1
|
Tamayo-Torres E, Garrido A, de Cabo R, Carretero J, Gómez-Cabrera MC. Molecular mechanisms of cancer cachexia. Role of exercise training. Mol Aspects Med 2024; 99:101293. [PMID: 39059039 DOI: 10.1016/j.mam.2024.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
Cancer-associated cachexia represents a multifactorial syndrome mainly characterized by muscle mass loss, which causes both a decrease in quality of life and anti-cancer therapy failure, among other consequences. The definition and diagnostic criteria of cachexia have changed and improved over time, including three different stages (pre-cachexia, cachexia, and refractory cachexia) and objective diagnostic markers. This metabolic wasting syndrome is characterized by a negative protein balance, and anti-cancer drugs like chemotherapy or immunotherapy exacerbate it through relatively unknown mechanisms. Due to its complexity, cachexia management involves a multidisciplinary strategy including not only nutritional and pharmacological interventions. Physical exercise has been proposed as a strategy to counteract the effects of cachexia on skeletal muscle, as it influences the mechanisms involved in the disease such as protein turnover, inflammation, oxidative stress, and mitochondrial dysfunction. This review will summarize the experimental and clinical evidence of the impact of physical exercise on cancer-associated cachexia.
Collapse
Affiliation(s)
- Eva Tamayo-Torres
- Department of Physiology, Faculty of Pharmacy, University of Valencia, 46100, Burjassot, Spain; Freshage Research Group. Department of Physiology. Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - Amanda Garrido
- Experimental Gerontology Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Rafael de Cabo
- Experimental Gerontology Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Julián Carretero
- Department of Physiology, Faculty of Pharmacy, University of Valencia, 46100, Burjassot, Spain.
| | - María Carmen Gómez-Cabrera
- Freshage Research Group. Department of Physiology. Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| |
Collapse
|
2
|
Kominami K, Akino M, Kanai M. Efficacy of Neuro-muscular Electrical Stimulation for Orthostatic Hypotension Associated with Long-term Disuse and Diabetic Autonomic Neuropathy: A Case Report. Phys Ther Res 2024; 27:180-185. [PMID: 39866392 PMCID: PMC11756561 DOI: 10.1298/ptr.e10298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/16/2024] [Indexed: 01/28/2025]
Abstract
Patient Background: A 75-year-old man had difficulty moving around at home because of loss of appetite and neglect of medication for several days. He was brought to the emergency room and admitted on the same day with a diagnosis of dehydration and diabetic ketoacidosis. He started physical therapy (PT), had frequent fainting and presyncope due to hypotension, and had difficulty leaving bed. The patient was transferred to our hospital to continue PT. Test results on admission were as follows: short physical performance battery (SPPB) [points], 1/12 points; chair stand 5 times (CS5) [sec], not possible; functional independent measure (FIM) [points], 66/126; standing test: blood pressure (BP) [mmHg], 130/60/HR [beats per minute], 76 in supine, 90/56/79 in sitting, 70/-/79 in standing. PROCESS After transfer, BP continued to fall markedly and he frequently fainted and required assistance with nearly all activities of daily living (ADL). Neuromuscular electrical stimulation (NMES) of the thigh and lower leg was performed five times a week for 30 min. After approximately 3 days of NMES, BP decreased slowly, presyncopic symptoms disappeared, and he could leave bed more frequently and for longer periods. The patient became independent in ADL and was discharged on Day 142. Results at discharge were as follows: SPPB, 11/12; CS5, 13.5; FIM, 114/126. DISCUSSION Although NMES is not effective for orthostatic hypotension (OH) associated with diabetic autonomic neuropathy (DAN), stabilization of BP early after the introduction of NMES may have been due to its peripheral sympathetic nerve-stimulating effect. CONCLUSION The combination of exercise therapy and NMES for OH caused by DAN can alleviate hypotension.
