L'innovazione tecnologica delle whole-body electromyostimulation (WB-EMS): applicazione nella prevenzione e trattamento delle demenze

Dementia represents the greatest global health and social care challenge of the 21st century (Lancet Commission, 2017). An estimated 50 million people worldwide are living with dementia, with enormous personal and social costs, and 10 million new people develop the condition each year. The worldwide prevalence is expected to triple to 152 million in the next 30 years, mainly due to an increasing elderly population. In Italy, about one million people have dementia and about 900,000 have mild cognitive impairment (MCI), involving more than three million people directly or indirectly in care (Bacigalupo et al., 2018; Sachdev et al., 2015). In this context, accurate multidimensional characterization of the elderly is essential to implement effective cognitive and functional decline prevention programs. Prevention of disability and cognitive-functional decline is crucial for improving quality of life and reducing burdens on health care systems. Cognitive decline plays a central role in functional capacity screening: when this decline progresses to dementia, it becomes an issue of health importance, as the associated costs account for a significant portion of overall health care expenditures. Physical activity plays a key role in the prevention and management of dementia, providing benefits to somatic function, mental and physical well-being, and cognitive abilities (Demurtas et al., 2020). However, many limiting factors prevent many individuals from engaging in continuous and structured physical activity (presence of caregivers, time available, ease of travel, etc.). Technology has enabled a quantum leap as a facilitator in this area. In particular, Whole Body Electromyostimulation (WB-EMS) technology can be an excellent training strategy for this population due to its time efficiency and individualization of training programs. No previous study has applied WB-EMS in dementia prevention and management. The primary objective of this study was to evaluate the effects of superimposed and supervised WB-EMS to aerobic exercise, performed on treadmill and rowing machine for 12 weeks, on physical and cognitive performance in patients with MCI. A secondary objective was to determine whether the WB-EMS protocol was safe and suitable for these subjects, taking into account their characteristics and degree of satisfaction to ensure adherence to the program. Sixty-one subjects (mean age 71 ± 5.64 years) were recruited for the present study. The study was designed as a randomized controlled trial, with subjects divided into two groups: Endurance Training Group (ETG) (n=33) and control group (CON) (n=28). The ETG group performed twelve weeks of aerobic treadmill and rowing machine training, twice a week, with superimposed WB-EMS. The CON group performed twelve weeks of aerobic training on treadmill and rowing machine, three times a week, without the superimposition of WB-EMS. Electromyostimulation was administered with continuous stimulation at 35 Hz, 350 μs. Before and at the end of the trial, physical and cognitive performance assessments were conducted. RM-ANOVA performed on physical performance showed a significant effect of time (F(1,59)=157.904; p< 0.001) for the arm curl test performed on the dominant limb, where both groups improved their performance. In addition, a significant difference emerged between groups, where ETG performed more repetitions than CON (F(1,59)=0.008; p=0.008). Relative to gender, a significant difference in time was found (F(1,59)=121.756; p< 0.001), where both men and women significantly improved repetitions between pre- and post-intervention (p<0.001). Regarding the arm curl test performed on the non-dominant limb, a significant effect over time was found (F(1,59)=77.096; p= 0.003), where ETG and CON participants were able to perform more repetitions in the post-intervention assessment than in the pre-intervention assessment (p< 0.001). Relative to gender, a significant difference in time was found (F(1,59)=79.003; p< 0.001), where both women and men significantly improved repetitions between pre- and post-intervention (p< 0.001). Regarding the sit to stand test, a significant effect over time was found (F(1,59)=25.872; p<0.001), where the ETG group showed a significant improvement in performance, while the CON group did not vary its performance (p=0.134). A significant interaction emerged (F(1,59)=8.135; p= 0.006), where the groups perform differently. Specifically, the ETG improves, and the CON does not. In addition, a significant difference emerged between groups, where ETG