Effects of whole-body electromyostimulation combined with individualized nutritional support on body composition in patients with advanced cancer: a controlled pilot trial

Abstract

Background: Physical exercise and nutritional treatment are promising measures to prevent muscle wasting that is frequently observed in advanced-stage cancer patients. However, conventional exercise is not always suitable for these patients due to physical weakness and therapeutic side effects. In this pilot study, we examined the effect of a combined approach of the novel training method whole-body electromyostimulation (WB-EMS) and individualized nutritional support on body composition with primary focus on skeletal muscle mass in advanced cancer patients under oncological treatment.

Methods: In a non-randomized controlled trial design patients (56.5% male; 59.9 ± 12.7 years) with advanced solid tumors (UICC III/IV, N = 131) undergoing anti-cancer therapy were allocated to a usual care control group (n = 35) receiving individualized nutritional support or to an intervention group (n = 96) that additionally performed a supervised physical exercise program in form of 20 min WB-EMS sessions (bipolar, 85 Hz) 2×/week for 12 weeks. The primary outcome of skeletal muscle mass and secondary outcomes of body composition, body weight and hand grip strength were measured at baseline, in weeks 4, 8 and 12 by bioelectrical impedance analysis and hand dynamometer. Effects of WB-EMS were estimated by linear mixed models. Secondary outcomes of physical function, hematological and blood chemistry parameters, quality of life and fatigue were assessed at baseline and week 12. Changes were analyzed by t-tests, Wilcoxon signed-rank or Mann-Whitney-U-tests.

Results: Twenty-four patients of the control and 58 of the WB-EMS group completed the 12-week trial. Patients of the WB-EMS group had a significantly higher skeletal muscle mass (0.53 kg [0.08, 0.98]; p = 0.022) and body weight (1.02 kg [0.05, 1.98]; p = 0.039) compared to controls at the end of intervention. WB-EMS also significantly improved physical function and performance status (p < 0.05). No significant differences of changes in quality of life, fatigue and blood parameters were detected between the study groups after 12 weeks.

Conclusions: Supervised WB-EMS training is a safe strength training method and combined with nutritional support it shows promising effects against muscle wasting and on physical function in advanced-stage cancer patients undergoing treatment.

Trial registration: ClinicalTrials.gov NCT02293239 (Date: November 18, 2014).

Keywords: Advanced cancer; Cancer cachexia; Nutrition; Physical exercise; Skeletal muscle mass; WB-EMS whole-body electromyostimulation.

Fig. 1

Patient flowchart. The flowchart shows the number of recruited and allocated patients, the number of patients who refused to participate before baseline assessment, the number of patients who dropped out during study course mentioning specific reasons and the number of patients that completed the whole intervention period of 12 weeks. Abbreviations: WB-EMS, whole-body electromyostimulation

Fig. 2

Estimated marginal means from LMM for body composition parameters and hand grip strength. a-f Estimated marginal means from linear mixed models (error bars show SEM) for body composition and hand grip strength are illustrated of the control group and the WB-EMS group at the different measuring times during the 12-week intervention period. Abbreviations: ECW, extracellular water; ICW, intracellular water; LMM, linear mixed models; WB-EMS, whole-body electromyostimulation