Collapse
Affiliation(s)
| | - Masatoshi Akino
- Department of Internal Medicine, Sapporo Kiyota Hospital, Japan
| | - Motoshi Kanai
- Department of Internal Medicine, Sanseikai Kitano Hospital, Japan
| |
Collapse
|
3
|
Alqurashi HB, Robinson K, O’Connor D, Piasecki M, Gordon AL, Masud T, Gladman JRF. The effects of neuromuscular electrical stimulation on hospitalised adults: systematic review and meta-analysis of randomised controlled trials. Age Ageing 2023; 52:afad236. [PMID: 38156975 PMCID: PMC10756181 DOI: 10.1093/ageing/afad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Neuromuscular electrical stimulation (NMES) is a treatment to prevent or reverse acquired disability in hospitalised adults. We conducted a systematic review and meta-analysis of its effectiveness. METHOD We searched MEDLINE, EMBASE, Cumulative Index to Nursing & Allied Health (CINAHL) and the Cochrane library. Inclusion criteria: randomised controlled trials of hospitalised adult patients comparing NMES to control or usual care. The primary outcome was muscle strength. Secondary outcomes were muscle size, function, hospital length of stay, molecular and cellular biomarkers, and adverse effects. We assessed risk of bias using the Cochrane risk-of-bias tool. We used Review Manager (RevMan) software for data extraction, critical appraisal and synthesis. We assessed certainty using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS A total of 42 papers were included involving 1,452 participants. Most studies had unclear or high risk of bias. NMES had a small effect on muscle strength (moderate certainty) (standardised mean difference (SMD) = 0.33; P < 0.00001), a moderate effect on muscle size (moderate certainty) (SMD = 0.66; P < 0.005), a small effect on walking performance (moderate certainty) (SMD = 0.48; P < 0.0001) and a small effect on functional mobility (low certainty) (SMD = 0.31; P < 0.05). There was a small and non-significant effect on health-related quality of life (very low certainty) (SMD = 0.35; P > 0.05). In total, 9% of participants reported undesirable experiences. The effects of NMES on length of hospital stay, and molecular and cellular biomarkers were unclear. CONCLUSIONS NMES is a promising intervention component that might help to reduce or prevent hospital-acquired disability.
Collapse
Affiliation(s)
- Helal B Alqurashi
- University of Nottingham, Nottingham, UK
- Department of Physical Therapy, Faculty of Applied Medical Science, Taif University, Taif, Saudi Arabia
- NIHR Nottingham Biomedical Research Centre (BRC), UK
| | - Katie Robinson
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Mathew Piasecki
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), UK
| | - Adam L Gordon
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), UK
- NIHR Applied Research Collaboration (ARC) East Midlands, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Tahir Masud
- NIHR Nottingham Biomedical Research Centre (BRC), UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John R F Gladman
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Applied Research Collaboration (ARC) East Midlands, UK
| |
Collapse
|
4
|
Schriwer E, Juthberg R, Flodin J, Ackermann PW. Motor point heatmap of the calf. J Neuroeng Rehabil 2023; 20:28. [PMID: 36859293 PMCID: PMC9976413 DOI: 10.1186/s12984-023-01152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Contractions of muscles in the calf induced by neuromuscular electrical stimulation (NMES) may prevent venous thromboembolism, help rehabilitation and optimize strength training, among other uses. However, compliance to NMES-treatment is limited by the use of suboptimal stimulation points which may cause discomfort and less effectivity. Knowledge of where one is most likely to find muscle motor points (MP) could improve NMES comfort and compliance. AIMS To anatomically map the MPs of the calf as well as to calculate the probability of finding a MP in different areas of the calf. MATERIAL AND METHODS On 30 healthy participants (mean age 37 years) anatomical landmarks on the lower limbs were defined. The location of the four most responsive MPs on respectively the medial and lateral head of gastrocnemius were determined in relation to these anatomical landmarks using a MP search pen and a pre-set MP search program with 3 Hz continuous stimulation (Search range:4.0-17.5 mA). The anatomy of the calves was normalized and subdivided into a matrix of 48 (6 × 8) smaller areas (3 × 3 cm), from upper medial to lower lateral, in order to calculate the probability of finding a MP in one of these areas. The probability of finding a MP was then calculated for each area and presented with a 95% confidence interval. RESULTS The MP heatmap displayed a higher concentration of MPs proximally and centrally on the calf. However, there were wide inter-individual differences in the location of the MPs. The highest probability of finding a MP was in area 4, located centrally and medially, and in area 29, located centrolaterally and around the maximum circumference, both with 50% probability (95% CI: 0.31-0.69). The second highest probability of finding MPs was in areas 9, 10, 16, proximally and medially, all with 47% probability (95% CI: 0.28-0.66). These areas 4, 9, 10, 16 and 29 exhibited significantly higher probability of finding motor points than all areas with a mean probability of 27% and lower (p < 0.05) The lateral and distal outskirts exhibited almost zero probability of finding MPs. CONCLUSIONS This MP heatmap of the calf could be used to expedite electrode placement and to improve compliance in order to receive consistent and enhanced results of NMES treatments.
