Design considerations for the development of neuromuscular electrical stimulation (NMES) exercise in cancer rehabilitation

Abstract

Aim: The aim of this narrative review is to explore design considerations for effective neuromuscular electrical stimulation exercise prescription in cancer rehabilitation, with simultaneous consideration for fundamental principles of exercise training and the current state of the art in neuromuscular electrical stimulation technologies and application methodologies. Method: Narrative review. Results: First, we consider the key neuromuscular electrical stimulation exercise design considerations, with a focus on training objectives and individual training requirements and constraints for individuals with cancer. Here, we contend that concurrent, low and high frequency neuromuscular electrical stimulation exercise, individually prescribed and progressed may be optimal for enhancing physical function. Second, we review the appropriate literature to identify the most appropriate stimulation parameters (pulse frequency, intensity, duration and duty cycle) to deliver effective neuromuscular electrical stimulation in cancer rehabilitation. Conclusions: We propose an informed and innovative neuromuscular electrical stimulation exercise intervention design and provide practical information for clinicians and practitioners who may work with and implement neuromuscular electrical stimulation exercise in cancer. ä IMPLICATIONS FOR REHABILITATION Neuromuscular electrical stimulation is an emerging technology in cancer rehabilitation to help provide an aerobic and muscle strengthening exercise stimulus. Neuromuscular electrical stimulation may help improve aerobic exercise capacity, muscle strength and augment quality of life. Current prescription in cancer lacks adherence to the fundamental principles of exercise training, which may negatively affect adherence.

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“…The neuromuscular electrical stimulation (NMES) is characterized by electrical impulses that are delivered to the muscle through electrodes placed on the skin that subsequently lead to muscle contraction (15). NMES has been used for the treatment of muscle weakness by patients with prolonged hospitalization (16), in cancer rehabilitation (17), in prevention of thromboembolism (18), for motor recovery in children with neurologic conditions (19) and for the treatment of sports injuries (20).…”

“…The neuromuscular electrical stimulation (NMES) is characterized by electrical impulses that are delivered to the muscle through electrodes placed on the skin that subsequently lead to muscle contraction 15 . NMES has been used for the treatment of muscle weakness by patients with prolonged hospitalization 16 , in cancer rehabilitation 17 , in prevention of thromboembolism 18 , for motor recovery in children with neurologic conditions 19 and for the treatment of sports injuries 20 Similarly, peripheral electrical stimulation (PES) applied through electrodes have been used for the recovery from injuries, for the treatment of chronic pain and for promoting motor rehabilitation 21 22 . Transcutaneous electrical nerve stimulation (TENS), which runs at one mA have been also tested primarily as treatments of pain 23 24 25 , but may also improve sensomotoric impairments that are evident in terms of vibration perception, balance control and gait 23 24 .…”

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“…The neuromuscular electrical stimulation (NMES) is characterized by electrical impulses that are delivered to the muscle through electrodes placed on the skin that subsequently lead to muscle contraction [15]. NMES has been used for the treatment of muscle weakness by patients with prolonged hospitalization [16], in cancer rehabilitation [17], in prevention of thromboembolism [18], for motor recovery in children with neurologic conditions [19] and for the treatment of sports injuries [20] Similarly, peripheral electrical stimulation (PES) applied through electrodes have been used for the recovery from injuries, for the treatment of chronic pain and for promoting motor rehabilitation [21,22]. Transcutaneous electrical nerve stimulation (TENS), which runs at one mA have been also tested primarily as treatments of pain [23][24][25], but may also improve sensomotoric impairments that are evident in terms of vibration perception, balance control and gait [23,24].…”

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“…Pelvic floor physical therapy should be used by physical therapists to help with pelvic floor symptoms [29]. In general, locomotion ability exercises such as standing and walking, lymphatic drainage massage, vantage, manual stretching, myofascial therapy, relaxation massage, stretching, strengthening, resisted exercise, PNF, aerobic exercise, TENS, patient education, and behavioural training are included in physical therapy for gynecologic cancer patients [30].…”