February 02, 2020

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

Dominic O'Connor, Olive Lennon, Conor Minogue, Brian Caulfield


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.

December 27, 2019

Feedback Design in Targeted Exercise Digital Biofeedback Systems for Home Rehabilitation: A Scoping Review

Louise Brennan, Enrique Dorronzoro Zubiete, Brian Caulfield


Digital biofeedback systems (DBSs) are used in physical rehabilitation to improve outcomes by engaging and educating patients and have the potential to support patients while doing targeted exercises during home rehabilitation. The components of feedback (mode, content, frequency and timing) can influence motor learning and engagement in various ways. The feedback design used in DBSs for targeted exercise home rehabilitation, as well as the evidence underpinning the feedback and how it is evaluated, is not clearly known. To explore these concepts, we conducted a scoping review where an electronic search of PUBMED, PEDro and ACM digital libraries was conducted from January 2000 to July 2019. The main inclusion criteria included DBSs for targeted exercises, in a home rehabilitation setting, which have been tested on a clinical population. Nineteen papers were reviewed, detailing thirteen different DBSs. Feedback was mainly visual, concurrent and descriptive, frequently providing knowledge of results. Three systems provided clear rationale for the use of feedback. Four studies conducted specific evaluations of the feedback, and seven studies evaluated feedback in a less detailed or indirect manner. Future studies should describe in detail the feedback design in DBSs and consider a robust evaluation of the feedback element of the intervention to determine its efficacy.

November 18, 2019

Personalization in Real-Time Physical Activity Coaching using Mobile Applications: A Scoping Review

Francisco Miguel Monteiro-Guerra ; Octavio Rivera-Romero ; Luis Fernandez Luque ; Brian Caulfield


Mobile monitoring for health and wellness is becoming more sophisticated and accurate, with an increased use of real-time personalization technologies that may improve the effectiveness of physical activity coaching systems. This study aimed to review real-time physical activity coaching applications that make use of personalization mechanisms. A scoping review, using the PRISMA-ScR checklist, was conducted on the literature published from July 2007 to July 2018. A data extraction tool was developed to analyze the systems on general characteristics, personalization, design foundations (behavior change and gamification) and evaluation methods. 28 papers describing 17 different mobile applications were included. The most used personalization concepts were Feedback (17/17), Goal Setting (15/17), User Targeting (9/17) and Inter-human Interaction (8/17), while the less commonly covered were Self-Learning (4/17), Context Awareness (3/17) and Adaptation (2/17). Few systems considered behavior change theories for design (6/17). A total of 42 instances of gamification-related elements were found across 15 systems, but only 6 explicitly mention its use. Most systems (15/17) were submitted to some type of evaluation. However, few assessed the effects of particular strategies or overall system effectiveness using randomized experimental designs (5/17). Although personalization is thought to improve user adherence in physical activity coaching applications, it is still far from reaching its full potential. We believe that future work should consider the theory and suggestions reported in prior work; leverage the needs of the target users for personalization; include behavior change foundations and explore gamification theory; and properly evaluate these systems.

November 04, 2019

Neuromuscular Electrical Stimulation (NMES) in the Management of Glioblastoma Multiforme - A Case Report

O'Connor, Dominic M.Sc; Caulfield, Brian PhD; Wright, Sarah M.Sc; Lennon, Olive PhD

Background and Purpose: 

Glioblastoma multiforme (GBM) is associated with debilitating physical and psychosocial side effects. Voluntary exercise recommended as an adjunct therapy is often limited by physical and neurological impairments. The potential effect of aerobic and muscle-strengthening neuromuscular electrical stimulation (termed concurrent NMES) exercise (4 weeks, 2-5 times/week, 30 minutes to 1 hour) delivered to the lower limbs in patients with GBM has not been examined. This case study explores the effect of a short-term concurrent NMES intervention progressing to NMES and supervised voluntary exercise (aerobic and resistance training) over a 10-week period in a patient with GBM undergoing adjuvant treatment.

October 31, 2019

A convolutional neural network algorithm for colon polyp detection

Ornela Bardhi, Daniel Sierra-Sosa, Begonya Garcia-Zapirain, Adel Elmaghraby

October 28, 2019

A Research Roadmap: Connected Health as an Enabler of Cancer Patient Support

Signorelli GR, Lehocki F, Mora Fernández M, O'Neill G, O'Connor D, Brennan L, Monteiro-Guerra F, Rivero-Rodriguez A, Hors-Fraile S, Munoz-Penas J, Bonjorn Dalmau M, Mota J, Oliveira RB, Mrinakova B, Putekova S, Muro N, Zambrana F, Garcia-Gomez JM



