Feasibility and suitability of a graded exercise test in patients with aggressive hemato-oncological disease

Abstract

Purpose Physical activity promises to reduce disease-related symptoms and therapy-related side effects in patients suffering from aggressive lymphoma (L) or acute leukemia (AL). For an efficient training program, determination of patients’ physical capacity with a purposive exercise test is crucial. Here, we evaluated the feasibility and suitability of a graded exercise test (GXT) frequently applied in patients suffering from solid tumors by assessing whether patients achieved criteria for maximal exercise testing according to the American College of Sports Medicine (ACSM). Methods The GXT was performed by 51 patients with an aggressive L or AL prior to the start or in the earliest possible phase of high-dose chemotherapy, following a recommended protocol for cancer patients, starting at 20 Watts (W), with an increase of 10 W/min until volitional exhaustion. Subsequently, we investigated whether the following ACSM criteria were fulfilled: (1) failure of heart rate to increase despite increasing workload, (2) post-exercise capillary lactate concentration ≥ 8.0 mmol L−1, (3) rating of perceived exertion at exercise cessation > 17 on the 6–20 Borg Scale. Results Out of 51 patients, two, six, and 35 participants met the first, second, and third criterion, respectively. No relevant relationships between the completion of the criteria and patients’ characteristics (e.g., gender, age) were found. Conclusion Although results of this study suggest a general feasibility of the applied GXT, the ACSM criteria were not met by the majority of the participants. Therefore, this study raises doubts about the suitability of the GXT protocol and the ACSM criteria for this group of patients.

Maximal cardiopulmonary exercise testing in laryngectomised patients using different heat and moisture exchangers – feasibility and exercise responses

“…36,37 Similar results to ours were found in a group of haemato-oncological patients during treatment: cardiopulmonary exercise testing (without breathing gas analysis) was found to be feasible and safe, but only a minority of patients reached maximal effort. 28 The researchers concluded that the protocol used might not be fitting for this low-fit and vulnerable group, and suggested the use of an endurance protocol at a fixed workload as a possible alternative. Although fixedworkload tests cannot be used to determine peak oxygen consumption (VO 2 peak), they can be useful to evaluate changes in exercise capacity over time in individuals, and to assess intervention effects in comparative studies.…”

“…For this purpose, muscle strength training, as well as aerobic training, have been suggested. 28,[38][39][40] In the context of rehabilitation, the question remains whether reaching maximal capacity should be a testing goal, or whether individual testing goals should be set to match the patient's treatment goals, wishes and possibilities. Further research is warranted to determine the best approach to exercise testing in low-fit cancer survivors, including those who have undergone total laryngectomy.…”

“…(Ninety-five per cent predicted maximum heart rate formula, in beats per minute = (211 − 0.64 × age) × 95 per cent.) 27,28 Cardiopulmonary exercise test data Variables of interest were: time spent on the test; peak workload; heart rate (beats per minute); perceived level of exertion (Borg score; 24 scores range from 6 to 20, with higher scores reflecting higher perceived effort); peak oxygen uptake (VO 2 peak), both absolute (l/minute) and relative to body weight (ml/kg/minute); respiratory exchange ratio; anaerobic threshold (VO 2 /kg); and ventilatory efficiency, expressed as minute ventilation/carbon dioxide production at anaerobic threshold (VE/VCO 2 ).…”

A Bout of High-Intensity Interval Training (HIIT) in Children and Adolescents during Acute Cancer Treatment—A Pilot Feasibility Study

“…During active recovery, patients were told not to stop cycling but to continue pedaling. Immediately after each interval, the participants were asked to state their subjective rate of perceived exertion according to an adapted BORG scale (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), appropriate for children (Borg 1962, Figure 2). The next interval was adjusted according to the named number on the scale.…”

“…In adult cancer patients, exercise is safe and feasible; can improve physical functioning; increase quality of life; and reduce side effects, such as chemotherapy-induced toxicities and cancer fatigue [6,7]. In addition, high-intensity interval training (HIIT) has been rendered applicable in adult cancer patients [8], as well as in adult cancer survivors [9]. Several lines of evidence suggest that physical activity and exercise directly affect cancer, and this, in turn, may affect cancer risk, survival, and recurrence.…”