Neuromuscular electrical stimulation in garments optimized for compliance

Purpose Physical inactivity is associated with muscle atrophy and venous thromboembolism, which may be prevented by neuromuscular electrical stimulation (NMES). This study aimed to investigate the effect on discomfort, current amplitude and energy consumption when varying the frequency and phase duration of low-intensity NMES (LI-NMES) via a sock with knitting-integrated transverse textile electrodes (TTE). Methods On eleven healthy participants (four females), calf-NMES via a TTE sock was applied with increasing intensity (mA) until ankle-plantar flexion at which point outcomes were compared when testing frequencies 1, 3, 10 and 36 Hz and phase durations 75, 150, 200, 300 and 400 µs. Discomfort was assessed with a numerical rating scale (NRS, 0–10) and energy consumption was calculated and expressed in milli-Joule (mJ). Significance set to p ≤ 0.05. Results 1 Hz yielded a median (inter-quartile range) NRS of 2.4 (1.0–3.4), significantly lower than both 3 Hz with NRS 2.8 (1.8–4.2), and 10 Hz with NRS 3.4 (1.4–5.4) (both p ≤ .014). Each increase in tested frequency resulted in significantly higher energy consumption, e.g. 0.6 mJ (0.5–0.8) for 1 Hz vs 14.9 mJ (12.3–21.2) for 36 Hz ( p = .003). Longer phase durations had no significant effect on discomfort despite generally requiring significantly lower current amplitudes. Phase durations 150, 200 and 400 µs required significantly lower energy consumption compared to 75 µs (all p ≤ .037). Conclusion LI-NMES applied via a TTE sock produces a relevant plantar flexion of the ankle with the best comfort and lowest energy consumption using 1 Hz and phase durations 150, 200 or 400 µs.