Exercise in allogeneic bone marrow transplantation: a qualitative representation of the patient perspective

Abstract

Purpose Exercise is emerging as a vital aspect of care to alleviate the physical and psychosocial symptom burden associated with allogeneic bone marrow transplantation (BMT). Understanding the patient perspective regarding exercise is important to move towards implementation. This study aimed to characterise experiences and views regarding participation in an exercise program in adults receiving treatment for haematological disease with allogeneic BMT. Methods Individual semi-structured interviews were conducted with 35 participants from either an early- or late-commencing supervised group-based exercise program. Using an inductive, conventional approach to qualitative content analysis data were independently analysed by two researchers. Results Six major themes and 33 sub-themes were identified: this encompassed motivation, physical opportunity and capability to exercise; psychosocial effects of group-based exercise; experienced impact of participation in an exercise program; and intervention design considerations. Key barriers to exercise included symptom severity and fluctuating health and distance or difficult access to an exercise facility or equipment, whilst facilitators included encouragement from staff; peer support in the group-based setting; flexibility; education; and ability to measure change. Conclusion This study highlights the importance of a flexible approach to exercise with consideration of individual symptoms and preferences. The perceived psychological impact of exercise should not be underestimated; future exercise programs should be designed in partnership with patients, with consideration of group-based activities to reduce social isolation if this is feasible in the treatment context. Intervention design should also acknowledge the individual’s physical and psychological capability, opportunity and automatic and reflective motivation to direct and sustain exercise behaviours following BMT.

Assessment of Rehabilitation Practices During Hematopoietic Stem Cell Transplantation in the United States: A Survey

“…In this sample, the most common reasons for not ordering rehabilitation therapies included lack of perceived need by the patient, lack of awareness of the clinical/rehabilitation team, and insurance coverage. Barriers for physical activity of cancer patients during hospital admission are complex and multifactorial 30-34. Influencing factors include patients’ perception that exercise/physical activity is not important and how the hospital environmental structure discourages physical activity.…”

“…For example, using the frequency, intensity, time, and type of specific resistance and aerobic exercises (FITT) framework could ensure that a specific exercise dosage is being delivered, optimizing the results of the exercise. 25 An exercise program should be tailored to specific symptoms and health needs of a population, 25,34 and the HSCT population has particular issues, such as decreased overall strength, gait, and balance impairments, reduced exercise capacity, sarcopenia, and malnutrition, among others. [1][2][3][4][5][6][7][8][9][10][11][12][13] Although there are no guidelines for the FITT components in the HSCT population, parameters from published randomized controlled trials involving the rehabilitation of hematological cancers could be adapted in HSCT patients.…”

Exercise Interventions During Hospitalization for Stem Cell Transplantation: An Integrative Review

“…Barriers to adherence to a group exercise intervention reported by participants included nausea, fatigue, weakness, severity of symptoms, emotional investment in others, and concern for infection risk. Facilitators included previous physical activity habits, accountability to staff and peers, explanation of the importance of exercise, access to exercise equipment and space, ability to follow progress, sense of community, and seeing peers do well (Abo et al, 2022).…”

“What I wanted to do was build myself back up and prepare”: qualitative findings from the PERCEPT trial of prehabilitation during autologous stem cell transplantation in myeloma

“…Poor physical functioning and perceived loss of control are associated with worse psychosocial outcomes and quality of life in people undergoing stem cell transplantation [ 51 , 52 ]. Qualitative findings among people undergoing allogeneic transplantation highlight that exercise is perceived as positively influencing recovery from treatment and can provide a sense of control and structure during transplant [ 53 ]. Transplant recipients welcomed support from clinicians, resources to support exercise and measurement of physical outcomes and that these provided automatic incentives and motivation to exercise during transplant [ 53 ].…”

“…Qualitative findings among people undergoing allogeneic transplantation highlight that exercise is perceived as positively influencing recovery from treatment and can provide a sense of control and structure during transplant [ 53 ]. Transplant recipients welcomed support from clinicians, resources to support exercise and measurement of physical outcomes and that these provided automatic incentives and motivation to exercise during transplant [ 53 ]. Other qualitative literature specifically amongst myeloma ASCT recipients have also found that patients place importance on the role of exercise for enhancing recovery [ 11 , 12 , 54 , 55 ].…”