Collapse
Affiliation(s)
- Elias Schriwer
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Robin Juthberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Flodin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
5
|
Maris S, Brands M, Lenskens D, Braeken G, Kemnitz S, Vanhove H, Mc Laughlin M, Meesen R, Brône B, Stessel B. Transcutaneous electrical nerve inhibition using medium frequency alternating current. Sci Rep 2022; 12:14911. [PMID: 36050354 PMCID: PMC9437086 DOI: 10.1038/s41598-022-18974-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Transcutaneous medium-frequency alternating electrical current is defined as an alternating current between 1 and 10 kHz and is capable of producing an instant, reversible block. This study aims to evaluate the efficacy of sensory perception and force production of the index and middle finger after transcutaneous medium-frequency alternating electrical current stimulation of the distal median nerve. A single-center prospective interventional cohort study was conducted in adult healthy volunteers at the Jessa Hospital, Hasselt, Belgium. Two different electrodes (PALS & 3M) were placed on the distal median nerve, which was located using a Sonosite X-Porte Ultrasound transducer, with the first electrode being placed on the skin at the level of the transverse carpal ligament and the second electrode 7 cm proximally to the first electrode. The tactile sensation was evaluated with Semmes–Weinstein monofilament test and sensation of pressure/pain was evaluated with an algometer. Peak force production was assessed with an electronic dynamometer. All measurements were performed at baseline and tMFAEC stimulation frequencies of 2 and 10 kHz in a randomized manner. Statistical analysis was performed with a one-way ANOVA with repeated measures test or a Friedman rank sum test, followed by the Wilcoxon signed rank test adjusted with Bonferroni correction. A p-value < 0.05 was considered statistically significant. From 9 to 13th of April 2021, 25 healthy volunteers were included in the Jessa Hospital, Hasselt, Belgium. A statistically significant reduction in tactile sensation during 2 kHz and 10 kHz stimulation compared to baseline was observed (2.89 ± 0.22 (PALS2); 3.35 ± 0.25 (3M2) and 2.14 ± 0.12 (PALS10); 2.38 ± 0.12 (3M10) versus − 1.75 ± 0.09 (baseline), p < 0.0001). 3M electrodes showed a tendency towards the elevation of pressure pain threshold compared to baseline. No significant difference in mean peak forces of the index and middle fingers after transcutaneous medium-frequency alternating electrical current stimulation with 2 and 10 kHz was found. This study demonstrates that transcutaneous medium-frequency alternating electrical current stimulation on the distal median nerve inhibits tactile sensory nerve activity in the index and middle finger when stimulation of 2 kHz and, to a lesser extent, 10 kHz was applied. A reduction of motor nerve activity was not observed but force production measurements may be prone to error. Trial registration: clinicaltrials.gov on 01/04/2021. NCT-Number: NCT04827173.
