A hospital and home-based exercise program to address functional decline in people following allogeneic stem cell transplantation
- 584 Downloads
The aims of this study are to investigate the feasibility of an exercise program commencing 60 days following allogeneic stem cell transplantation (alloSCT), to investigate changes in physical function and health-related quality of life (HRQoL) in patients from pre- to post-alloSCT and to explore changes in patient outcomes before and after the program.
This study is a single site, prospective case series including 43 adults undergoing alloSCT. The intervention was an 8-week outpatient and home-based exercise and education program. Outcomes included feasibility (consent, attendance, compliance and completion rates), functional exercise capacity (incremental shuttle walk test), muscle strength (hand-held dynamometry), self-efficacy for physical activity (Physical Activity Assessment Inventory) and HRQoL (Functional Assessment of Cancer Therapy-Bone Marrow Transplant). Outcomes were measured pre-alloSCT, 60 days post-alloSCT (pre-intervention) and 100 days post-alloSCT (post-intervention).
The consent rate was 93%. From baseline to 60 days post-alloSCT, there was significant decline in functional exercise capacity (mean difference 224 m, 95% CI 153–295, p < 0.0005), self-efficacy for physical activity (294 points, 95% CI 136–452, p = 0.001) and HRQoL (15 points, 95% CI 8–21, p < 0.0005). Ten participants did not commence the exercise program due to death (n = 5), illness (n = 1) or cancellation of alloSCT (n = 4). The intervention was feasible in those not affected by major medical complications or death. No adverse events occurred. From pre- to post-intervention, there was significant improvement in functional exercise capacity (p = 0.001) and HRQoL (p = 0.001).
AlloSCT results in significant decline in functional exercise capacity, self-efficacy for physical activity and HRQoL, which may be improved through an exercise program. This pilot demonstrated safety, feasibility and high patient interest. Further randomised research is required.
KeywordsAllogeneic stem cell transplantation Bone marrow transplant Exercise Physical activity Physiotherapy Functional capacity
The authors would like to thank the RMH Fight Cancer Foundation for their grant-in-aid to make this research possible. The authors would also like to thank the participants for their contribution to the study, and the Departments of Physiotherapy, Bone Marrow Transplant and Respiratory Medicine at Royal Melbourne Hospital.
This study was supported by grant funding from the Royal Melbourne Hospital Fight Cancer Foundation.
Compliance with ethical standards
Conflict of interest
- 4.Morishita S, Kaida K, Ikegame K, Yoshihara S, Taniguchi K, Okada M, Kodama N, Ogawa H, Domen K (2012) Impaired physiological function and health-related QOL in patients before hematopoietic stem-cell transplantation. Support Care Cancer 20(4):821–829. https://doi.org/10.1007/s00520-011-1156-2 CrossRefPubMedGoogle Scholar
- 5.Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426. https://doi.org/10.1249/MSS.0b013e3181e0c112 CrossRefPubMedGoogle Scholar
- 8.van Haren IEPM, Timmerman H, Potting CM, Blijlevens NMA, Bart Staal J, Nijhuis-van der Sanden MWG (2013) Physical exercise for patients undergoing hematopoietic stem cell transplantation: systematic review and meta-analyses of randomized controlled trials. Phys Ther 93(4):514–528. https://doi.org/10.2522/ptj.20120181 CrossRefPubMedGoogle Scholar
- 11.von Elm E, Altman D, Egger M, Pocock S, Gøtzsche P, Vandenbroucke J (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008 CrossRefGoogle Scholar
- 16.McQuellon RP, Russell GB, Cella DF, Craven BL, Brady M, Bonomi A, Hurd DD (1997) Quality of life measurement in bone marrow transplantation: development of the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) scale. Bone Marrow Transplant 19(4):357–368. https://doi.org/10.1038/sj.bmt.1700672 CrossRefPubMedGoogle Scholar