performed more repetitions than CON (F(1,59)=11.758; p= 0.001). Relative to gender, a significant difference emerged over time (F(1,59)=25,900; p<0.001), where both men (p<0.001) and women (p=0.008) improved their performance. No differences between groups were found (F(1,59)=1.430; p= 0.237). A significant effect of time was observed for the soda pop test (F(1,59)=21.111; p< 0.001). The test showed that ETG and CON participants had increased oculo-manual coordination in the post-intervention assessment compared with the pre-intervention assessment (p< 0.001). Relative to gender, a significant difference in time was found (F(1,59)=21.601; p= 0.001), where both women and men significantly improved performance between pre- and post-intervention (woman p= 0.001 ; man p=0.003). A significant effect of time was observed for the hand grip test performed on the dominant limb (F(1,59)=43.366; p< 0.001). The test showed that ETG and CON participants had increased strength values in the post-intervention assessment compared with the pre-intervention assessment (p< 0.001). Relative to gender, a significant difference in time emerged (F(1,59)=46.215; p< 0.001), where both men and women significantly improved grip strength between pre- and post-intervention (man p< 0.001; woman p=0.001). A significant effect of time was observed for the 6-minute walk test (F(1,59)=44.361; p< 0.001). The test showed that ETG and CON participants, in the post-intervention assessment, increased the meters walked compared with the pre-intervention assessment (ETG p< 0.001; CON p=0.020). In addition, we observed a time*group interaction (p=0.003), with different behaviour between groups where ETG improved more than CON. In addition, a significant difference emerged between groups, where ETG showed better performance than CON (F(1,59)=13.695; p< 0.001). Relative to gender, a significant difference in time was found (F(1,59)=41.963; p< 0.001), where both women and men significantly improved performance between pre- and post-intervention (man p= 0.001; woman p<0.001). A significant effect of time was observed for the 8 foot up and go test (F(1,59)=14.416; p< 0.001). The test showed that ETG and CON participants significantly improved their performance in the post-intervention assessment than in the pre-intervention assessment (p< 0.001). Relative to gender, a significant difference in time emerged (F(1,59)=95.194; p< 0.001), where both women and men significantly improved performance between pre- and post-intervention (man p= 0.03; woman p= 0.019). A significant effect of time was observed for the Tinetti Balance and Gait test (F(1,59)=100.054; p< 0.001). The test showed that ETG and CON participants significantly improved performance in the post-intervention assessment compared with the pre-intervention assessment (p< 0.001). In addition, a significant difference emerged in the time*group interaction, where ETG showed better performance than CON (F(1,59)=6.682; p= 0.012). Relative to gender, a significant difference in time was found (F(1,59)=14.909; p< 0.001), where both men and women significantly improved performance between pre- and post-intervention (p< 0.001). A significant effect of time was observed for the chair sit and reach test performed on the dominant limb (F(1,59)=13.955; p<0.001). The test showed that participants in the ETG (p=0.014) and CON (p=0.008) groups had improved performance compared with the pre-intervention assessment. No difference between groups emerged (F(1,59)=14.079; p=0.371). Relative to gender, a significant difference emerged over time (p<0.001), where both men (p=0.002) and women (p=0.038) significantly improved their performance compared with the pre-intervention assessment. No differences between groups emerged (F(1,59)=1.491; p=0.227). A significant effect of time was observed for the chair sit and reach test performed on the non-dominant limb (F(1,59)=29.133; p<0.001). The test showed that participants in the ETG (p<0.001) and CON (p<0.001) groups had improved performance compared with the pre-intervention assessment. No difference between groups was found (F(1,59)=0.008; p=0.927). Relative to gender, a significant difference emerged over time (F(1,59)=28.425; p<0.001), where both men (p=0.001) and women (p=<0.001) significantly improved their performance compared with the pre-intervention assessment. No differences between groups emerged (F(1,59)=1.622; p=0.208). RM-ANOVA performed on cognitive performance showed no significant effect of time for the MMSE test performed (F(1,59)=0.238; p=0.628). No significant difference emerged between groups (F(1,59)=0.491; p= 0.486). Relative to gender, no differences over time (F(1,59)=0.256; p= 