Key result
Neuromuscular Electrical Stimulation (NMES) significantly improved peak oxygen uptake (MD 2.03 mL/kg/min) and exercise capacity in patients with HFrEF compared to control interventions.
Why the study?
Many patients with HFrEF are unable to participate in conventional exercise-based cardiac rehabilitation, and the clinical effectiveness of NMES as an alternative rehabilitation treatment remains uncertain.
Does neuromuscular electrical stimulation (NMES) improve exercise capacity and cardiac function in adult patients with HFrEF?
Meta-Analysis (n=636)
Does neuromuscular electrical stimulation (NMES) improve exercise capacity and cardiac function in adult patients with HFrEF?
Mean Difference: 2.03 (95% CI 1.21–2.84)
p-value: p=< 0.00001
Neuromuscular electrical stimulation (NMES) offers meaningful physiological and functional benefits, particularly improving exercise capacity, supporting its role as an adjunct rehabilitation modality in HFrEF patients who cannot tolerate conventional exercise.
Supports NMES as rehabilitation alternative for HFrEF patients unable to exercise conventionally; confirms peak VO2 gains across 12 RCTs.
Heart Failure with Reduced Ejection Fraction (HFrEF) is associated with substantial functional impairment, and many patients are unable to participate in conventional exercise-based cardiac rehabilitation. Neuromuscular Electrical Stimulation (NMES) has been proposed as an alternative rehabilitation treatment, but its clinical effectiveness remains uncertain. This review aims to evaluate the effectiveness of NMES in improving cardiac function and exercise capacity in patients with HFrEF. A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing NMES with standard medical therapy, exercise training, or no intervention in adult patients with HFrEF were identified through major electronic databases. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Pooled effects were calculated as Mean Differences (MD) with 95% Confidence Intervals (CIs) using Review Manager (RevMan) version 5.4. Twelve RCTs involving 636 participants were included. NMES significantly improved peak oxygen uptake (VO2 peak) (MD 2.03 mL/kg/min; 95% CI 1.21 to 2.84; p < 0.00001), systolic blood pressure (MD −2.02; 95% CI −3.97 to −0.06; p = 0.04), Left Ventricular Ejection Fraction (LVEF) (MD −1.38%; 95% CI −2.73 to −0.03; p = 0.05), and Heart Rate (HR) (MD 2.19 beats/min; 95% CI 0.44 to 3.95; p = 0.01). A borderline significant improvement was observed in the Six-Minute Walk Test (6MWT) distance (MD −11.40 m; 95% CI −23.04 to 0.24; p = 0.05). No significant effects were found for diastolic blood pressure (MD −0.12; 95% CI −3.30 to 3.06; p = 0.94) or Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (MD 1.97; 95% CI −9.06 to 13.01; p = 0.73). NMES is associated with meaningful improvements in exercise capacity and selected parameters of cardiac function in patients with HFrEF, supporting its role as a potential adjunct rehabilitation treatment.
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Alparisi et al. (2026) conducted a meta-analysis in Heart Failure with Reduced Ejection Fraction (HFrEF) (n=636). Neuromuscular Electrical Stimulation (NMES) vs. Standard medical therapy, exercise training, or no intervention was evaluated on Peak oxygen uptake (VO2 peak) (MD 2.03 mL/kg/min, 95% CI 1.21 to 2.84, p=< 0.00001). Neuromuscular Electrical Stimulation (NMES) significantly improved peak oxygen uptake (MD 2.03 mL/kg/min) and exercise capacity in patients with HFrEF compared to control interventions.
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