Archives of physical medicine and rehabilitation · 2025
Part I: Effects of Asynchronous vs Conventional Synchronous Neuromuscular Electrical Stimulation on Maximal Evoked Torque, Fatigability, Discomfort, and Strength Gains: A Systematic Review With Meta-analysis and Meta-regression.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Cavalcante Jonathan Galvão Tenório, Ribeiro Victor Hugo de Souza, Marqueti Rita de Cássia, Babault Nicolas, Maffiuletti Nicola A, Costa Rochelle, Vaz Marco Aurélio, Durigan João Luiz Quaglioti
Аннотация
OBJECTIVE: To compare the effects of asynchronous versus conventional synchronous neuromuscular electrical stimulation (NMES) on evoked torque, fatigability, discomfort, and training-induced strength gains.
DATA SOURCES: A systematic search was conducted in 6 electronic databases (PubMed, EMBASE, PEDro, LILACS, SciELO, and Web of Science) for studies published up to April 2025. Guided by a Population, Intervention, Comparator, Outcome, Time Frame framework, we combined terms for the population (humans), intervention (electrical stimulation), comparator (synchronous, asynchronous, spatially distributed sequential, conventional), and outcomes (torque, muscle strength, fatigue, discomfort, evoked contraction).
STUDY SELECTION: We included cross-sectional, repeated measures, or randomized controlled trials of adult or elderly participants (healthy or clinical) receiving electrically induced isometric or dynamic contractions without voluntary effort. Comparisons involved synchronous vs asynchronous current delivery. Outcomes were maximal evoked torque, fatigability, perceived discomfort, and strength adaptations. A total of 22 studies were included from 11,044 records.
DATA EXTRACTION: Two independent reviewers extracted participant demographics, stimulation parameters, electrode configurations, and outcomes. Study quality was assessed with the PEDro scale and evidence quality via GRADE.
DATA SYNTHESIS: Meta-analysis showed that asynchronous NMES produced greater isometric evoked torque than synchronous NMES (P<.01; SMD 95% CI, 0.245-0.957), especially when using larger electrodes (P=.042, β=0.0023). No difference was found in dynamic evoked torque (P=.95; 95% CI, -1.44 to 1.35). Fatigability was significantly lower with asynchronous NMES for both isometric (P<.01; SMD 95% CI, 0.49-1.21) and dynamic contractions (P<.01; SMD 95% CI, 0.61-2.76). Discomfort and strength data were insufficient for firm conclusions.
CONCLUSIONS: Asynchronous NMES effectively reduces muscle fatigability compared with synchronous stimulation. These findings may help clinicians and researchers in optimizing NMES protocols and support the development of asynchronous NMES solutions for clinical use.
DATA SOURCES: A systematic search was conducted in 6 electronic databases (PubMed, EMBASE, PEDro, LILACS, SciELO, and Web of Science) for studies published up to April 2025. Guided by a Population, Intervention, Comparator, Outcome, Time Frame framework, we combined terms for the population (humans), intervention (electrical stimulation), comparator (synchronous, asynchronous, spatially distributed sequential, conventional), and outcomes (torque, muscle strength, fatigue, discomfort, evoked contraction).
STUDY SELECTION: We included cross-sectional, repeated measures, or randomized controlled trials of adult or elderly participants (healthy or clinical) receiving electrically induced isometric or dynamic contractions without voluntary effort. Comparisons involved synchronous vs asynchronous current delivery. Outcomes were maximal evoked torque, fatigability, perceived discomfort, and strength adaptations. A total of 22 studies were included from 11,044 records.
DATA EXTRACTION: Two independent reviewers extracted participant demographics, stimulation parameters, electrode configurations, and outcomes. Study quality was assessed with the PEDro scale and evidence quality via GRADE.
DATA SYNTHESIS: Meta-analysis showed that asynchronous NMES produced greater isometric evoked torque than synchronous NMES (P<.01; SMD 95% CI, 0.245-0.957), especially when using larger electrodes (P=.042, β=0.0023). No difference was found in dynamic evoked torque (P=.95; 95% CI, -1.44 to 1.35). Fatigability was significantly lower with asynchronous NMES for both isometric (P<.01; SMD 95% CI, 0.49-1.21) and dynamic contractions (P<.01; SMD 95% CI, 0.61-2.76). Discomfort and strength data were insufficient for firm conclusions.
CONCLUSIONS: Asynchronous NMES effectively reduces muscle fatigability compared with synchronous stimulation. These findings may help clinicians and researchers in optimizing NMES protocols and support the development of asynchronous NMES solutions for clinical use.