TOPLINE:

Adding neuromuscular electrical stimulation (NMES) to physiotherapy in hospitalized patients with severe heart failure (HF) — including recent heart transplant recipients and those with implanted cardiac devices — was safe and improved overall functional performance more than physiotherapy alone, particularly in patients with lower function at baseline.

METHODOLOGY:

• Researchers conducted a prospective randomized controlled study at a German hospital to evaluate whether adding NMES to standard physiotherapy was safe and improved function in hospitalized patients with severe HF.
• They enrolled 30 adults (mean age, about 48 years; 19 men) who had advanced HF or were within 6 months post-heart transplant and were expected to stay hospitalized for at least 2 weeks; patients with implanted cardiac devices or left ventricular assist devices (LVADs) were also included.
• Patients were randomly assigned to receive either regular physiotherapy (control) or physiotherapy plus NMES for 1 hour per day, 5 days per week, over 2 weeks (10 sessions). Stimulation targeted the front and back thigh muscles and calf muscles, with frequency gradually increased from 2 to 35 Hz.
• Functional performance was measured at baseline and after 2 weeks using five tests, including the 6-minute walking test and the sit-to-stand test. The results were combined into a composite StimFIT5 Score, which served as the primary endpoint.
• The researchers also assessed depressive symptoms using Patient Health Questionnaire-9 (PHQ-9) and monitored safety by evaluating skin reactions, creatine kinase levels, hemodynamic instability or arrhythmias, and potential interference with cardiac devices or LVADs.

TAKEAWAY:

• NMES was safe and well tolerated, with no severe adverse events — no hemodynamic instability or arrhythmias, no electromagnetic interference in patients with implanted devices, and no significant changes in LVAD parameters or creatine kinase levels.
• The StimFIT5 Score improved in both the stimulation group (P < .001) and the control group (P = .006), but the improvement was greater in the stimulation group (P = .002). Patients with low baseline performance had greater percentage improvement than those with high baseline performance (P = .008).
• Both female and male patients in the stimulation group showed significant improvements in all functional parameters, with no statistically significant differences in the degree of improvement between sexes.
• PHQ-9 scores decreased in both groups, with no significant difference between the groups.

IN PRACTICE:

"NMES should be considered as an additional therapy option, particularly in patients with severe heart failure and extremely low functional performance level; however, further evaluation is needed," the researchers wrote.

SOURCE:

The study was led by Theresa Maria Betz, of University Hospital Heidelberg in Heidelberg, Germany. It was published online on January 19, 2026, in ESC Heart Failure.

LIMITATIONS:

The study had a small cohort size and lacked blinding. The length of hospital stay before enrollment varied widely, ranging from 4 to 164 days. The composite StimFIT5 Score requires further validation.

DISCLOSURES:

This study did not receive any specific funding. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.