Supportive Care in Cancer

, Volume 27, Issue 10, pp 3823–3831 | Cite as

Personalised and progressive neuromuscular electrical stimulation (NMES) in patients with cancer—a clinical case series

  • Dominic O’ConnorEmail author
  • Matilde Mora Fernandez
  • Gabriel Signorelli
  • Pedro Valero
  • Brian Caulfield
Original Article



Neuromuscular electrical stimulation (NMES) may be a pragmatic short-term alternative to voluntary exercise to augment cancer rehabilitation. However, previous attempts to use NMES as an exercise modality in this cohort have been unsuccessful, largely due to the use of NMES protocols that were developed for other rehabilitation contexts. We assessed the effects of a personalised and progressive NMES exercise intervention, designed with early-stage cancer rehabilitation in mind, on exercise capacity, lower body functional strength and quality of life in (QoL) in patients who are currently undergoing or have recently completed treatment for cancer.


Ten adult patients were recruited. A personalised and progressive NMES exercise intervention was implemented in each case over a 4–8-week period. The 30-s sit-to-stand test (STS), 6-min walk test (6MWT) and EORTC QLQ C-30 were performed pre- and post-intervention. Patients completed semi-structured interviews post-intervention to explore their experiences and views on the intervention and its impact on their daily lives.


Six of the 10 recruited patients completed the intervention and completed pre-and post-assessments. Four of 6 patients improved STS, 5 of 6 patients improved 6MWT and 4 of 6 patients improved Global QoL. Perceived benefits included improved muscle strength and more confidence when walking.


A personalised and progressive NMES exercise intervention appears safe and may improve functional capacity and QoL in adults who are undergoing or have recently completed treatment for cancer. Replication of these results in a controlled prospective study is warranted prior to clinical implementation.


Neuromuscular electrical stimulation Adult cancer survivors Rehabilitation Oncology Physical function 



