IJCS | Volume 32, Nº5, September/October 2019

DOI: 10.5935/2359-4802.20190081 490 EDITORIAL International Journal of Cardiovascular Sciences. 2019;32(5):490-491 Mailing Address: Sergio Chermont Rua Marques de Paraná, 303. Postal Code: 24033-900, Niterói, Rio de Janeiro, RJ – Brazil. E-mail: schermont@yahoo.com.br Neuromuscular Electrical Stimulation: A Promising Modality of Exercise Training in Cardiovascular Rehabilitation Phase I? Sergio Chermont 1, 2 a nd Mônica Quintão 1, 3 Universidade Federal Fluminense, 1 Niterói, RJ - Brazil Hospital Santa Martha, 2 Rio de Janeiro, RJ – Brazil Instituto Nacional de Câncer, 3 Rio de Janeiro, RJ – Brazil Editorial related to the article: Neuromuscular Electrical Stimulation on Hemodynamic and Respiratory Response in Patients Submitted to Cardiac Surgery: Pilot Randomized Clinical Trial Heart failure; Thoracic Surgery; Transcutaneous Electric Nerve Stimulation; Cardiac Rehabilitation. Keywords There are currently few indications for the use of neuromuscular electrical stimulation (NMES) in cardiac patients that are based on systematic reviews or even meta-analyses from the perspective of evidence-based practice. Therefore, the therapeutic potential of NMES is probably still poorly explored. Previous studies have shown benefits of NMES in patients with stable chronic heart failure (CHF). 1 However, we wonder whether the application of this technique in cardiac patients has been extensively explored. We are certainly dealing with a new therapeutic possibility so far rarely recommended and employed in patients with cardiovascular diseases, especially in intrahospital cardiovascular rehabilitation. In this scenario, what could be added to the current knowledge and its main indications? In the absence of well-defined protocols, feasibility and safety studies may be considered as a starting point for further studies and for paving the way clinical trials and to determine whether or not the conduct is favorable for a patient`s specific clinical condition. So, what would be the role of NMES in heart surgery? Cerqueira et al., 2 used NMES in patients undergoing cardiac surgery in the immediate postoperative period. This study evaluated the effects of NMES on systolic blood pressure, diastolic blood pressure and heart rate (HR) and peripheral oxygen saturation, which can be considered as independent predictive variables with a negative impact on adverse events in the immediate postoperative period of cardiac surgery. 2 The authors in this study demonstrated that in the first 23.13 ± 5.24 hours after cardiac surgery there were no abnormalities in hemodynamic and respiratory parameters between patients who underwent NMES and their respective control group. 2 By investigating the feasibility and safety of the use of this technique in patients, Cerqueira et al. 2 reported that, in their sample, NMES did not determine significant abnormal findings that could result in risk to patients in the immediate postoperative period. 2 NMES can be considered a promising newmodality of exercise training in cardiovascular rehabilitation (CVR). In fact, the use of this technique in patients with heart failure (NYHA III/IV) and reduced functional capacity led to improved exercise tolerance in those patients who could not perform conventional exercises. 3-5 According to meta-analyses on the use of NMES, Cerqueira et al. used this technique as intensely as in other studies that produced benefits in patients with HF. 1,5 During phase I of CVR, as in the case of patients in the postoperative period of cardiac surgery, conventional exercise is recommended as the first choice, especially in individuals who have the ability to do so. 6 Patients in the postoperative period of cardiac surgery often present loss of cardiopulmonary capacity. A recent study evaluated four different CVR protocols in 40 patients in the postoperative period of cardiac surgery. Protocols that included early ambulation and exercise of the four segments decreased in-hospital functional losses, improved recovery and walking distance. 7 This type of