This is a recurring question in the field of physical exercise/fitness. A priori we could say that taking into account the physiological requirements of muscle contraction induced by electrostimulation, there is no problem in applying this type of stimulation by a qualified professional.
Recently, the first high-impact article has been published in which whole-body electrostimulation is applied together with nutritional intervention in oncological patients for 12 weeks (1). In it, a group of patients is compared to which a nutritional strategy is applied, with another that follows the same nutritional strategy plus two weekly workouts with WB EMS.
… It is also pointed out that neuromuscular electrostimulation (EMS / NEMS) could be a new therapeutic alternative to avoid muscle atrophy and the progressive deterioration of the physical condition of these patients …
The conclusions of this study tell us that there is a significant improvement in muscle mass and body weight, which makes this tool a useful element in the fight against cachexia.
In addition, there are improvements on physical condition based on grip strength (manual dynamometry) and the 6-minute walk test. It is interesting to note that both groups have improvements in this respect, which highlights the importance of the nutritional intervention, but the results are better in patients who trained with WB EMS.
It is very remarkable that there are no negative results in the analytics carried out periodically throughout the process. There is no excessive muscle damage and no physiological marker pro-cancer or pro-pathological is potentiated.
The results of this study do not suppose a revolution for the field of study, but if they are a historical antecedent that will allow increasing the growth of the scientific knowledge of this area.
As much or more important than this; This article adds to the scientific evidence that well-programmed and controlled physical exercise brings great benefits to oncological patients, even in advanced stages.
Is there a history of the use of electrostimulation in cancer patients or other serious patients?
Of course, we find bibliography related to different types of patients.
In the present case, cancer patients, we see there are medical systems aimed at alleviating neuropathic pain during chemotherapy with positive results (2). These devices place electrostimulation electrodes differently and have a different goal in neuromuscular electrostimulation, but base their treatment on the use of low frequencies, that’s why they deserve to be mentioned.
… it is the doctor (oncologist) the maximum authority in the direction of the treatment of the patient …
In other serious patients, such as those who need hemodialysis or who have a severe renal condition, it has been observed how the use of electrostimulation has a positive impact.
Electrostimulation provides benefits related to improving muscle strength, functional capacity and muscle composition (quadriceps). It is also noted that neuromuscular electrical (EMS / NEMS) could be a new therapeutic alternative to prevent muscular atrophy and progressive deterioration of the physical condition of these patients. The potential beneficial effects of NMES in hemodialysis patients need to be established (3).
There is evidence that the application of electrostimulation in cardiac or pulmonary patients has a positive effect on their body composition, oxygen consumption and strength levels. (4-6).
Why is its use usually discouraged in these patients?
Before trying to answer this question it is noteworthy that the doctor (oncologist) the highest authority in the management of patient treatment and will he/she who authorizes and coordinates the various professionals involved in both primary treatment and complementary to it.
We do not really see any evidence or direct relationship about it. It is really the lack of consensus regarding the forms of application that makes this technique be considered contraindicated at a general level (that is not legal).
… Neuromuscular electrostimulation has been shown to have a high capacity to increase vascularization …
We must “split hairs” and unite physiopathological concepts and the physiology of exercise to find possible negative interactions or situations in which we must take special care when applying this type of technique.
By reviewing the literature we could highlight the following aspects as important points to consider.
Energy metabolism and lactate:
Today it is accepted that the main energy resource during electrostimulation training is glycogen-carbohydrate (7) (8). * In future posts we will talk about this aspect and we will see if we are obtaining data that point to another address.
In several diseases, such as cancer, the disease can occur in one of its stages with an acidosis (lactic acid), that is, the chronic elevation of blood lactate levels that is usually <2mmol / L (9).
If the exercise intensity (voluntary with superimposed electrostimulation) is high, it will lead to a higher lactate production rate, which, in certain circumstances, such as metabolic acidosis, can be harmful. We must bear in mind that the chronic elevation of blood lactate levels in critical and oncological patients is related to a decrease in their life expectancy (10-12).
… Electrostimulation can be of great help to improve body composition and muscle function in several types of patients. No damage or side effects are detected …
One of the fundamental factors to prevent or reverse the metabolic acidosis in patients is to improve the blood perfusion of the tissues (9). Neuromuscular electrostimulation has been shown to have a high capacity to increase vascularization (13), in addition to increasing the production of nitric oxide synthase and therefore improving the perfusion of oxygen to peripheral tissues (14).
But there are a number of issues to be solved that are important:
- Does a small peak of lactate at acute level influence this situation?
- Would using electrostimulation programs that do not increase blood lactate levels be a correct procedure in case of metabolic acidosis?
- Improving the rate of metabolization-buffering of lactate in these patients from early stages (prior to acidosis) can help to improve the evolution of their disease?
- Does the metabolic improvement produced by the stimulation of an organ as important as skeletal muscle have a positive impact on the cancer patient, even in advanced stages?
As we have already indicated, physical exercise brings great benefits to this population group, so it is a matter of time to clarify these issues by providing data and concrete protocols.
Vascularization of tissues and angiogenesis:
Angiogenesis is broadly defined as the growth of new capillaries from existing vessels and constitutes an important part of developmental morphogenesis, response to injury and pathogenesis (15,16), in this case the tumor.
In many cases part of the cancer patient’s treatment is based on anti-angiogenic therapy (avoiding angiogenesis). This usually occurs in the phases of treatment aimed at controlling or decreasing the tumor size and avoiding metastasis (17,18).
