Supportive Care in Cancer

, Volume 27, Issue 3, pp 1013–1020 | Cite as

Safety and feasibility of electrical muscle stimulation in patients undergoing autologous and allogeneic stem cell transplantation or intensive chemotherapy

  • M. BewarderEmail author
  • A. Klostermann
  • M. Ahlgrimm
  • J. T. Bittenbring
  • M. Pfreundschuh
  • S. Wagenpfeil
  • D. Kaddu-Mulindwa
Original Article


Intensive chemotherapy, with or without following autologous or allogeneic stem cell transplantation (HSCT), is often the only curative treatment option for patients with hematological malignancies and leave many survivors physically and psychologically impaired. Electrical muscle stimulation (EMS) is a proven tool to improve physical performance in seniors and patients with chronic diseases. We therefore investigated the safety and feasibility of EMS in 45 patients undergoing autologous HSCT (n = 13), allogeneic HSCT (n = 11) and intensive chemotherapy (n = 21). Furthermore, physical (assessed by 6-min walking distance (6MWD) and short physical performance battery (SPPB)) and psychological performance (assessed by multidimensional fatigue inventory (MFI) and the EORTC QOL-C30 questionnaire) were measured before chemotherapy (T1) and at discharge from hospital (T2). Four patients died due to septic shock, two withdrew consent before the start of EMS training and five stopped EMS training during the study because of chemotherapy-related complications, loss of motivation or loss of ability to use EMS autonomously. Thirty-four out of 45 (76%) patients used EMS throughout the study period and participated in physical and psychological tests at time points 1 and 2. EMS-related adverse events were hematoma (n = 1) and muscle pain (n = 2). No bleeding events > 1 according to the WHO bleeding scale occurred. Decline in 6MWD from T1 to T2 was 24 m. The SPPB score stayed the same with 11 points at T1 and T2. Most MFI subscales showed stable fatigue levels and quality of life (QoL) did not decrease significantly throughout therapy. EMS is feasible and safe in patients undergoing intensive chemotherapy. Trial registration: NCT03467087


Electric muscle stimulation Supportive care Stem cell transplantation 


Compliance with ethical standards

All patients provided written informed consent and all procedures were approved by the local ethics committee (Ärztekammer des Saarlandes).

Conflict of interest

The authors declare that there are no conflicts of interest.


