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.
Highlights
With an increasing trend, 40,000 newly diagnosed cases of malign hematological diseases were registered and accounted for approximately 19,000 deaths in Germany in 2013 (RobertKoch-Institut, 2016)
The wholebody electromyostimulation (WB-EMS) technology enables a simultaneous muscle contraction of all large muscle groups that is supported by easy-to-perform dynamic exercises, as we described in detail previously (Schink et al, 2018)
Observed benefits of a dual intervention of WB-EMS and individualized nutritional support on muscle mass in patients with advanced solid cancers (Schink et al, 2018), led us to the primary hypothesis that this combined approach is feasible in hematological patients and may show better effects on stabilizing or even increasing skeletal muscle mass than a dietary support alone. Within this multimodal approach we investigated the effect of the exercise and nutrition therapy on objective outcomes including bodyweight and body composition, physical functioning, hematological and blood chemistry parameters as well as on patient-reported quality of life and fatigue
Summary
40,000 newly diagnosed cases of malign hematological diseases were registered and accounted for approximately 19,000 deaths in Germany in 2013 (RobertKoch-Institut, 2016). Side effects linked to the disease as well as therapy complications such as anemia, a high susceptibility for infections, fatigue or Graft-versus-Host-Disease (GvHD) lead to a decreased physical activity – especially in patients with a long inpatient treatment (Danaher et al, 2006; Morishita et al, 2012a; Wiskemann et al, 2014). While fat mass increases during and after the oncological therapy, muscle mass declines Those alterations are hardly reversible into the pre-illness and pre-treatment status and may result in sarcopenic obesity that may predispose patients for other metabolic diseases in future (Morishita et al, 2012b; Orgel et al, 2016; Xiao et al, 2016). Muscle wasting and physical deconditioning thereby enhance symptoms of fatigue, and substantially impair patients’ quality of life, reduce therapy options and worsen prognosis (Danaher et al, 2006; Mosher et al, 2009; Morishita et al, 2012a,b; Lanic et al, 2014; Chu et al, 2017)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