As other forms of physical exercise or “muscle work” electrostimulation can induce angiogenesis at the muscle level. A specific range of frequencies (8-10 Hz) especially enhances this process (13).
Although there are no data to suggest that angiogenesis induced by muscle stimulation has systemic effects, we could choose not to use these frequency ranges until we know what effects they have on the oncological patient.
– The first publication about the use of WBEMS in cancer patients has come to light.
– Electrostimulation can be of great help to improve body composition and muscle function in several types of patients. No damage or side effects are detected.
– The inclusion of quality physical exercise programs should be a priority in any health model, public or private.
– In many cases, physical exercise is contraindicated due to a lack of knowledge of the benefits that can be reported or due to the inability to provide a proper way to manage and control it. The same goes for the various tools that can be used to perform such physical exercise.
– The reason why full-body electrostimulation has been considered as a contraindicated tool for oncological patients is the lack of specific information, not because of the existence of evidence against its use.
– The complexity of each case makes it essential to evaluate and control all the necessary variables to ensure the correct development of a physical exercise program.
– We must have qualified personnel for the introduction of physical exercise within a program to improve the patient’s health.
- Schink K, Herrmann HJ, Schwappacher R, Meyer J, Orlemann T, Waldmann E, et al. Effects of whole-body electromyostimulation combined with individualized nutritional support on body composition in patients with advanced cancer: a controlled pilot trial. BMC Cancer [Internet]. 2018; 1-17. Available from: https://link.springer.com/article/10.1186/s12885-018-4790-y?utm_source=researcher_app&utm_medium=referral&utm_campaign=MKEF_USG_Researcher_inbound
- Smith TJ, Coyne PJ, Parker GL, Dodson P, Ramakrishnan V. Pilot trial of a patient-specific cutaneous electrostimulation device (MC5-A Calmare®) for chemotherapy-induced neuropathy. J Pain Symptom Manage [Internet]. 2010; 40 (6): 883-91. Available from: http://dx.doi.org/10.1016/j.jpainsymman.2010.03.022
- Esteve V, Carneiro J, Moreno F, Fulquet M, Garriga S, Pou M, et al. Effect of neuromuscular electrostimulation on muscle strength, functional capacity and body composition in patients on hemodialysis. Nephrology [Internet]. 2017 Jan 1 [cited 2018 May 1]; 37 (1): 68-77. Available from: https://www.sciencedirect.com/science/article/pii/S0211699516300741
- Hill K, Cavalheri V, Mathur S, Roig M, Robles P, Te D, et al. Neuromuscular electrostimulation for adults with chronic obstructive pulmonary disease (Review). Send to Cochrane Database Syst Rev. 2018; (5).
- Jones S, Wdc M, Gao W, Ij H, Wilcock A, Maddocks M. Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease (Review). Cochrane Libr. 2016; (10).
- Spadaccio C, Rainer A, De Marco F, Lusini M, Gallo P, Sedati P, et al. In situ electrostimulation drives a regenerative shift in the zone of infarcted myocardium. Cell Transplant. 2013; 22 (3): 493-503.
- Herrero AJ, Garcia-lopez J. on muscle function (I) TRAINING PARAMETERS WITH ELECTROSTIMULATION AND CHRONIC EFFECTS ON MUSCLE FUNCTION (I). 2006 (January).
- Grosset J-F, Crowe L, De Vito G, O’Shea D, Caulfield B. Comparative effect of a 1 h session of electrical muscle stimulation and walking activity on energy expenditure and substrate oxidation in obese subjects. Appl Physiol Nutr Metab Appl Nutr Metab. 2013; 38 (November 2012): 57-65.
- Gainza FJ, Gimeno I, Muniz R. Lactic acidosis. Nephrology 1998; 18 (5): 357-61.
- Park YJ, Kim DH, Kim SC, Kim TY, Kang C, Lee SH, et al. Serum lactate upon emergency department arrival as a predictor of 30-day in-hospital mortality in an unselected population. PLoS One. 2018; 13 (1): 1-14.
- Bou Chebl R, Khuri C, Shami A, Rajha E, Faris N, Bachir R, et al. Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: A retrospective study. Scand J Trauma Resusc Emerg Med. 2017; 25 (1): 1-7.
- Maher S, Temkit M, Buras M, McLemore R, Butler R, Chowdhury Y, et al. Serum Lactate and Mortality in Emergency Department Patients with Cancer. West J Emerg Med [Internet]. 1996; 19 (5): 827-33. Available from: https://escholarship.org/uc/item/7bm9d2h4
- Benito-Martínez E. Simultaneous combination of neuromuscular electrostimulation and plyometrics. A complement to speed and jump training [Internet]. 2013. 204 p. Available from: http://ruja.ujaen.es/handle/10953/531
- Filipovic A, Kleinöder H, Plück D, Hollmann W, Bloch W, Grau M. Influence of whole-body electrostimulation on human red blood cell deformability. J Strength Cond Res. 2015; 29 (9): 2570-8.
- DMA P. Angiogenesis. Arch Cardiol Mex. 2004; 74: 499-501.
- Sottile J. Regulation of angiogenesis by extracellular matrix. Biochim Biophys Acta – Rev Cancer. 2004; 1654 (1): 13-22.
- Kerbel RS. Tumor angiogenesis: past, present and the near future. Carcinogenesis 2000; 21 (3): 505-15.
- Shimizu K, Asai T, Oku N. Antineovascular therapy, a novel antiangiogenic approach. Expert Opin Ther Targets [Internet]. 2005; 9 (1): 63-76. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15757482