0.615) and between groups were found (F(1,59)=0.015; p= 0.904). Regarding the RAVLT imm, a significant difference over time was found (F(1,59)=11.477; p= 0.001), where ETG participants in the post-intervention assessment showed a higher score than in the pre-intervention assessment (p< 0.001) while the CON did not change their scores (p=0.130). In addition, a significant difference emerged between groups, where ETG scored better than CON (F(1,59)=17.515; p< 0.001). Relative to gender, a significant difference over time emerged (F(1,59)=9.902; p= 0.003), where women significantly improved repetitions between pre- and post-intervention (p= 0.002), while men showed no significant change (p= 0.251); however, no difference between groups was found (F(1,59)=0.043; p= 0.837). Regarding the RAVLT diff, a significant difference over time was found (F(1,59)=16.114; p< 0.001), where ETG participants in the post-intervention assessment showed a significant difference from the pre-intervention assessment (p< 0.001) while CON did not vary their scores (p=0.155). No difference between groups emerged (F(1,59)=0.548; p= 0.462). Relative to gender, a significant difference emerged over time (F(1,59)=16.516; p< 0.001), where both men and women significantly improved repetitions between pre- and post-intervention (man p= 0.005; woman p= 0.007); however, no difference between groups was found (F(1,59)=0.011; p= 0.915). A significant difference in time was found in Stroop time (F(1,59)=14.982; p<0.001), where ETG and CON participants, in the post-intervention assessment, significantly reduced the time to complete the test compared to the pre-intervention assessment (ETG p= 0.001; CON p=0.050). No difference between groups was found (F(1,59)=0.524; p= 0.472). Relative to gender, a significant difference over time was found (F(1,59)=15.441; p< 0.001), where both men and women significantly improved performance between pre- and post-intervention (man p= 0.009; woman p=0.006); however, no difference between groups emerged (F(1,59)=1.054; p= 0.309). Regarding Stroop error, no difference over time was found (F(1,59)=0.152; p= 0.188). No difference between groups was found (F(1,59)=3.038; p= 0.087). Relative to gender, no differences over time (F(1,59)=2.087; p= 0.154) and between groups emerged (F(1,59)=1.029; p= 0.315). As for the TMT test, no significant difference over time was found (F(1,59)=0.152; p=0.698). In addition, no significant difference emerged between groups (F(1,59)=0.012; p= 0.912). Relative to gender, no significant differences over time (F(1,59)=0.185 ; p= 0.668) and between groups (F(1,59)=1.907 ; p= 0.173) were found. A significant difference in time was found in the FAB test (F(1,59)=14.416 ; p< 0.001), where ETG and CON participants, in the post-intervention assessment, showed improvement in performance compared with the pre-intervention assessment (ETG p= 0.001 ; CON p=0.043). Relative to gender, a significant difference in time was found (F(1,59)=14.834; p< 0.001), where both men and women significantly improved performance between pre- and post-intervention (man p= 0.019; woman p=0.004); however, no difference between groups was found (F(1,59)=0.031 ; p= 0.860). No significant difference over time was found in the PROSA test (F(1,59)=0.933; p=0.338); however, a significant difference emerged between groups, where ETG scored better than CON (F(1,59)=4.141 p< 0.046). Relative to gender, no significant differences over time (F(1,59)=1.064; p= 0.306) and between groups (F(1,59)=2.477; p= 0.121) were found. A significant difference in time was found in the test of attentional matrices (F(1,59)=36.538; p< 0.001), where ETG and CON participants, in the post-intervention assessment, showed improvement in performance compared with the pre-intervention assessment (ETG p< 0.001; CON p=0.018). Furthermore, from the significant time*group interaction, we observed a different trend between the groups, where ETG improved more than CON. In addition, a significant difference was found between groups, where ETG scored better than CON (F(1,59)=6.352; p=0.014). Relative to gender, a significant difference over time emerged (F(1,59)=36.741; p< 0.001), both men and women significantly improved their scores between pre- and post-intervention (man p< 0.001; woman p= 0.001); however, no difference between groups was found (F(1,59)=0.269; p= 0.606). The improvements achieved in motor performance (balance, upper and lower limb strength, grip strength, walking ability and agility) and maintenance of cognitive function after 12 weeks of the experimental protocol confirm the effectiveness of WB-EMS technology also in dementia prevention and management.