- 17.Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB CrossRefPubMedGoogle Scholar
- 18.Haas BK, Northam S (2010) Measuring self-efficacy: development of the physical activity assessment inventory. South Online J Nurs Res 10:35–51Google Scholar
- 23.Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, HillsdaleGoogle Scholar
- 24.Wiskemann J, Dreger P, Schwerdtfeger R, Bondong A, Huber G, Kleindienst N, Ulrich CM, Bohus M (2011) Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood 117(9):2604–2613. https://doi.org/10.1182/blood-2010-09-306308 CrossRefPubMedGoogle Scholar
- 25.Baumann FT, Zopf EM, Nykamp E, Kraut L, Schule K, Elter T, Fauser AA, Bloch W (2011) Physical activity for patients undergoing an allogeneic hematopoietic stem cell transplantation: benefits of a moderate exercise intervention. Eur J Haematol 87(2):148–156. https://doi.org/10.1111/j.1600-0609.2011.01640.x CrossRefPubMedGoogle Scholar
- 26.Shelton ML, Lee JQ, Morris GS, Massey PR, Kendall DG, Munsell MF, Anderson KO, Simmonds MJ, Giralt SA (2009) A randomized control trial of a supervised versus a self-directed exercise program for allogeneic stem cell transplant patients. Psycho-Oncology 18(4):353–359. https://doi.org/10.1002/pon.1505 CrossRefPubMedGoogle Scholar
- 27.Jarden M, Baadsgaard MT, Hovgaard DJ, Boesen E, Adamsen L (2009) A randomized trial on the effect of a multimodal intervention on physical capacity, functional performance and quality of life in adult patients undergoing allogeneic SCT. Bone Marrow Transplant 43(9):725–737. https://doi.org/10.1038/bmt.2009.27 CrossRefPubMedGoogle Scholar
- 28.DeFor TE, Burns LJ, Gold EM, Weisdorf DJ (2007) A randomized trial of the effect of a walking regimen on the functional status of 100 adult allogeneic donor hematopoietic cell transplant patients. Biol Blood Marrow Transplant 13(8):948–955. https://doi.org/10.1016/j.bbmt.2007.04.008 CrossRefPubMedGoogle Scholar
- 31.Wooden M (2014) The measurement of physical activity in wave 13 of the HILDA survey. HILDA project discussion paper series. No. 3/14, December 2014. Melbourne instituteGoogle Scholar
- 35.Silver JK, Baima J (2013) Cancer prehabilitation: an opportunity to decrease treatment- related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil 92(8):715–727. https://doi.org/10.1097/PHM.0b013e31829b4afe CrossRefPubMedGoogle Scholar
- 36.Wingard JR, William AW, Martens M, Le-Rademacher J, Logan B, Knight JM, Jacobsen PB, Jim H, Majhail NS, Syrjala K, Rizzo JD, Lee SJ (2017) Pretransplantation exercise and hematopoietic cell transplantation survival: a secondary analysis of blood and marrow transplant clinical trials network (BMT CTN 0902). Biol Blood Marrow Transplant 23(1):161–164. https://doi.org/10.1016/j.bbmt.2016.10.007 CrossRefPubMedGoogle Scholar
- 39.Jacobsen PB, Le-Rademacher J, Jim H, Syrjala K, Wingard JR, Logan B, Wu J, Majhail NS, Wood W, Rizzo JD, Geller NL, Kitko C, Faber E, Abidi MH, Slater S, Horowitz MM, Lee SJ (2014) Exercise and stress management training prior to hematopoietic cell transplantation: blood and marrow transplant clinical trials network (BMT CTN) 0902. Biol Blood Marrow Transplant 20(10):1530–1536. https://doi.org/10.1016/j.bbmt.2014.05.027 CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, May AM, Galvao DA, Chinapaw MJ, Steindorf K, Irwin ML, Stuiver MM, Hayes S, Griffith KA, Lucia A, Mesters I, van Weert E, Knoop H, Goedendorp MM, Mutrie N, Daley AJ, McConnachie A, Bohus M, Thorsen L, Schulz KH, Short CE, James EL, Plotnikoff RC, Arbane G, Schmidt ME, Potthoff K, van Beurden M, Oldenburg HS, Sonke GS, van Harten WH, Garrod R, Schmitz KH, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, Kersten MJ, Nollet F, Wenzel J, Wiskemann J, Verdonck-de Leeuw IM, Brug J (2017) Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev 52:91–104. https://doi.org/10.1016/j.ctrv.2016.11.010 CrossRefPubMedGoogle Scholar