Collapse
Affiliation(s)
- Seppe Maris
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium. .,Faculty of Medicine and Life Sciences, BIOMED Research Institute, UHasselt, Agoralaan Gebouw C, 3590, Diepenbeek, Belgium.
| | - Michiel Brands
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Daniele Lenskens
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.,Department of Anaesthesiology and Pain Medicine, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Geert Braeken
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Stefan Kemnitz
- Faculty of Medicine and Life Sciences, BIOMED Research Institute, UHasselt, Agoralaan Gebouw C, 3590, Diepenbeek, Belgium
| | - Herbert Vanhove
- Faculty of Medicine and Life Sciences, BIOMED Research Institute, UHasselt, Agoralaan Gebouw C, 3590, Diepenbeek, Belgium
| | - Myles Mc Laughlin
- Exp ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Raf Meesen
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Agoralaan Gebouw A, 3590, Diepenbeek, Belgium.,Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Department of Movement Sciences, KU Leuven, Herestraat 49, 3500, Leuven, Belgium
| | - Bert Brône
- Faculty of Medicine and Life Sciences, BIOMED Research Institute, UHasselt, Agoralaan Gebouw C, 3590, Diepenbeek, Belgium
| | - Björn Stessel
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, BIOMED Research Institute, UHasselt, Agoralaan Gebouw C, 3590, Diepenbeek, Belgium
| |
Collapse
|
6
|
Püsküllüoğlu M, Tomaszewski KA, Grela-Wojewoda A, Pacholczak-Madej R, Ebner F. Effects of Transcutaneous Electrical Nerve Stimulation on Pain and Chemotherapy-Induced Peripheral Neuropathy in Cancer Patients: A Systematic Review. Medicina (B Aires) 2022; 58:medicina58020284. [PMID: 35208610 PMCID: PMC8876365 DOI: 10.3390/medicina58020284] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Transcutaneous electrical nerve stimulation (TENS) is the usage of a mild electrical current through electrodes that stimulate nerves. Patients with malignancies experience pain and chemotherapy-induced peripheral neuropathy. A systematic review was performed to find research evaluating the effect of TENS on these two common symptoms decreasing the quality of life in cancer patients. PubMed, the Cochrane Central Register of Controlled Trials and EMBASE were searched. Original studies, namely randomized controlled trials, quasi-randomized controlled trials and controlled clinical trials, published between April 2007 and May 2020, were considered. The quality of the selected studies was assessed. Seven papers were incorporated in a qualitative synthesis, with 260 patients in total. The studies varied in terms of design, populations, endpoints, quality, treatment duration, procedures and follow-up period. Based on the results, no strict recommendations concerning TENS usage in the cancer patient population could be issued. However, the existing evidence allows us to state that TENS is a safe procedure that may be self-administered by the patients with malignancy in an attempt to relieve different types of pain. There is a need for multi-center, randomized clinical trials with a good methodological design and adequate sample size.
Collapse
Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 00-001 Krakow, Poland; (A.G.-W.); (R.P.-M.)
- Labcorp (Polska) Sp. z o.o., 05-825 Warsaw, Poland
- Correspondence:
| | - Krzysztof A. Tomaszewski
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland;
- Scanmed St. Raphael Hospital, 30-693 Krakow, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 00-001 Krakow, Poland; (A.G.-W.); (R.P.-M.)
| | - Renata Pacholczak-Madej
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 00-001 Krakow, Poland; (A.G.-W.); (R.P.-M.)
- Department of Anatomy, Medical College, Jagiellonian University, 31-008 Krakow, Poland
| | - Florian Ebner
- Helios Amper-Klinikum Dachau, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität, 85221 München, Germany;
| |
Collapse
|
7
|
Modeling optical design parameters for fine stimulation in sciatic nerve of optogenetic mice. Sci Rep 2021; 11:22588. [PMID: 34799602 PMCID: PMC8605010 DOI: 10.1038/s41598-021-01353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/28/2021] [Indexed: 11/08/2022] Open
Abstract
Optogenetics presents an alternative method for interfacing with the nervous system over the gold-standard of electrical stimulation. While electrical stimulation requires electrodes to be surgically embedded in tissue for in vivo studies, optical stimulation offers a less-invasive approach that may yield more specific, localized stimulation. The advent of optogenetic laboratory animals-whose motor neurons can be activated when illuminated with blue light-enables research into refining optical stimulation of the mammalian nervous system where subsets of nerve fibers within a nerve may be stimulated without embedding any device directly into the nerve itself. However, optical stimulation has a major drawback in that light is readily scattered and absorbed in tissue thereby limiting the depth with which a single emission source can penetrate. We hypothesize that the use of multiple, focused light emissions deployed around the circumference of a nerve can overcome these light-scattering limitations. To understand the physical parameters necessary to produce pinpointed light stimulation within a single nerve, we employed a simplified Monte Carlo simulation to estimate the size of nerves where this technique may be successful, as well as the necessary optical lens design for emitters to be used during future in vivo studies. By modeling multiple focused beams, we find that only fascicles within a nerve diameter less than 1 mm are fully accessible to focused optical stimulation; a minimum of 4 light sources is required to generate a photon intensity at a point in a nerve over the initial contact along its surface. To elicit the same effect in larger nerves, focusing lenses would require a numerical aperture [Formula: see text]. These simulations inform on the design of instrumentation capable of stimulating disparate motor neurons in mouse sciatic nerve to control hindlimb movement.