The evidence that quality of life is a positive variable for the survival of cancer patients has prompted the interest of the health and pharmaceutical industry in considering that variable as a final clinical outcome. Sustained improvements in cancer care in recent years have resulted in increased numbers of people living with and beyond cancer, with increased attention being placed on improving quality of life for those individuals. Connected Health provides the foundations for the transformation of cancer care into a patient-centric model, focused on providing fully connected, personalized support and therapy for the unique needs of each patient. Connected Health creates an opportunity to overcome barriers to health care support among patients diagnosed with chronic conditions. This paper provides an overview of important areas for the foundations of the creation of a new Connected Health paradigm in cancer care. Here we discuss the capabilities of mobile and wearable technologies; we also discuss pervasive and persuasive strategies and device systems to provide multidisciplinary and inclusive approaches for cancer patients for mental well-being, physical activity promotion, and rehabilitation. Several examples already show that there is enthusiasm in strengthening the possibilities offered by Connected Health in persuasive and pervasive technology in cancer care. Developments harnessing the Internet of Things, personalization, patient-centered design, and artificial intelligence help to monitor and assess the health status of cancer patients. Furthermore, this paper analyses the data infrastructure ecosystem for Connected Health and its semantic interoperability with the Connected Health economy ecosystem and its associated barriers. Interoperability is essential when developing Connected Health solutions that integrate with health systems and electronic health records. Given the exponential business growth of the Connected Health economy, there is an urgent need to develop mHealth (mobile health) exponentially, making it both an attractive and challenging market. In conclusion, there is a need for user-centered and multidisciplinary standards of practice to the design, development, evaluation, and implementation of Connected Health interventions in cancer care to ensure their acceptability, practicality, feasibility, effectiveness, affordability, safety, and equity.

February 07, 2019

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

Dominic O’Connor, Matilde Mora Fernandez, Gabriel Signorelli, Pedro Valero, Brian Caulfield




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.

August 30, 2018

Fit for life after cancer: does exercise timing matter?

O'Connor D, Daly A, Mulvin C, Lennon O.




To assess the effects of a single exercise session per week for 6 weeks on quality of life (QoL), fatigue and exercise participation in male and female cancer survivors with follow-up at 6 months. A secondary aim was to identify if the timing of exercise delivery determined its effect.


An exploratory prospective cohort study design was implemented. Twenty-five patients undergoing or who had completed cancer treatment (11 active treatment; 14 completed treatment) undertook exercise and educational sessions (Fit for Life) 1×/week. The Brief Fatigue Inventory (BFI), the European Organisation for Research and Treatment of Cancer QoL C-30 (EORTC QLQ C-30) and the Godin Leisure Time Exercise Questionnaire (GLTEQ) were used to assess fatigue, QoL and exercise levels, respectively. Participants were evaluated before and after the intervention, and after 6 months.


There was a significant group × time interaction for the GLTEQ at 6 months post in favour of exercising during active treatment (p=0.01). No other group × time interactions were observed across the EORTC QLQ C-30 or BFI. There was a significant main effect for time for EORTC QLQ C-30 Global with a significant increase observed between pre and 6 months post.


Exercise 1×/week delivered during treatment may impact on long-term exercise participation in adult cancer survivors. This lower volume programme may improve QoL, but has minimal effect on fatigue suggesting an insufficient exercise dosage to impact this variable. This study generates interesting proof of concept results and may be helpful in the development of larger randomised controlled trials.

July 17, 2018

The efficacy and prescription of neuromuscular electrical stimulation (NMES) in adult cancer survivors: a systematic review and meta-analysis.

O'Connor D, Caulfield B, Lennon O.




This study aims to (1) summarise and critically evaluate the effects of neuromuscular electrical stimulation (NMES) on indices of health and quality of life (QoL) in adult cancer survivors, (2) assess the safety of NMES as a rehabilitation method in this population, and (3) identify commonly used NMES treatment parameters and describe treatment progression.


A systematic search of four electronic databases targeted studies evaluating the effects of NMES on physical function, aerobic fitness, muscle strength, body composition, and health-related quality of life (HR-QoL) in adult cancer survivors, published through March 2018. Two reviewers independently reviewed and appraised the risk of bias of each study.


Nine studies were included. Meta-analyses found that the overall pooled effect favoured NMES for improving muscle strength, but the standardised mean difference was not significant (0.36; 95% CI - 0.25, 0.96). Further meta-analyses indicated that NMES significantly improved HR-QoL (0.36; 95% CI 0.10, 0.62), with notable gains identified under the subcategories QoL Function (0.87; 95% CI 0.32, 1.42). Current NMES prescription is not standardised and NMES is prescribed to target secondary complications of treatment. Risk of bias was high for most studies.


NMES use in adult cancer survivors is an emerging field and current literature is limited by studies of poor quality and a lack of adequately powered RCTs. Existing evidence suggests that NMES is safe and may be more effective than usual care for improving HR-QoL. Prescription and progression should be tailored for the individual based on functional deficits.

