES exercise system delivers a repeating set of four complex staggered pulses at high intensities (typically 100 mA+) through an array of eight thigh electrodes.
The primary outcome measures were changes in haemoglobin A1c and the responses in a questionnaire on participants' perceptions of the system. Body mass and composition were also measured before and after the NMES intervention period.
All participants could use the system at a level that left them breathless and sweaty and with a heart rate over 120 beats per minute. Haemoglobin A1c levels improved by 0.8±0.7% from 7.4±1.3% (mean ± SD) to 6.6±1.0% (p=0.01). All participants considered the system suitable for people with diabetes, would recommend it and would continue to use it twice a week ‘to maintain improvements’.
These results suggest that aerobic NMES may be acceptable and have a beneficial effect on haemoglobin A1c of some men with diabetes. The treatment may be of particular benefit in those who will not or cannot do adequate amounts of voluntary exercise. A randomised control trial is required for conclusive efficacy data.
Advanced NMES techniques can now deliver aerobic exercise at training intensities. Improvements in aerobic fitness have been shown in the healthy, those with cardiac failure and the obese.
It was hypothesised that this could be of benefit to those with type 2 diabetes, particularly those with barriers to voluntary exercise.
A pilot study was undertaken to assess the system and its effects on HbA1c.
All participants could use the system, unsupervised, at home, at intensities that made them sweaty and breathless.
Average improvement in HbA1c of 0.8 ± 0.7% (p=0.01) is consistent with exercise interventions.
The system may be an alternative for patients that will not or cannot undertake voluntary exercise.
Strengths and limitations of this study
The technology used is now well proven to have substantial aerobic training effects in other groups.
There were no other lifestyle interventions.
This is a small uncontrolled pilot study on a group of men who pro-actively volunteered for participation in an exercise programme. While the results are promising, it was not a randomised controlled trial, and the sample may not be representative of patients with type 2 diabetes mellitus.