Collapse
|
8
|
Padilha CS, Cella PS, Chimin P, Voltarelli FA, Marinello PC, Testa MTDEJ, Guirro PB, Duarte JAR, Cecchini R, Guarnier FA, Deminice R. Resistance Training's Ability to Prevent Cancer-induced Muscle Atrophy Extends Anabolic Stimulus. Med Sci Sports Exerc 2021; 53:1572-1582. [PMID: 33731662 DOI: 10.1249/mss.0000000000002624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to determine the role of mammalian target of rapamycin (mTORC1) activation and catabolic markers in resistance training's (RT) antiatrophy effect during cachexia-induced muscle loss. METHODS Myofiber atrophy was induced by injecting Walker 256 tumor cells into rats exposed or not exposed to the RT protocol of ladder climbing. The role of RT-induced anabolic stimulation was investigated in tumor-bearing rats with the mTORC1 inhibitor rapamycin, and cross-sectional areas of skeletal muscle were evaluated to identify atrophy or hypertrophy. Components of the mTORC1 and ubiquitin-proteasome pathways were assessed by real-time polymerase chain reaction or immunoblotting. RESULTS Although RT prevented myofiber atrophy and impaired the strength of tumor-bearing rats, in healthy rats, it promoted activated mTORC1, as demonstrated by p70S6K's increased phosphorylation and myofiber's enlarged cross-sectional area. However, RT promoted no changes in the ratio of p70S6K to phospho-p70S6K protein expression while prevented myofiber atrophy in tumor-bearing rats. Beyond that, treatment with rapamycin did not preclude RT's preventive effect on myofiber atrophy in tumor-bearing rats. Thus, RT's ability to prevent cancer-induced myofiber atrophy seems to be independent of mTORC1's and p70S6K's activation. Indeed, RT's preventive effect on cancer-induced myofiber atrophy was associated with its capacity to attenuate elevated tumor necrosis factor α and interleukin 6 as well as to prevent oxidative damage in muscles and an elevated abundance of atrogin-1. CONCLUSIONS By inducing attenuated myofiber atrophy independent of mTORC1's signaling activation, RT prevents muscle atrophy during cancer by reducing inflammation, oxidative damage, and atrogin-1 expression.
