Effects of NMES and Exercise in Hematological Cancer
Condition: Hematologic Malignancy; Muscle Weakness
MeSH terms: Hematologic Neoplasms; Muscle Weakness
Study type: Interventional

Summary: 
      Physical activity levels of adult hematologic cancer patients are deficient. The resulting
      physical inactivity causes fatigue, muscle loss, and deterioration in physical performance
      values. However, physical exercise programs still play a minor role in treating hematological
      malignancies. In addition, there are no reliable data in the literature regarding risk
      factors, feasibility, and exercise results in individuals with hematological malignancies.
      Although it is known that the use of corticosteroids, which are among the drugs given during
      chemotherapy, causes muscle weakness, there are no physical exercise programs performed with
      this patient group in the literature. The current study aims to compare the effects of
      resistance exercise and resistance exercise combined with neuromuscular electrical
      stimulation on muscle strength, functional lower extremity strength, and mobility in
      hematological cancer patients during chemotherapy.
    

Detailed description: 
      Although people with hematological malignancies have to endure long stages of treatment and
      inactivity that are known to reduce their physical performance levels, it is still common
      practice to rest and avoid intense exercise. Although physical activity and exercise are
      important approaches to many diseases, their effects on cancer have been studied recently.
      There are still not enough studies in this area and it is not widely used. In recent studies,
      it is thought that exercise may benefit the symptoms that develop due to treatment in cancer
      patients. Even in the presence of severe muscle weakness and fatigue, skeletal muscle
      provides great adaptation when there is an appropriate exercise stimulus. In addition,
      exercise can increase immune functions, so it is thought that exercise practices in
      hematological cancer patients can specifically improve cellular functions such as microbial
      phagocytosis, T-cell proliferation, vaccine response, and killing tumor cells. There are
      various studies and approaches that try to create a different strategy and include physical
      exercise in the treatment strategy of hematological malignancies. These exercise programs
      generally include aerobics, flexibility, and resistance training methods. The necessity of
      developing alternative methods to exercise is emphasized in the literature due to the
      development of complications that affect participation in basic exercises such as walking.
      Resistance exercise training has been effective in improving muscle strength and endurance in
      cancer survivors, with most of the research on those with breast cancer, prostate cancer, and
      head and neck cancer. The number of studies providing strengthening training in patients with
      hematological cancer is limited. Neuromuscular electrical stimulation (NMES) has proven
      efficacy in improving muscle strength in a variety of populations. NMES training also has
      applicability for the cancer population to prevent treatment-related complications and
      improve health-related quality of life. However, there is still no high-level evidence to
      support the administration of NMES in cancer patients. In the present study, we aimed to
      evaluate the effect of resistance exercise improve muscle weakness in hematological cancer
      patients receiving intensive chemotherapy after HSCT. In addition, we aimed to evaluate the
      effect of resistance exercise and NMES training on fatigue, mobility, and quality of life in
      hematological cancer patients.
    

Intervention name(s): Neuromuscular Electrical Stimulation; Structured Exercise
Intervention type(s): Device; Other
Intervention description(s): Neuromuscular Electrical Stimulation (NMES) is based on the principle of creating a contraction by stimulating the nerve fibers innervating the related muscle in the healthy muscle and the muscle fibers in the denervated muscle with electrical current. The electric currents used in stimulation of muscles and nerves perform this function by changing the electrical potential of cell membranes.
It is contraindicated in pregnancy, presence of pacemaker, severe heart disease, epilepsy, fracture, dementia and impaired consciousness. We prevent contraindicated situations by excluding volunteer participants with these characteristics.; Warm-up exercise, main training program and cool down exercise. Main training consists of resistance exercises to be applied with resistance bands of different resistance or with the patient's own body weight. Our prescribed training protocol includes 4-6 different exercises for each limb (bench press with resistance band, upper extremity proprioceptive neuromuscular facilitation exercises, biceps/triceps curl, leg press, knee extension, 4-way hip motion, mini squat). Intensity, sets, and number of repetitions will be adapted to a target score between 12 and 14 using the Borg scale. It will be applied as low intensity, long-term passive stretching exercises to the pectoral, hamstring, and gastrosoleus muscle groups. Patients will perform 1 set of 10 repetitions of each resistance exercise determined by their level of fatigue. Resistance will be increased every three visits. If the patient complains of excessive fatigue, the resistance will be reduced to the previous level.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Hematology; Therapeutic Electrical Stimulation; Exercise Therapy