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Background Before and after hematopoietic stem cell transplantation (HSCT), most patients suffer from psychophysical limitations due to the treatment. Exercise interventions demonstrate beneficial effects on, for example, strength, endurance, or health‐related quality of life during and after HSCT, but with a great variation among patients concerning the response to exercise. This study examines the influence of the initial fitness on the effects of an exercise therapy in pediatric HSCT. Procedure Fifty‐three children and adolescents (10.9 ± 3.5 years) scheduled for HSCT were randomized into an exercise intervention group (IG) or a control group (CG). During hospitalization, the IG performed endurance, strength, and flexibility training three times per week. The CG included a nonexercise program. A 6‐min walk test was completed before and after the inpatient period. Baseline results (6‐min walking distance [6MWD]) were used to split both groups into the following: IGUNFIT, n = 14; IGFIT, n = 12; CGUNFIT, n = 16; CGFIT, n = 11. Differences in outcome changes between groups were analyzed with H‐test. Result Intergroup comparison revealed significant differences between IGUNFIT and CGUNFIT (P < 0.05). The IGUNFIT increased their 6MWD by +8% (vs. IGFIT, +1%); both CGs presented a decline in 6MWD (CGUNFIT, –14%; CGFIT, –16%). At discharge, the IGFIT achieved 85.5 ± 10.3% of healthy reference values. Conclusions The current results indicate that exercise during pediatric HSCT is feasible and contributes to prevention of treatment‐related loss of physical function. As seen in healthy persons, patients’ benefits might depend on their initial fitness level. As a diminished physical capability may result in higher training effects, impaired especially patients should engage in exercise.

Introduction.Exercise therapy is a frequently applied method in paediatric oncology but there is insufficient evidence for its effectiveness in paediatric stem cell transplantation. Methods. in a single-centre randomized controlled trial, the effect of exercise therapy (intervention group) was compared with concentration and relaxation techniques (control group). overall, 72 children were recruited before transplantation and randomly assigned into these 2 groups. They received exercise therapy during and after their hospital stay. A total of 47 inpatient children (age: 6-18 years) were evaluated in phase i: 21 in the intervention and 26 in the control group. The expression of cancer-related fatigue before and after therapy was documented by using the PedsQL 3.0 Multidimensional Fatigue Scale. Results. All patients deteriorated with regard to fatigue during their hospital stay. A total of 23 outpatient children (stratified into 4 groups) who continued or started exercise therapy showed a significant improvement over 3 and 6 months (phase ii) after discharge from hospital (total fatigue score: p < 0.001, general fatigue: p = 0.002, sleep and rest fatigue: p < 0.001). Conclusions. inpatient children showed no positive effects of exercise therapy on cancer-related fatigue. After discharge, the children in exercise therapy attained better physical constitution. Exercise therapy is effective for successful rehabilitation and outpatient reintegration and therefore recommended to reduce cancer-related fatigue.

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