Neuromuscular electrical stimulation: an alternative therapy in cancer rehabilitation?
Currently more than 10 million people are diagnosed with cancer annually, with the number of cases set to increase by 50% between now and 2030. However, fortunately due to earlier detection and better cancer treatments people are living longer with an 8% and 3% decrease in cancer mortality in men and women respectively reported since 2011.
Exercise can be used throughout the cancer journey to improve both function and psychological well-being. Currently it is the most cost effective drug we have in the battle to offset some of the common side effects of cancer and its treatment such as fatigue and muscle weakness. However, disappointing is the lack of discussion amongst patients and their doctors on the benefits of exercise. This has been linked to a lack of confidence in the doctor’s ability to give the right advice. This is frustrating as it has been acknowledged the persuasive role that doctors can have in promoting exercise.
Now, doctors should be recommending exercise to patients who can participate. Unfortunately, because of the side effects associated with cancer and its treatment, voluntary exercise participation is not always possible. Even getting out of bed, and walking to the other end of the room can be challenging for some. This highlights an urgent need for alternative therapies to help accelerate cancer rehabilitation.
Neuromuscular electrical stimulation may be a pragmatic solution. It involves the involuntary contraction of muscles via a small handheld battery powered unit and electrodes which are placed on the skin close to the muscles. Muscles which are targeted are the large muscle in the legs. NMES can make muscles contract in a rhythmical way as to mimic aerobic exercise like walking or running. Previous studies have shown that this method of NMES can make a person exercise at an intensity similar to walking, running or cycling.
Unfortunately, like most good things, NMES has limitations. To those unaccustomed to the sensation it can be uncomfortable making it hard to reach intensities which would be beneficial. Increasing stimulation intensity is crucial for its success so we need to find ways in which patients can increase the intensity as quickly and by as much as possible. Currently and over the last few months I have been looking at ways in which we can do this. By doing so we will be hopefully be able to implement NMES into cancer rehabilitation and provide an alternative to voluntary exercise to help accelerate patient rehabilitation. First though over the next few months I will be beginning pilot trials in Beacon Hospital here in Dublin to assess the use of NMES and get some subjective feedback from cancer patients regarding their thoughts on the technology.
I’m looking forward to getting a break from academia and getting stuck into the clinical side of things and speaking to patients, physiotherapists and consultants. I’m hoping that the feedback I receive from the patients will allow me to further improve NMES and help me get some effective protocols in place before my secondment to Spain. Oh, and Spain…I’ll tell you about it next time.