  1. 1.
    Morishita S, Kaida K, Tanaka T, Itani Y, Ikegame K, Okada M, Ishii S, Kodama N, Ogawa H, Domen K (2012) Prevalence of sarcopenia and relevance of body composition, physiological function, fatigue, and health-related quality of life in patients before allogeneic hematopoietic stem cell transplantation. Support Care Cancer 20(12):3161–3168CrossRefGoogle Scholar
  2. 2.
    Tuchman SA, Lane A, Hornsby WE, Bishop C, Thomas S, Herndon JE II, Long G, Gasparetto C, Jones LW (2015) Quantitative measures of physical functioning after autologous hematopoietic stem cell transplantation in multiple myeloma: a feasibility study. Clin Lymphoma Myeloma Leuk 15(2):103–109CrossRefGoogle Scholar
  3. 3.
    Wiskemann J, Kleindienst N, Kuehl R, Dreger P, Schwerdtfeger R, Bohus M (2015) Effects of physical exercise on survival after allogeneic stem cell transplantation. Int J Cancer 137(11):2749–2756CrossRefGoogle Scholar
  4. 4.
    Wiskemann J, Huber G (2008) Physical exercise as adjuvant therapy for patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 41(4):321–329CrossRefGoogle Scholar
  5. 5.
    Steinberg A, Asher A, Bailey C, Fu JB (2015) The role of physical rehabilitation in stem cell transplantation patients. Support Care Cancer 23(8):2447–2460CrossRefGoogle Scholar
  6. 6.
    Takekiyo T, Dozono K, Mitsuishi T, Murayama Y, Maeda A, Nakano N, Kubota A, Tokunaga M, Takeuchi S, Takatsuka Y, Utsunomiya A (2015) Effect of exercise therapy on muscle mass and physical functioning in patients undergoing allogeneic hematopoietic stem cell transplantation. Support Care Cancer 23(4):985–992CrossRefGoogle Scholar
  7. 7.
    Dobsak P et al (2006) Electrical stimulation of skeletal muscles. An alternative to aerobic exercise training in patients with chronic heart failure? Int Heart J 47(3):441–453CrossRefGoogle Scholar
  8. 8.
    Deley G, Eicher JC, Verges B, Wolf JE, Casillas JM (2008) Do low-frequency electrical myostimulation and aerobic training similarly improve performance in chronic heart failure patients with different exercise capacities? J Rehabil Med 40(3):219–224CrossRefGoogle Scholar
  9. 9.
    Nuhr MJ et al (2004) Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure. Eur Heart J 25(2):136–143CrossRefGoogle Scholar
  10. 10.
    Kern H et al (2014) Electrical stimulation counteracts muscle decline in seniors. Front Aging Neurosci 6:189CrossRefGoogle Scholar
  11. 11.
    Jones S et al (2016) Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev 10:CD009419Google Scholar
  12. 12.
    Windholz T, Swanson T, Vanderbyl BL, Jagoe RT (2014) The feasibility and acceptability of neuromuscular electrical stimulation to improve exercise performance in patients with advanced cancer: a pilot study. BMC Palliat Care 13:23CrossRefGoogle Scholar
  13. 13.
    Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47(1):207–214CrossRefGoogle Scholar
  14. 14.
    Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2):M85–M94CrossRefGoogle Scholar
  15. 15.
    Klepin HD, Geiger AM, Tooze JA, Kritchevsky SB, Williamson JD, Pardee TS, Ellis LR, Powell BL (2013) Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia. Blood 121(21):4287–4294CrossRefGoogle Scholar
  16. 16.
    Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM (1982) Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 284(6329):1607–1608CrossRefGoogle Scholar
  17. 17.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376CrossRefGoogle Scholar
  18. 18.
    Fayers PM et al (2001) The EORTC QLQ-C30 Scoring Manual (3rd Edition). European Organisation for Research and Treatment of CancerGoogle Scholar
  19. 19.
    Smets EM et al (1995) The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39(3):315–325CrossRefGoogle Scholar
  20. 20.
    Schwarz R, Krauss O, Hinz A (2003) Fatigue in the general population. Onkologie 26(2):140–144Google Scholar
  21. 21.
    Smets EM et al (1996) Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. Br J Cancer 73(2):241–245CrossRefGoogle Scholar
  22. 22.
    Kastner A, Braun M, Meyer T (2015) Two cases of rhabdomyolysis after training with electromyostimulation by 2 young male professional soccer players. Clin J Sport Med 25(6):e71–e73Google Scholar
  23. 23.
    Fisher S, Ottenbacher KJ, Goodwin JS, Graham JE, Ostir GV (2009) Short physical performance battery in hospitalized older adults. Aging Clin Exp Res 21(6):445–452CrossRefGoogle Scholar
  24. 24.
    Klepin HD, Tooze JA, Pardee TS, Ellis LR, Berenzon D, Mihalko SL, Danhauer SC, Rao AV, Wildes TM, Williamson JD, Powell BL, Kritchevsky SB (2016) Effect of intensive chemotherapy on physical, cognitive, and emotional health of older adults with acute myeloid leukemia. J Am Geriatr Soc 64(10):1988–1995CrossRefGoogle Scholar
  25. 25.
    Laboratories, A.T.S.C.o.P.S.f.C.P.F (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166(1):111–7Google Scholar
  26. 26.
    Enright PL, Sherrill DL (1998) Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 158(5 Pt 1):1384–1387CrossRefGoogle Scholar
  27. 27.
    Wiskemann J, Kuehl R, Dreger P, Schwerdtfeger R, Huber G, Ulrich CM, Jaeger D, Bohus M (2014) Efficacy of exercise training in SCT patients--who benefits most? Bone Marrow Transplant 49(3):443–448CrossRefGoogle Scholar
  28. 28.
    Esser P, Kuba K, Mehnert A, Schwinn A, Schirmer L, Schulz-Kindermann F, Kruse M, Koch U, Zander AR, Kröger N, Schilling G, Götze H, Scherwath A (2017) Investigating the temporal course, relevance and risk factors of fatigue over 5 years: a prospective study among patients receiving allogeneic HSCT. Bone Marrow Transplant 52(5):753–758CrossRefGoogle Scholar
  29. 29.
    Frodin U et al (2015) Frequent and long-term follow-up of health-related quality of life following allogeneic haematopoietic stem cell transplantation. Eur J Cancer Care (Engl) 24(6):898–910CrossRefGoogle Scholar
  30. 30.
    Lin JM et al (2009) Further validation of the multidimensional fatigue inventory in a US adult population sample. Popul Health Metr 7:18CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic for Hematology and OncologyUniversity Hospital SaarlandHomburgGermany
  2. 2.Institute for Medical Biometry, Epidemiology and Medical InformaticsSaarland UniversityHomburgGermany

Personalised recommendations