Physical exercise as adjuvant therapy for patients undergoing hematopoietic stem cell transplantation

Self Cite

Patients undergoing allo-HCT often experience a substantial loss in physical performance. We have recently published the general effectiveness of an exercise intervention in 105 allo-HCT patients on physical performance and psychosocial well-being. However, predictor variables for differentiated treatment response remained unclear. To determine the impact of basic physical performance on treatment response, we assessed muscle strength and endurance performance at four assessment points before and after allo-HCT. The exercise group started training 2 weeks before admission and ended 6-8 weeks after discharge. Comparing initially fit with unfit classified patients, the fit patients lost 31% of the strength of the knee-extensors, whereas the unfit patients lost only 1% (Po0.05). For endurance capacity, fit patients lost 4% of their walking capability, whereas unfit patients gained 13% (Po0.05). The individual percent change was statistically different at the 0.05 level in all measures of physical performance. Individual training response in allo-HCT patients strongly depends on the initial physical performance level. Unfit patients can be trained safely and may benefit more from this exercise intervention than fit patients. This result is of major clinical relevance and should encourage hematologists to promote exercise even more in impaired/unfit allo-HCT patients.

Section: Introductionmentioning

confidence: 69%

Efficacy of exercise training in SCT patients-who benefits most?

Wiskemann

Kuehl

Dreger

et al. 2013

Self Cite

“…There are several studies of transplanted adults advocating the beneficial effect of physical exercise intervention. 4,9,13,27 There are hardly any studies on the effect of an exercise program in children. In a small group of children, p12 months post transplant, the experience of physical and overall health benefits after an 8-week exercise training program was reported.…”

Section: Discussionmentioning

confidence: 99%

“…12 In adults, significant impairment in physical performance has been reported after high-dose chemotherapy, auto-SCT, 5,6 and after allo-SCT. 13 Long-term follow-up studies focusing on physical ability or musculoskeletal function of transplanted children are few. According to a meta-analysis based on three articles, physical fitness measured by VO 2 peak tended to be reduced in survivors of childhood leukemia studied several years after treatment.…”

Section: Introductionmentioning

confidence: 99%

Suboptimal long-term physical performance in children and young adults after pediatric allo-SCT

Hovi

Kurimo

Taskinen

et al. 2009

We present a set of tests for physical performance used for annual prospective follow-up after a pediatric transplant. Of the 103 eligible patients transplanted at a mean age of 8.8 years, 94 were included. The results were divided into early, performed 1 (n ¼ 46) or 2 (n ¼ 12) years post transplant, and late tests (n ¼ 66), performed 4-16 (mean 6) years post transplant. A total of 30 patients had tests both at early and late time points (paired tests). The control subjects included 522 healthy age-and gendermatched schoolchildren. Using their test results, the s.d. score (SDS) was calculated for each patient and for each test individually. Both in the early and late tests, patients had the mean SDS for each test significantly lower (Po0.001) than controls, varying from À0.6 to À2.0 SDS. Specifically, tests measuring trunk muscles gave impaired results. In the group with paired tests, the results improved in four of six tests. In late tests, age at SCT, extensive chronic GVHD and being a sports club member correlated with the results. The potential beneficial effect of an exercise intervention program on impaired physical performance after pediatric SCT merits prospective studies.

“…However, these results may not be applicable to haematological cancer patients treated with PBSC transplantation as most studies were conducted on patients with solid tumours (that is, breast, prostate and colon). To date, several studies have examined the role of exercise across different phases of PBSC transplantation (that is, before, during and after hospital discharge), [12][13][14][15][16] but no study has examined the role of nutrition support delivered by a dietitian amongst PBSC transplantation patients after hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

Telephone-delivered nutrition and exercise counselling after auto-SCT: a pilot, randomised controlled trial

Hung

Bauer

Horsely

et al. 2014

Adverse changes in nutrition-related outcomes including quality of life (QoL) occur after PBSC transplantation. This randomised controlled trial aims to evaluate the impact of nutrition and exercise counselling provided at hospital discharge on nutritional status, body composition and QoL post transplantation. Usual care (UC) (n = 19) received no intervention after discharge; extended care (EC) (n = 18) received fortnightly telephone counselling from a dietitian and exercise physiologist up to 100 days post transplantation. Nutritional status (patient-generated subjective global assessment, and diet history), QoL (EORTC QLQ-C30 version 3) and body composition (air displacement plethysmography) were assessed at pre-admission, discharge and 100 days post transplantation. Intervention groups were compared using two-sample t-tests of changes in the outcomes; results were adjusted using analysis of covariance. EC exhibited clinically important but not statistically significant increases in protein intake (14.7 g; confidence interval (CI) 95% − 6.5, 35.9, P = 0.165), cognitive functioning (7.2; CI 95% − 7.9, 22.2, P = 0.337) and social functioning (16.5; CI 95% − 7.3, 40.3, P = 0.165) compared with UC. Relative to pre-admission, EC experienced less weight loss than UC (−3.3 kg; CI 95% − 6.7, 0.2, P = 0.062). Physical activity was not significantly different between the groups. Ongoing nutrition and exercise counselling may prevent further weight loss and improve dietary intake and certain QoL components in autologous PBSC transplantation patients following hospitalisation.