June 30, 2018

The use of neuromuscular electrical stimulation (NMES) for managing the complications of ageing related to reduced exercise participation.

O'Connor D, Brennan L, Caulfield B.



Exercise participation and activity levels are low in many older adults, and when paired with the multi-systemic effects of ageing, such as sarcopenia and decreased cardiovascular function, can result in a loss of functional independence. Voluntary exercise may not always be feasible for these individuals, highlighting a need for alternative therapies. There is a growing body of literature that recognises the positive effects of neuromuscular electrical stimulation (NMES) on muscle strength, muscle mass and cardiorespiratory function in older adults. However, NMES suffers from poor clinical acceptability due to multiple barriers to its use, and poor patient engagement and adherence have been noted. Technology-based supports to exercise, such as biofeedback and 'gamification', have been effectively paired with a variety of rehabilitation interventions. This suggests that these supports could be promising additions to an NMES exercise system to reduce barriers to its use and maximise clinical outcomes.

May 21, 2018

The application of neuromuscular electrical stimulation (NMES) in cancer rehabilitation: current prescription, pitfalls, and future directions.

O'Connor D, Caulfield B.



The plethora of treatment complications associated with cancer can be offset by regular exercise participation; however, adherence to current guidelines is poor, in particular in those unable or not allowed to participate in voluntary exercise due to their underlying disease. Alternative therapies such as neuromuscular electrical stimulation (NMES) are promising although previous results in cancer survivors have been equivocal. This is likely in response to methodological issues such as inappropriate NMES prescription. Therefore, the aim of this commentary is to propose three key areas which should be addressed to increase NMES effectiveness in cancer rehabilitation; (1) NMES exercise should target both the neuromuscular and cardiovascular systems through low- and high-frequency modalities, (2) technological advancements such as mobile app-based systems should be leveraged to improve at-home monitoring of home-based NMES exercise, and (3) prescription and progression should follow the fundamental principles of exercise to overcome the heterogeneity in daily physiological, functional, and psychological factors faced by survivors. Addressing these three key areas in future studies may help improve NMES exercise effectiveness and accelerate patient rehabilitation.

January 23, 2018

Activating Technology for Connected Health in Cancer: Protocol for a Research and Training Program.

Mountford N, Dorronzoro Zubiete E, Kessie T, Garcia-Zapirain B, Nuño-Solinís R, Coyle D, Munksgaard KB, Fernandez-Luque L, Rivera Romero O, Mora Fernandez M, Valero Jimenez P, Daly A, Whelan R, Caulfield B.




As cancer survival rates increase, the challenge of ensuring that cancer survivors reclaim their quality of life (QoL) becomes more important. This paper outlines the research element of a research and training program that is designed to do just that.


Bridging sectors, disciplines, and geographies, it brings together eight PhD projects and students from across Europe to identify the underlying barriers, test different technology-enabled rehabilitative approaches, propose a model to optimize the patient pathways, and examine the business models that might underpin a sustainable approach to cancer survivor reintegration using technology.


The program, funded under the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 722012, includes deep disciplinary PhD projects, intersectoral and international secondments, interdisciplinary plenary training schools, and virtual subject-specific education modules.


The 8 students have now been recruited and are at the early stages of their projects.


CATCH will provide a comprehensive training and research program by embracing all key elements-technical, social, and economic sciences-required to produce researchers and project outcomes that are capable of meeting existing and future needs in cancer rehabilitation.

December 17, 2017

Automatic colon polyp detection using Convolutional encoder-decoder model

Ornela Bardhi, Daniel Sierra-Sosa, Begonya Garcia-Zapirain, Adel Elmaghraby


Colorectal cancer is a leading cause of cancer deaths, estimated 696 thousand worldwide. Recent years have seen an increase of deep learning techniques and algorithms being used to detect colon polyps. In this work we address colon polyp detection using Convolutional Neural Networks (CNNs) combined with Autoencoders. We use 3 publicly available databases namely: CVC-ColonDB, CVC-ClinicDB and ETIS-LaribPolypDB, to train the model. The results obtained in terms of accuracy are: 0.937, 0.951, 0.967 for the above-mentioned databases respectively. Due to the nature of the colon polyps, diverse shapes and characteristics, there is still place for improvements.

December 03, 2017

Mobile Phone Apps for Quality of Life and Well-Being Assessment in Breast and Prostate Cancer Patients: Systematic Review.

Rincon E, Monteiro-Guerra F, Rivera-Romero O, Dorronzoro-Zubiete E, Sanchez-Bocanegra CL, Gabarron E.




Mobile phone health apps are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. Although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients' quality of life (QoL) and well-being.


The purposes of this study were to review the scientific literature on mobile phone apps targeting breast or prostate cancer patients and involving QoL and well-being (anxiety and depression symptoms) and analyze the clinical and technological characteristics, strengths, and weaknesses of these apps, as well as patients' user experience with them.


