The application of neuromuscular electrical stimulation (NMES) in cancer rehabilitation: current prescription, pitfalls, and future directions

The plethora of treatment complications associated with cancer can be offset by regular exercise participation; however, adherence to current guidelines is poor, in particular in those unable or not allowed to participate in voluntary exercise due to their underlying disease. Alternative therapies such as neuromuscular electrical stimulation (NMES) are promising although previous results in cancer survivors have been equivocal. This is likely in response to methodological issues such as inappropriate NMES prescription. Therefore, the aim of this commentary is to propose three key areas which should be addressed to increase NMES effectiveness in cancer rehabilitation; (1) NMES exercise should target both the neuromuscular and cardiovascular systems through low- and high-frequency modalities, (2) technological advancements such as mobile app-based systems should be leveraged to improve at-home monitoring of home-based NMES exercise, and (3) prescription and progression should follow the fundamental principles of exercise to overcome the heterogeneity in daily physiological, functional, and psychological factors faced by survivors. Addressing these three key areas in future studies may help improve NMES exercise effectiveness and accelerate patient rehabilitation.