Neuromuscular Electrical Stimulation (NMES) in the Management of Glioblastoma Multiforme

Abstract

Background and Purpose: Glioblastoma multiforme (GBM) is associated with debilitating physical and psychosocial side effects. Voluntary exercise recommended as an adjunct therapy is often limited by physical and neurological impairments. The potential effect of aerobic and muscle-strengthening neuromuscular electrical stimulation (termed concurrent NMES) exercise (4 weeks, 2-5 times/week, 30 minutes to 1 hour) delivered to the lower limbs in patients with GBM has not been examined. This case study explores the effect of a short-term concurrent NMES intervention progressing to NMES and supervised voluntary exercise (aerobic and resistance training) over a 10-week period in a patient with GBM undergoing adjuvant treatment. Case Description: The case was a 61-year-old man with GBM who had completed radiotherapy treatment (40 Gy) and was undergoing adjuvant chemotherapy. Eastern Cooperative Oncology Group level was 3. Assessments were conducted at baseline, and at weeks 4 and 10 of the intervention. Outcomes included 30-second sit-to-stand (30STS), Timed Up and Go (TUG), European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and Godin Leisure Time Questionnaire. Outcomes: The intervention was well tolerated, with more than 70% NMES exercise adherence over 10 weeks and progression to combined NMES and voluntary exercise at week 5. No adverse events were reported. Despite self-reported increases in fatigue levels, clinically meaningful improvements were observed at weeks 4 and 10 for 30STS, TUG, and physical quality of life (QoL). Self-report physical activity levels increased at week 10. Discussion: In this first clinical case report, a 10-week NMES/voluntary exercise intervention led to improvements in physical and QoL outcomes. This initial evidence suggests NMES exercise is safe and feasible and may act as a bridge to voluntary exercise. NMES demonstrated promise as an effective supportive intervention in the management of GBM. Future clinical trials are required to expand on these initial findings.