We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Excerpta Medica Database, PsycINFO, PubMed, Scopus, and MEDLINE to identify studies involving apps focused on breast and/or prostate cancer patients and QoL and/or well-being published between January 1, 2000, and July 12, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the apps previously identified in the health literature research that were available from the official app stores.


The systematic review of the literature yielded 3862 articles. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. Four studies targeted breast cancer patients and 1 focused on prostate cancer patients. Four studies referred to apps that assessed QoL. Only 1 among the 5 analyzed apps was available from the official app store. In 3 studies, an app-related intervention was carried out, and 2 of them reported an improvement on QoL. The lengths of the app-related interventions varied from 4 to 12 weeks. Because 2 of the studies only tracked use of the app, no effect on QoL or well-being was found.


Despite the existence of hundreds of studies involving cancer-focused mobile phone apps, there is a lack of rigorous trials regarding the QoL and/or well-being assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that effectively represent useful, accurate, and reliable tools for cancer patients' disease management.

May 31, 2017

Conceptualising a Targeted Rehabilitation Exercise Biofeedback System for a Cancer Survivorship Population

Brennan L, Daly A, Caulfield B.



Introduction The increased prevalence of cancer survivors requires a focus on developing long-term, cost-effective management strategies to prevent and limit disability and morbidity. Background Cancer survivors with pain, weakness and restricted movement often benefit from targeted exercise programmes provided by a Physiotherapist. Physical, psychological and situational factors can impact on patients abilities to complete these exercises. In recent years, interactive biofeedback exercise systems have been shown to be effective in the rehabilitation of musculoskeletal impairments. Such a system has not yet been developed for cancer survivors. Proposal An targeted rehabilitation exercise biofeedback system for use in cancer survivors is proposed. This system aims to enhance rehabilitation outcomes using biofeedback, gamification and adherence promotion strategies. Conclusion An online targeted-exercise biofeedback system for use in cancer rehabilitation would be an innovative, beneficial development for the growing numbers of individuals surviving cancer.

May 31, 2017

Quality of Information About Physical Activity in Breast Cancer Facebook Pages: A Preliminary Content Reviewcatchy title...

Signorelli GR, Fernandez MM, Monteiro-Guerra F, Fernandez-Luque L, Caulfield B.



In this study, we focused on posting frequency and quality of exercise and physical activity content in Facebook. We sought to (1) explore the frequency of exercise and physical activity topics posted on specialized Breast Cancer channels and (2) evaluate the quality of these information. Evaluations of informations quality were performed independently by two sports and exercise experts, with previous breast cancer physical activity experience, using the DISCERN instrument. Despite of almost one hundred Facebook pages about Breast Cancer, only six are explicitly dedicated to physical activity and exercise and those pages do not have a significant numbers of likes. It shows that there is no specialized and focused serious initiative on Facebook looking for improve Breast Cancer educational levels about exercise and motivating them to engage in a physical activity lifestyle. There are very few, and low quality posts about exercise and physical activity for breast cancer showing that less importance tan it need has been given to this topic.

May 31, 2017

The design of a mobile app for promotion of physical activity and self-management in prostate cancer survivors: personas, feature ideation and low-fidelity prototyping

Monteiro-Guerra F, Rivera-Romero O, Mylonopoulou V, Signorelli GR, Zambrana F, Fernandez-Luque L.



Most prostate cancer survivors are confronted with disease-related and treatment-related side effects that impact their quality of life. A tool that combines specific physical activity coaching with the promotion of a healthy lifestyle and self-management guidance might be a successful method to enhance a lifestyle change in these patients. As a prerequisite for useful health technology, it is important to consider a design process centred in the patients. The aim of this study was to investigate the context of the problem and the user needs to support the ideation of a low-fidelity prototype of a tool to promote a healthy lifestyle in survivors of early-stage prostate cancer survivors. A user-centred design approach was followed involving a multidisciplinary team. The prototype was developed in 3 phases. In phase 1, the context was studied with 2 systematic reviews of the state of practice and consulting with 3 specialists in Oncology, resulting in a global use case and main requirements. In phase 2, the needs and barriers of the users were studied based on literature research and validated with 3 specialists, resulting in the creation of 3 personas. In phase 3, 2 sessions were held to ideate and prioritize possible app features, based on brainstorming and selection techniques. Using the Ninja Mock and software a low-fidelity prototype was developed, resulting in 25 interactive screens. Understanding the user needs and context seems to be essential to highlight key goals hence facilitating the bridge between ideation of the tool and the intended users tasks and experiences. The conclusion of this first stage of the design process brings valuable details (such as barriers of the users to technology and physical activity) for future iterations of design of the mobile app.

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© 2016 CATCH. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement 
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