Collapse
Affiliation(s)
| | - Paola S Cella
- Department of Physical Education, State University of Londrina, Londrina, PR, BRAZIL
| | - Patrícia Chimin
- Department of Physical Education, State University of Londrina, Londrina, PR, BRAZIL
| | - Fabrício A Voltarelli
- Federal University of Mato Grosso, Graduate Program of Health Sciences, Faculty of Medicine, Cuiabá, BRAZIL
| | | | | | - Philippe B Guirro
- Department of Physical Education, State University of Londrina, Londrina, PR, BRAZIL
| | - José A R Duarte
- University of Porto, CIAFEL, Faculty of Sport, Porto, PORTUGAL
| | - Rubens Cecchini
- State University of Londrina, Department of General Pathology, Londrina, PR, BRAZIL
| | - Flávia A Guarnier
- State University of Londrina, Department of General Pathology, Londrina, PR, BRAZIL
| | - Rafael Deminice
- Department of Physical Education, State University of Londrina, Londrina, PR, BRAZIL
| |
Collapse
|
9
|
Neuromuscular Electrical Stimulation (NMES) in the Management of Glioblastoma Multiforme: A Case Report. REHABILITATION ONCOLOGY 2021. [DOI: 10.1097/01.reo.0000000000000189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
O'Connor D, Lennon O, Wright S, Caulfield B. Self-directed home-based neuromuscular electrical stimulation (NMES) in patients with advanced cancer and poor performance status: a feasibility study. Support Care Cancer 2020; 28:5529-5536. [PMID: 32179996 PMCID: PMC7547042 DOI: 10.1007/s00520-020-05394-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/17/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Concurrent neuromuscular electrical stimulation (NMES) involving sub-tetanic low frequency and tetanic high frequency which targets aerobic and muscular fitness is a potential alternative to conventional exercise in cancer rehabilitation. However, its safety and feasibility in patients with advanced cancer are unknown. The aim of this feasibility study was to determine safety and feasibility and evaluate changes in functional and health-related quality of life (HR-QoL) outcomes in individuals with advanced cancer and poor performance status after concurrent NMES. These results should help inform the design of future studies. METHODS Participants with advanced cancer and poor performance status (Eastern Cooperative Oncology Group scale ≥ 2) (n = 18) were recruited. The intervention included a novel NMES intervention implemented over a 4-week period. Functional exercise capacity, lower limb muscle endurance and HR-QoL were measured by 6-min walk test (6MWT), 30-s sit-to-stand (30STS) and European Organization for Research and Treatment quality of life questionnaire core-30 (EORTC QLQ C30) pre and post-intervention. Participants unable to complete the 6-min walk test completed the timed up and go test. Participant experience and the impact of the intervention on daily life were investigated through semi-structured interviews. RESULTS Ten of 18 participants completed the intervention. No adverse events were reported. Seven of 8 participants improved 6MWT performance (2 of 2 improved timed up and go), 8 of 10 participants improved 30STS and 8 of 10 participants improved Global quality of life. Perceived benefits included improved mobility and muscle strength. CONCLUSIONS Neuromuscular electrical stimulation appears safe and feasible in advanced cancer and may improve physical and HR-QoL outcomes. Future prospective trials are warranted to confirm these findings prior to clinical implementation in an advanced cancer setting.
Collapse
Affiliation(s)
- Dominic O'Connor
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
- The Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Dublin, Ireland.
- Queens University, Belfast, Ireland.
| | - Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Sarah Wright
- Physiotherapy Department, Beacon Hospital, Dublin, Ireland
| | - Brian Caulfield
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- The Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Dublin, Ireland
| |
Collapse
|
11
|
Lavigne C, Twomey R, Lau H, Francis G, Culos-Reed SN, Millet GY. Feasibility of eccentric overloading and neuromuscular electrical stimulation to improve muscle strength and muscle mass after treatment for head and neck cancer. J Cancer Surviv 2020; 14:790-805. [PMID: 32447575 DOI: 10.1007/s11764-020-00893-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/07/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Treatment of head and neck cancer (HNC) results in severe weight loss, mainly due to the loss of lean body mass. Consequently, decreases in muscular strength and health-related quality of life (HRQL) occur. This study investigated the feasibility of a 12-week novel strength training (NST) and conventional strength training (CST) intervention delivered after HNC treatment. METHODS Participants were randomized to a NST group (n = 11) involving eccentric overloaded strength training and neuromuscular electrical stimulation (NMES), or a CST group (n = 11) involving dynamic resistance exercises matched for training volume. Feasibility outcomes included recruitment, completion, adherence, and evidence of progression. A neuromuscular assessment involving maximal isometric voluntary contractions (MIVCs) in the knee extensors was evaluated prior to and during incremental cycling to volitional exhaustion at baseline and after the interventions. Anthropometrics and patient-reported outcomes (PROs) were also assessed. RESULTS Although recruitment was challenging, completion was 100% in NST and 82% in CST. Adherence was 92% in NST and 81% in CST. Overall, MIVC increased by 19 ± 23%, muscle cross-sectional area improved 18 ± 22%, cycling exercise time improved by 18 ± 13%, and improvements in HRQL and fatigue were clinically relevant. CONCLUSIONS Both interventions were found to be feasible for HNC patients after treatment. Strength training significantly improved maximal muscle strength, muscle cross-sectional area, and PROs after HNC treatment. Future research should include fully powered trials and consider the use of eccentric overloading and NMES during HNC treatment. IMPLICATIONS FOR CANCER SURVIVORS Eccentric- and NMES-emphasized strength training may be useful alternatives to conventional strength training after HNC treatment.
