For patients with rheumatoid arthritis (RA), both neuromuscular electrical stimulation and high-intensity volitional resistance training can effectively improve muscle structure and function, according to results published in Arthritis Care & Research.

Some patients with RA may be unable to tolerate high-intensity resistance exercise, or it may be contraindicated. Neuromuscular electrical stimulation may be a viable alternative for these patients, although attrition must be considered.

The study included adults with RA who were assigned to receive 36 sessions of neuromuscular electrical stimulation (n=31) or volitional training (n=28) over the course of 16 weeks. Outcome measures included muscle structure and function (measured using quadriceps muscle area, density, and strength), performance-based and patient-reported physical function, feasibility (measured by pain, disease activity, attrition, and adherence), and myocyte characteristics (measured using area, proportion of type I or II muscle fibers, and intramyocellular lipid content).

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The intensity of the neuromuscular electrical stimulation intervention was significantly less compared with the volitional intervention (31% vs 77% of maximum effort).

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Participants in both groups experienced significant improvements in muscle structure and function (P values from <.001 to .019). Improvements in muscle characteristics and physical function did not differ between the groups.

In the neuromuscular electrical stimulation group, attrition was 29% compared with 7% in the volitional group. The researchers also note that the exercises did not result in serious adverse events or increases in pain and disease activity.

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Piva SR, Khoja SS, Toledo FGS, et al. Neuromuscular electrical stimulation compared to volitional exercise in improving muscle function in rheumatoid arthritis: a randomized pilot study [published online May 21, 2018]. Arthritis Care Res. doi: 10.1002/acr.23602