D O’Connor and G Signorelli are supported by a grant from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement no. 722012.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Courneya KS, Friedenreich CM (2001) Framework PEACE: an organizational model for examining physical exercise across the cancer experience. Ann Behav Med 23:263–272. CrossRefGoogle Scholar
  2. 2.
    Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R (2007) Cancer treatment-induced alterations in muscular fitness and quality of life: the role of exercise training. Ann Oncol 18:1957–1962. CrossRefGoogle Scholar
  3. 3.
    Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T, Exercise for People with Cancer Guideline Development Group (2017) Exercise for people with cancer: a systematic review. Curr Oncol 24:e290–e315. CrossRefGoogle Scholar
  4. 4.
    Spence RR, Heesch KC, Brown WJ (2010) Exercise and cancer rehabilitation: a systematic review. Cancer Treat Rev 36:185–194CrossRefGoogle Scholar
  5. 5.
    Gerritsen JKW, Vincent AJPE (2015) Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 50:796–803.
  6. 6.
    Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen V, Schwartz AL, American College of Sports Medicine (2010) American college of sports medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42:1409–1426CrossRefGoogle Scholar
  7. 7.
    Crevenna R (2013) From neuromuscular electrical stimulation and biofeedback-assisted exercise up to triathlon competitions-regular physical activity for cancer patients in Austria. Eur Rev Aging Phys Act 10:53–55. CrossRefGoogle Scholar
  8. 8.
    Hultman E, Sjöholm H, Jäderholm-Ek I, Krynicki J (1983) Evaluation of methods for electrical stimulation of human skeletal muscle in situ. Pflügers Arch Eur J Physiol 398:139–141. CrossRefGoogle Scholar
  9. 9.
    Maffiuletti NA, Roig M, Karatzanos E, Nanas S (2013) Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review. BMC Med 11:137. CrossRefGoogle Scholar
  10. 10.
    Bax L, Staes F, Verhagen A (2005) Does neuromuscular electrical stimulation strengthen the quadriceps femoris? A systematic review of randomised controlled trials. Sports Med 35:191–212. CrossRefGoogle Scholar
  11. 11.
    Maffiuletti NA, Gondin J, Place N, Stevens-Lapsley J, Vivodtzev I, Minetto MA (2017) The clinical use of neuromuscular electrical stimulation for neuromuscular rehabilitation: what are we overlooking? Arch Phys Med Rehabil 99:806–812. CrossRefGoogle Scholar
  12. 12.
    Doheny EP, Caulfield BM, Minogue CM, Lowery MM (2010) Effect of subcutaneous fat thickness and surface electrode configuration during neuromuscular electrical stimulation. Med Eng Phys 32:468–474. CrossRefGoogle Scholar
  13. 13.
    O’Connor D, Caulfield B (2018) The application of neuromuscular electrical stimulation (NMES) in cancer rehabilitation: current prescription, pitfalls, and future directions. Support Care Cancer. 26:3661–3663.
  14. 14.
    O’Connor D, Caulfield B, Lennon O (2018) The efficacy and prescription of neuromuscular electrical stimulation (NMES) in adult cancer survivors: a systematic review and meta-analysis. Support Care Cancer. 26:3985–4000.
  15. 15.
    Minogue CM, Caulfield BM, Reilly RB (2007) What are the electrical stimulation design parameters for maximum VO 2 aimed at cardio-pulmonary rehabilitation? In: Annual International Conference of the IEEE Engineering in Medicine and Biology - Proceedings pp 2428–2431Google Scholar
  16. 16.
    Caulfield B, Crowe L, Coughlan G, Minogue C (2011) Clinical application of neuromuscular electrical stimulation induced cardiovascular exercise. In: Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS pp 3266–3269Google Scholar
  17. 17.
    Banerjee P (2011) Can electrical muscle stimulation of the legs produce cardiovascular exercise? J Clin Exp Cardiol 02:134–136. CrossRefGoogle Scholar
  18. 18.
    Banerjee P, Caulfield B, Crowe L, Clark AL (2009) Prolonged electrical muscle stimulation exercise improves strength, peak VO2, and exercise capacity in patients with stable chronic heart failure. J Card Fail 15:319–326. CrossRefGoogle Scholar
  19. 19.
    Caulfield B, Prendergast A, Rainsford G, Minogue C (2013) Self directed home based electrical muscle stimulation training improves exercise tolerance and strength in healthy elderly. Conf Proc . Annu Int Conf IEEE Eng Med Biol Soc IEEE Eng Med Biol Soc Annu Conf 2013:7036–7039 . doi:
  20. 20.
    Neo J, Fettes L, Gao W, Higginson IJ, Maddocks M (2017) Disability in activities of daily living among adults with cancer: a systematic review and meta-analysis. Cancer Treat Rev 61:94–106CrossRefGoogle Scholar
  21. 21.
    Cenik F, Schoberwalter D, Keilani M, Maehr B, Wolzt M, Marhold M, Crevenna R (2016) Neuromuscular electrical stimulation of the thighs in cardiac patients with implantable cardioverter defibrillators. Wien Klin Wochenschr 128:802–808CrossRefGoogle Scholar
  22. 22.
    Fairman CM, Zourdos MC, Helms ER, Focht BC (2017) A scientific rationale to improve resistance training prescription in exercise oncology. Sport Med 47:1457–1465. CrossRefGoogle Scholar
  23. 23.
    Vivodtzev I, Debigaré R, Gagnon P et al (2012) Functional and muscular effects of neuromuscular electrical stimulation in patients with severe COPD: a randomized clinical trial. Chest 141:716–725. CrossRefGoogle Scholar
  24. 24.
    Maddocks M, Nolan CM, Man WD-C et al (2016) Neuromuscular electrical stimulation to improve exercise capacity in patients with severe COPD: a randomised double-blind, placebo-controlled trial. Lancet Respir Med 4:27–36. CrossRefGoogle Scholar
  25. 25.
    Applebaum EV, Breton D, Feng ZW, Ta AT, Walsh K, Chassé K, Robbins SM (2017) Modified 30-second sit to stand test predicts falls in a cohort of institutionalized older veterans. PLoS One 12:e0176946. CrossRefGoogle Scholar
  26. 26.
    Maringwa J, Quinten C, King M, Ringash J, Osoba D, Coens C, Martinelli F, Reeve BB, Gotay C, Greimel E, Flechtner H, Cleeland CS, Schmucker-von Koch J, Weis J, van den Bent MJ, Stupp R, Taphoorn MJ, Bottomley A, on behalf of the EORTC PROBE Project and Brain Cancer Group (2011) Minimal clinically meaningful differences for the EORTC QLQ-C30 and EORTC QLQ-BN20 scales in brain cancer patients. Ann Oncol 22:2107–2112. CrossRefGoogle Scholar
  27. 27.
    Crevenna R, Marosi C, Schmidinger M, Fialka-Moser V (2006) Neuromuscular electrical stimulation for a patient with metastatic lung cancer - a case report. Support Care Cancer 14:970–973. CrossRefGoogle Scholar
  28. 28.
    Bewarder M, Klostermann A, Ahlgrimm M, Bittenbring JT, Pfreundschuh M, Wagenpfeil S, Kaddu-Mulindwa D (2018) Safety and feasibility of electrical muscle stimulation in patients undergoing autologous and allogeneic stem cell transplantation or intensive chemotherapy. Support Care Cancer.
  29. 29.
    Delitto A, Strube MJ, Shulman AD, Minor SD (1992) A study of discomfort with electrical stimulation. Phys Ther 72:410–421. CrossRefGoogle Scholar
  30. 30.
    Vivodtzev I, Rivard B, Gagnon P, Mainguy V, Dubé A, Bélanger M, Jean B, Maltais F (2014) Tolerance and physiological correlates of neuromuscular electrical stimulation in COPD: a pilot study. PLoS One 9(5):e94850.
  31. 31.
    Bohannon RW, Crouch R (2017) Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract 23:377–381CrossRefGoogle Scholar
  32. 32.
    Roig M, Reid WD (2009) Electrical stimulation and peripheral muscle function in COPD: a systematic review. Respir Med 103:485–495CrossRefGoogle Scholar
  33. 33.
    Amidei C, Kushner DS (2015) Clinical implications of motor deficits related to brain tumors†. Neuro-Oncol Pract 2:179–184CrossRefGoogle Scholar
  34. 34.
    Batchelor TT, Taylor LP, Thaler HT, Posner JB, DeAngelis LM (1997) Steroid myopathy in cancer patients. Neurology 48:1234–1238CrossRefGoogle Scholar
  35. 35.
    Flechtner H, Bottomley A (2003) Fatigue and quality of life: lessons from the real world. Oncologist 8(Suppl 1):5–9. CrossRefGoogle Scholar
  36. 36.
    Bland KA, Neil-Sztramko SE, Kirkham AA, Bonsignore A, van Patten CL, McKenzie DC, Gelmon KA, Campbell KL (2018) Predictors of attendance to an oncologist-referred exercise program for women with breast cancer. Support Care Cancer 26:3297–3306. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Public Health, Physiotherapy and Sports ScienceUniversity College DublinDublinIreland
  2. 2.Insight Centre for Data Analytics, O’Brien Centre for ScienceUniversity College DublinDublinIreland
  3. 3.OncoavanzeSevilleSpain
  4. 4.University of SevilleSevilleSpain

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