Collapse
Affiliation(s)
- Colin Lavigne
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Harold Lau
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - George Francis
- Division of Physical Medicine & Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychosocial Resources, Cancer Care, Alberta Health Services, Tom Baker Cancer Centre, Calgary, Canada
| | - Guillaume Y Millet
- Faculty of Kinesiology, University of Calgary, Calgary, Canada. .,Inter-university Laboratory of Human Movement Biology, Univ Lyon, UJM-Saint-Etienne, EA 7424, F-42023, Saint-Etienne, France. .,Institut Universitaire de France (IUF), Paris, France. .,Jean Monnet University Saint-Etienne, 10 rue de la Marandière, 42270, Saint Priest en Jarez, France.
| |
Collapse
|
12
|
Toth MJ, Voigt TB, Tourville TW, Prior SM, Guigni BA, Schlosberg AV, Smith IB, Forest TJ, Kaufman PA, Wood ME, Rehman H, Dittus K. Effect of neuromuscular electrical stimulation on skeletal muscle size and function in patients with breast cancer receiving chemotherapy. J Appl Physiol (1985) 2020; 128:1654-1665. [PMID: 32378975 DOI: 10.1152/japplphysiol.00203.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Exercise has numerous benefits for patients with cancer, but implementation is challenging because of practical and logistical hurdles. This study examined whether neuromuscular electrical stimulation (NMES) can serve as a surrogate for classic exercise by eliciting an exercise training response in skeletal muscle of women diagnosed with breast cancer undergoing chemotherapy. Patients (n = 22) with histologically confirmed stage I, II, or III breast cancer scheduled to receive neoadjuvant or adjuvant chemotherapy were randomized to 8 wk of bilateral neuromuscular electrical stimulation (NMES; 5 days/wk) to their quadriceps muscles or control. Biopsy of the vastus lateralis was performed at baseline and after 8 wk of intervention to assess muscle fiber size, contractility, and mitochondrial content. Seventeen patients (8 control/9 NMES) completed the trial and were included in analyses. NMES promoted muscle fiber hypertrophy (P < 0.001), particularly in fast-twitch, myosin heavy chain (MHC) IIA fibers (P < 0.05) and tended to induce fiber type shifts in MHC II fibers. The effects of NMES on single-muscle fiber contractility were modest, and it was unable to prevent declines in the function in MHC IIA fibers. NMES did not alter intermyofibrillar mitochondrial content/structure but was associated with reductions in subsarcolemmal mitochondria. Our results demonstrate that NMES induces muscle fiber hypertrophy and fiber type shifts in MHC II fibers but had minimal effects on fiber contractility and promoted reductions in subsarcolemmal mitochondria. Further studies are warranted to evaluate the utility of NMES as an exercise surrogate in cancer patients and other conditions.NEW & NOTEWORTHY This is the first study to evaluate whether neuromuscular electrical stimulation (NMES) can be used as an exercise surrogate to improve skeletal muscle fiber size or function in cancer patients receiving treatment. We show that NMES promoted muscle fiber hypertrophy and fiber type shifts but had minimal effects on single-fiber contractility and reduced subsarcolemmal mitochondria.
