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Front. Physiol. | doi: 10.3389/fphys.2018.01808

Whole-body electromyostimulation combined with individualized nutritional support improves body composition in patients with hematological malignancies – a pilot study

Kristin Schink1, 2, 3,  Dejan Reljic1, 2, 3,  Hans J. Herrmann1, 2, 3, Julia Meyer1, 2, 3, Andreas Mackensen1, 3,  Markus F. Neurath1, 3 and  Yurdagül Zopf1, 2, 3*
  • 1Department of Medicine 1, Universitätsklinikum Erlangen, Germany
  • 2Hector-Center für Ernährung, Bewegung und Sport, Medizinischen Klinik 1, Universitätsklinikum Erlangen, Germany
  • 3Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany

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 four 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 six-minute-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 Registry Number: NCT02293239
Registered at:

Keywords: Body Composition, physical function, WB-EMS whole-body electromyostimulation, Exercise, Skeletal muscle mass, nutrition, Hematological malignances, Cancer

Received: 09 Oct 2018; Accepted: 30 Nov 2018.

Edited by:

Michael Fröhlich, Technische Universität Kaiserslautern, Germany

Reviewed by:

Christoph Zinner, Hessische Hochschule für Polizei und Verwaltung, Germany
Bernd Wegener, Ludwig Maximilian University of Munich, Germany  

Copyright: © 2018 Schink, Reljic, Herrmann, Meyer, Mackensen, Neurath and Zopf. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Yurdagül Zopf, Universitätsklinikum Erlangen, Department of Medicine 1, Erlangen, 91054, Bavaria, Germany,