Effects of Neuromuscular Electrical Stimulation and Aerobic Exercise Training on Arterial Stiffness and Autonomic Functions in Patients With Chronic Heart Failure *Petr Dobšák, ‡Josef Tomandl, †Lenka Spinarova, †Jiri Vitovec, §Ladislav Dusek, **Marie Novakova, §Jiri Jarkovsky, †Jan Krejci, †Petr Hude, †Tomáš Honek, *Jarmila Siegelova, and *Pavel Homolka *Department of Sports Medicine and Rehabilitation and †1st Department of Internal Medicine, St. Anna Faculty Hospital and Masaryk University of Brno; ‡Department of Biochemistry; §Institute of Biostatistics and Analyses, Masaryk University of Brno; and **Institute of Physiology, Faculty of Medicine, Masaryk University of Brno, Brno, Czech Republic Abstract: Neuromuscular electrical stimulation (NMES) of leg muscles has been introduced in clinical practice as a rehabilitation (RHB) method in patients with chronic heart failure (CHF); however, the role of NMES on the reduction of arterial stiffness and autonomic disbalance in these patients has not yet been studied. Sixty-one patients with stable CHF (mean age 58.9 [2.1] years; mean ejection fraction 31 [4.2]%, New York Heart Association II–III) were randomly assigned into two groups. Patients in (i) exercise training group (ET; n = 30) underwent 12 weeks of bicycle ET (3 ¥ 40 min/week); (ii) group NMES (n = 31) performed 12 weeks of NMES of quadriceps and calf muscles (frequency 10 Hz, mode “20 s on–20 s off,” inten- sity 60 mA), 2 ¥ 60 min/day. Noninvasive assessment of arterial stiffness was done using the cardio-ankle vascular index (CAVI).CAVI and heart rate variability (HRV) and ɺ VO 2peak were evaluated before and after RHB program. Both types of RHB reduced significantly CAVI (ET from 9.6 [0.2] to 8.9 [0.2], P < 0.012; NMES from 9.3 [0.2] to 8.7 [0.2], P < 0.013), increased high frequency (HF) component of HRV (+65.6%; P = 0.001) and decreased ratio of low frequency (LF) component with HF component (LF/HF ratio) in group ET (-39.8%; P < 0.001). Changes of HRV parameters in group NMES were not significant; however, a marked tendency to autonomic stabilization was present. Both types of RHB led also to significant increase of ɺ VO 2peak (ET from 18.7 [0.7] to 20.8 [0.7] mL/kg/min, P < 0.004; NMES from 17.3 [0.7] to 19.0 [0.7] mL/kg/min, P < 0.001). ET or NMES has been shown to improve signifi- cantly arterial stiffness and to stabilize autonomic balance. Key Words: Exercise—Electrical stimulation—Heart failure—Arterial stiffness—Heart rate variability. The incidence of chronic heart failure (CHF) in the European population is 0.4–2% and rises up to 6–10% for those above 65 years of age (1). Its prog- nosis is poor, and its diagnostics and therapy are demanding, from a medical as well as economical point of view.Typical symptoms of a failing heart are neuro-humoral hyperactivation (2) resulting in endothelial dysfunction, vasoconstriction, and pro- inflammatory processes, which potentiate one other (3). These pathological changes have immense impact especially on skeletal muscles where devastat- ing structural and metabolic changes and extensive atrophies take place (4). A demonstrable relationship between increased tonus of sympathetic nervous system, decreased fitness, and bad prognosis has been proved (5–7). Supervised exercise training (ET) could reverse these pathologic changes in CHF patients. Numerous reports have clearly demon- strated the benefits of exercise on functional capacity, muscle performance, and autonomic nervous system (ANS) regulation (8–10). Noteworthy new data about successful application of the neuromuscu- lar electrical stimulation (NMES) in rehabilitation doi:10.1111/j.1525-1594.2012.01474.x Received December 2011; revised February 2012. Address correspondence and reprint requests to Professor Petr Dobšák, Department of Sports Medicine and Rehabilitation, St. Anna Faculty Hospital in Brno, Pekar ˇská 53, 656 91 Brno, Czech Republic. E-mail: petr.dobsak@fnusa.cz © 2012, Copyright the Authors Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc. Artificial Organs 2012, ••(••):••–••