Collapse
Affiliation(s)
- Michael J Toth
- Department of Medicine, University of Vermont, Burlington, Vermont.,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, Vermont.,Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont.,Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Thomas B Voigt
- Department of Medicine, University of Vermont, Burlington, Vermont
| | - Timothy W Tourville
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont.,College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont
| | - Shannon M Prior
- Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Blas A Guigni
- Department of Medicine, University of Vermont, Burlington, Vermont.,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, Vermont
| | | | - Isaac B Smith
- Department of Medicine, University of Vermont, Burlington, Vermont
| | - Taylor J Forest
- Department of Medicine, University of Vermont, Burlington, Vermont
| | - Peter A Kaufman
- Department of Medicine, University of Vermont, Burlington, Vermont.,Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Marie E Wood
- Department of Medicine, University of Vermont, Burlington, Vermont.,Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Hibba Rehman
- Department of Medicine, University of Vermont, Burlington, Vermont.,Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Kim Dittus
- Department of Medicine, University of Vermont, Burlington, Vermont.,Vermont Cancer Center, University of Vermont, Burlington, Vermont
| |
Collapse
|
13
|
O'Connor D, Lennon O, Minogue C, Caulfield B. Design considerations for the development of neuromuscular electrical stimulation (NMES) exercise in cancer rehabilitation. Disabil Rehabil 2020; 43:3117-3126. [PMID: 32116053 DOI: 10.1080/09638288.2020.1726510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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.Implications for rehabilitationNeuromuscular 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.
Collapse
Affiliation(s)
- Dominic O'Connor
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | | | - Brian Caulfield
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| |
Collapse
|
14
|
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. A Research Roadmap: Connected Health as an Enabler of Cancer Patient Support. J Med Internet Res 2019; 21:e14360. [PMID: 31663861 PMCID: PMC6914240 DOI: 10.2196/14360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/07/2019] [Accepted: 08/25/2019] [Indexed: 12/30/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Gabriel Ruiz Signorelli
- Oncoavanze, Seville, Spain.,Sport & Society Research Group, Faculty of Educational Sciences, University of Seville, Seville, Spain.,Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Belfield Campus, Dublin, Ireland
| | - Fedor Lehocki
- Slovak University of Technology in Bratislava, Bratislava, Slovakia.,National Centre of Telemedicine Services, Bratislava, Slovakia
| | - Matilde Mora Fernández
- Sport & Society Research Group, Faculty of Educational Sciences, University of Seville, Seville, Spain
| | - Gillian O'Neill
- Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Belfield Campus, Dublin, Ireland
| | - Dominic O'Connor
- Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Belfield Campus, Dublin, Ireland
| | - Louise Brennan
- Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Belfield Campus, Dublin, Ireland.,Beacon Hospital, Dublin, Ireland
| | - Francisco Monteiro-Guerra
- Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Belfield Campus, Dublin, Ireland.,Salumedia Tecnologías, Seville, Spain
| | | | - Santiago Hors-Fraile
- Salumedia Tecnologías, Seville, Spain.,Maastricht University, Maastricht, Netherlands.,Architecture and Computer Technology Department, University of Seville, Seville, Spain
| | | | | | - Jorge Mota
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Ricardo B Oliveira
- Laboratory of Active Living, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Bela Mrinakova
- First Department of Oncology, Comenius University, Bratislava, Slovakia
| | - Silvia Putekova
- Faculty of Health Care and Social Work, University of Trnava, Trnava, Slovakia
| | - Naiara Muro
- Laboratoire d'informatique médicale et d'ingénierie des connaissances en e-Santé, Sorbonne Universités, Paris, France.,eHealth and Biomedical Applications, Vicomtech, Donostia-San Sebastian, Spain.,Biodonostia, Donostia-San Sebastián, Spain
| | - Francisco Zambrana
- Department of Oncology, Infanta Sofia University Hospital, Madrid, Spain
| | - Juan M Garcia-Gomez
- Biomedical Data Science Lab, The Institute of Information and Communication Technologies, Universitat Politecnica de Valencia, Valencia, Spain
| |
Collapse
|
15
|
O’Connor D, Fernandez MM, Signorelli G, Valero P, Caulfield B. Personalised and progressive neuromuscular electrical stimulation (NMES) in patients with cancer—a clinical case series. Support Care Cancer 2019; 27:3823-3831. [DOI: 10.1007/s00520-019-04679-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
|