Whole-Body Electromyostimulation Combined With Individualized Nutritional Support Improves Body Composition in Patients With Hematological Malignancies - A Pilot Study

Kristin Schink, Dejan Reljic, Hans J Herrmann, Julia Meyer, Andreas Mackensen, Markus F Neurath, Yurdagül Zopf, Kristin Schink, Dejan Reljic, Hans J Herrmann, Julia Meyer, Andreas Mackensen, Markus F Neurath, Yurdagül Zopf

Abstract

Patients undergoing the complex treatment for hematological malignancies are exposed to a high physiological and psychological distress inducing fatigue and physical inactivity. In line with cancer-related metabolic changes patients are predisposed for skeletal muscle mass loss that leads to a functional decline, affects therapeutic success, and quality of life. Benefits of physical exercise and nutritional interventions on muscle maintenance are observed in solid cancer patients, but marginally investigated in patients with hematological cancer. We here studied the effects of a combined supportive exercise and nutrition intervention using whole-body electromyostimulation (WB-EMS) training and individualized nutritional support in patients actively treated for hematological malignancy. In a controlled pilot trial, 31 patients (67.7% male; 58.0 ± 16.7 years) with various hematological cancers were allocated to a control group (n = 9) receiving nutritional support of usual care regarding a high protein intake (>1.0 g/kg/d) or to a physical exercise group (n = 22) additionally performing WB-EMS training twice weekly for 12 weeks. Bodyweight and body composition assessed by bioelectrical impedance analysis were measured every 4 weeks. Physical function, blood parameters, quality of life and fatigue were assessed at baseline and after 12 weeks. No WB-EMS-related adverse effects occurred. Patients attending the exercise program presented a higher skeletal muscle mass than controls after 12-weeks (1.51 kg [0.41, 2.60]; p = 0.008). In contrast, patients of the control group showed a higher fat mass percentage than patients of the WB-EMS group (-4.46% [-7.15, -1.77]; p = 0.001) that was accompanied by an increase in serum triglycerides in contrast to a decrease in the WB-EMS group (change ± SD, control 36.3 ± 50.6 mg/dl; WB-EMS -31.8 ± 68.7 mg/dl; p = 0.064). No significant group differences for lower limb strength, quality of life, and fatigue were detected. However, compared to controls the WB-EMS group significantly improved in physical functioning indicated by a higher increase in the 6-min-walking distance (p = 0.046). A combined therapeutic intervention of WB-EMS and protein-rich nutritional support seems to be safe and effective in improving skeletal muscle mass and body composition in hematological cancer patients during active oncological treatment. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02293239.

Keywords: body composition; cancer; exercise; hematological malignancies; nutrition; physical function; skeletal muscle mass; whole-body electromyostimulation.

Figures

FIGURE 1
FIGURE 1
Patient flowchart. The flowchart shows the number of the allocated patients and the number of patients who dropped out during study course with dropout reasons and the number of patients who completed the whole intervention period of 12 weeks. During the study, body composition analysis was missed by 1 patient of the WB-EMS group at week 4 and 1 control and 2 WB-EMS patients at week 8. WB-EMS, whole-body electromyostimulation.
FIGURE 2
FIGURE 2
Changes in body composition during the 12-week intervention period. Unadjusted estimated marginal means with 95% confidence intervals of the body composition parameters (A) skeletal muscle mass, (B) fat mass percentage, (C) bodyweight, (D) FFMI, (E) FMI, and (F) phase angle are illustrated for the control group and the WB-EMS group over the 12-week study course. WB-EMS, whole-body electromyostimulation; FMI, fat mass index; FFMI, fat free mass index.
FIGURE 3
FIGURE 3
Relationship between daily protein intake and change in skeletal muscle mass. Pearson correlation between daily protein intake (g/kg bodyweight) and change in skeletal muscle mass (kg) of the control (n = 6) and the WB-EMS group (n = 9) after 12 weeks. SMM, skeletal muscle mass; WB-EMS, whole-body electromyostimulation.

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