Vibrotherapy during intensive chemotherapy of cancer patients – a pilot study

Chemotherapy is often associated with the deterioration of the functional efficiency of cancer patients, which may generate additional undesirable health problems. Physiotherapy based on resistance exercise, which can prevent these health problems, is not always tolerated by patients due to the physiological side effects of chemotherapy. Vibrotherapy can help here as a “non-invasive” physiotherapeutic technique that replaces physical activity of low to moderate intensity. Vibrotherapy in the form of simple exercises during whole-body vibration (WBV) effectively stimulates the neuromuscular system not evoking a significant blood pressure increase. Therefore, scientists from the University of Freiburg (Germany) decided to investigate whether WBVs are tolerated by cancer patients even during intensive or high-dose chemotherapy. They hypothesized that WBV would induce favorable functional adaptations.

• No increase in chemotherapy side effects was observed after WBV.
• Jump height and physical performance improved significantly after WBV (+2.3 cm and -1.3 s in the TUG test, respectively).
• WBV improved body posture (eyes open: +60 mm; eyes closed: +88 mm).
• The maximum power output during the chair rising test (CRT) and the time during CRT did not change after WBV or in the control group.
• 63% of patients considered WBV training as “fairly good”, 30% as “very good”, 7% as “minimally good”, and no one considered it “not good at all”.
• There were no changes in blood pressure or heart rate in either before vs after each exercise session or before (T0) vs after (T1) the whole experiment.

Prepared on the basis of:

Feasibility of whole body vibration during intensive chemotherapy in patients with hematological malignancies – a randomized controlled pilot study. Pahl A, Wehrle A, Kneis S, Gollhofer A, Bertz H. BMC Cancer. 2018 Sep 25;18(1):920.

Study population

Twenty hospitalized blood cancer patients undergoing intensive or high-dose chemotherapy were enrolled in the study. However, in the final functional fitness and mobility analysis, only eleven patients were included because of technical reasons.

Test procedure

Patients were randomly assigned to an intervention group (IG) or an active control group (CG). The final analysis included 6 patients from the IG group and 5 from the CG group.

Individual training for both groups was performed during three 20-minute sessions per week. The IG exercise protocol included three sets of different exercises (static and dynamic squats, heel lift, or a combination of both) on a vibrating platform. Patients achieved exercise intensity from 14 to 16 on the Borg perceived effort rating scale (6-20).

CG performed aerobic exercise on a bicycle ergometer with the same intensity as that observed in IG and the sessions on the ergometer also lasted 20 minutes.

In order to assess the functional efficiency of the patients, jump height, duration of the chair rising test (CRT), timed-up-and-go test (TUG), and maximum power output during jumping or CRT were measured.

The tested parameters were assessed before and after each session and before the entire experimental cycle = before the first administration of chemotherapy (T0) or immediately before discharge from the hospital (T1).

Use of vibration in the study

The vibration was provided by the Galileo® Sport vibration platform (Novotec Medical GmbH, Germany). To obtain the best neuromuscular response, frequencies in the range of 18-25 Hz and amplitudes of 3.5-4 mm were used.

Results

The feasibility of training between the groups was similar (IG: median 62%, range 39-77; CG: 67%, 58-100; p = 0.315). No increase in side effects of chemotherapy was observed after WBV. Jump height (+2.3 cm, 95% CI 0.1-4.4; p = 0.028) and TUG performance (-1.3 s, 95% CI -2.53 – -0.65; p = 0.027) improved significantly after exercising with WBV. After WBV also postural improvement was achieved (open eyes: +60 mm, 95% CI 2-236, p = 0.046; closed eyes: +88 mm, 95% CI 49-214, p = 0.028). On the other hand, in CG there were no significant changes in jump height, TUG performance or improved posture. The maximum output power during CRT and the time during CRT in both groups did not change. In addition, 63% of IG patients considered WBV training as “fairly good”, 30% as “very good”, 7% as “minimally good”, and no one considered it “not good at all”. No changes were observed in either group in blood pressure or heart rate after vs before any given training session or before the introduction of training (T0) vs after it (T1).

Comment

The presented studies are the first to prove the feasibility of WBV during intensive/ high-dose chemotherapy in hospitalized cancer patients. In addition, WBV-induced neuromuscular adaptations produced functional benefits important for the autonomy of patients. The authors therefore believe that WBV can be implemented as an alternative training method during intensive chemotherapy.

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