Multimodal Assessment of NMES Effects on Respiratory and Peripheral Muscles in COPD

Chronic Obstructive Pulmonary Disease (COPD) is characterized by chronic airflow limitation and progressive respiratory and peripheral muscle dysfunction. While pulmonary rehabilitation is a cornerstone of management, severe breathlessness often limits a patient's exercise tolerance. Neuromuscular Electrical Stimulation (NMES) offers an alternative modality to train specific muscle groups without inducing severe dyspnea. However, the comparative efficacy of stimulating respiratory muscles versus peripheral muscle groups requires deeper investigation using precise physiological and biochemical markers. This study utilizes a three-arm randomized controlled design to evaluate and compare the localized and systemic effects of targeted NMES. The mechanical properties of the respiratory system will be monitored using diaphragm ultrasound, focusing on active contractility and movement. Concurrently, systemic inflammation and muscle anabolic responses will be analyzed through plasma biomarkers to understand the underlying biomolecular pathways. Upon meeting the eligibility criteria and providing written informed consent, the 45 participants will be randomly assigned to one of three study arms in a 1:1:1 ratio. All participants will undergo a standardized baseline assessment. Following the allocation, each group will complete their designated 8-week intervention protocol consisting of 3 sessions per week (total of 24 sessions) concurrently with Pursed-Lip Breathing (PLB) training. A comprehensive post-intervention reassessment will be conducted immediately following the final session to determine the comparative physiological and biochemical outcomes.