Exercise prescription and tailored physical activity intervention in onco‐hematology inpatients, a personalized bedside approach to improve clinical best practice

Abstract

Therapy of hematological malignancies lasts for long periods implicating various complications. The chemotherapy induces fatigue and forces bed rest. These features strongly contribute to a general impairment of the physical efficiency. Oppositely, an increase of physical exercise can prevent or reduce this weakening. Few trials examined the efficacy of an exercise in onco‐hematological inpatients, during their hospitalization. Therefore, this study aimed to determine the feasibility of an inter‐hospital intervention and the beneficial role of a tailored exercise program in the maintenance of the physical function in onco‐hematological inpatients. The study included 42 patients, which were allocated in two groups. In the intervention group (IG) a tailored exercise protocol during patient's hospitalization was administered. Exercise protocol was focused on development of strength, balance control, and flexibility; sessions were directly performed in the patient's hospital room everyday for 15 to 30 minutes. Exercise was supervised by an exercise specialist and driven by a multimedia support. Control group (CG) remained physically inactive for all period of hospitalization. To examine the interaction between the two situations (T0 and T1) and the two groups (IG and CG) for all dependent variables, a 2 × 2 within–subjects contrasts model analysis of variance was applied. Within groups analysis displayed significant differences in grip and leg strength and in static balance control (P < 0.05) with medium to very large effect size. Results from this investigation showed that a tailored exercise protocol administered to hospitalized onco‐hematological patients was feasible and efficient to promote the maintenance of their physical function, improving clinical best practice including exercise to the traditional treatment. Moreover, the magnitude of the difference between the IG and the CG underlined the importance to invite and stimulate patients to workout to preserve the physical function, counteracting side effects of chemotherapy treatments with a concurrent reduction in bed rest syndrome.

Safety and feasibility of exercise interventions in patients with hematological cancer undergoing chemotherapy: a systematic review

“…All included studies consider themselves “pilot studies” or claim any kind of researched feasibility of their chosen activity intervention [ 8 , 23 , 24 , 27 – 35 ], even if feasibility is neither a declared primary nor secondary outcome in some studies. The group of patients varies between patients diagnosed with acute myeloid leukemia (AML) only, acute leukemia, lymphoma only, and a mixed group of leukemia and lymphoma patients, which were investigated in five [ 23 , 24 , 27 , 30 , 33 ], two [ 29 , 35 ], one [ 34 ], and four studies [ 8 , 28 , 31 , 32 ], respectively. A more detailed overview of the study characteristics and interventions is presented in Table 2 .…”

“…Six of the included studies followed a randomized controlled study design [ 8 , 23 , 29 , 30 , 34 , 35 ], four had no control group [ 24 , 27 , 32 , 33 ], one was a matched pair control [ 28 ], and one had a convenience sample [ 31 ] (patients, who chose to not participate in accordance with the exercise protocol, were asked to be part of the control group). It was further possible to classify all included studies into one of the following groups: randomized pilot studies [ 8 , 29 , 35 ], non-randomized pilot studies [ 24 , 28 , 32 , 33 ], or feasibility studies [ 23 , 27 , 30 , 31 , 34 ]. This classification was done in accordance with the conceptual framework to define the feasibility and pilot studies of Eldridge et al [ 17 ].…”

“…A two-armed trial with a convenience sample was executed by Duregon et al [ 31 ]. They investigated (i) the feasibility of the exercise program, (ii) the implementation of the support of tablets in the exercise routine, and (iii) the effects of the training program on physical function.…”

Clinical exercise therapy program with multiple myeloma patients: Impacts on feasibility, adherence and efficacy

“…Low quality intervention studies and qualitative studies indicate associations between exercise and positive outcomes in MM patients, such as improvements in physical capacity, strength, and quality of life [9,[12][13][14][15]. These previous studies systematically excluded patients with limitations for participation in exercise therapy, such as histories of or increased risks for bone lesions.…”

Potential Cost Savings for the Healthcare System by Physical Activity in Different Chronic Diseases: A Pilot Study in the Veneto Region of Italy

“…Therefore, in terms of the prevention and treatment of many chronic conditions, a tailored exercise prescription and programs, based on specific guidelines, are necessary, although still underutilised [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. In order to improve this practice, awareness and knowledge must also be increased, particularly for policy makers.…”