Supportive Care in Cancer

, Volume 26, Issue 6, pp 1727–1736 | Cite as

A hospital and home-based exercise program to address functional decline in people following allogeneic stem cell transplantation

  • S. AboEmail author
  • D. Ritchie
  • L. Denehy
  • Y. Panek-Hudson
  • L. Irving
  • C. L. Granger
Original Article



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.


Allogeneic 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.

Funding sources

This study was supported by grant funding from the Royal Melbourne Hospital Fight Cancer Foundation.

Compliance with ethical standards

Conflict of interest

None declared.


  1. 1.
    Copelan EA (2006) Hematopoietic stem-cell transplantation. N Engl J Med 354:1813–1826. CrossRefPubMedGoogle Scholar
  2. 2.
    Jenq RR, van den Brink MR (2010) Allogeneic haematopoietic stem cell transplantation: individualized stem cell and immune therapy of cancer. Nat Rev Cancer 10(3):213–221. CrossRefPubMedGoogle Scholar
  3. 3.
    Nivison-Smith I, Bardy P, Dodds AJ, Ma DD, Aarons D, Tran S, Wilcox L, Szer J (2016) A review of hematopoietic cell transplantation in Australia and New Zealand, 2005 to 2013. Biol Blood Marrow Transplant 22(2):284–291. CrossRefPubMedGoogle Scholar
  4. 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. CrossRefPubMedGoogle Scholar
  5. 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. CrossRefPubMedGoogle Scholar
  6. 6.
    Fong DYT, Ho JWC, Hui BPH, Lee AM, Macfarlane DJ, Leung SSK, Cerin E, Chan WYY, Leung IPF, Lam SHS, Taylor AJ, Cheng K-k (2012) Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ 344(jan30 5):344. CrossRefGoogle Scholar
  7. 7.
    Dennett AM, Peiris CL, Shields N, Prendergast LA, Taylor NF (2016) Moderate-intensity exercise reduces fatigue and improves mobility in cancer survivors: a systematic review and meta-regression. J Physiother 62(2):68–82. CrossRefPubMedGoogle Scholar
  8. 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. CrossRefPubMedGoogle Scholar
  9. 9.
    Steinberg A, Asher A, Bailey C, Fu J (2015) The role of physical rehabilitation in stem cell transplantation patients. Support Care Cancer 23(8):2447–2460. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Canestraro A, Nakhle A, Stack M, Strong K, Wright A, Beauchamp M, Berg K, Brooks D (2013) Oncology rehabilitation provision and practice patterns across Canada. Physiother Can 65(1):94–102. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 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. CrossRefGoogle Scholar
  12. 12.
    Parreira VF, Janaudis-Ferreira T, Evans RA, Mathur S, Goldstein RS, Brooks D (2014) Measurement properties of the incremental shuttle walk test. A systematic review. Chest 145(6):1357–1369. CrossRefPubMedGoogle Scholar
  13. 13.
    Probst VS, Hernandes NA, Teixeira DC, Felcar JM, Mesquita RB, Goncalves CG, Hayashi D, Singh S, Pitta F (2012) Reference values for the incremental shuttle walking test. Respir Med 106(2):243–248. CrossRefPubMedGoogle Scholar
  14. 14.
    Thorborg K, Petersen J, Magnusson SP, Holmich P (2010) Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports 20(3):493–501. CrossRefPubMedGoogle Scholar
  15. 15.
    Bohannon RW, Schaubert KL (2005) Test-retest reliability of grip-strength measures obtained over a 12-week interval from community-dwelling elders. J Hand Ther 18(4):426–427, quiz 428. CrossRefPubMedGoogle Scholar
  16. 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. CrossRefPubMedGoogle Scholar
  17. 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. CrossRefPubMedGoogle Scholar
  18. 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
  19. 19.
    Mahler DA, Horowitz MB (1994) Perception of breathlessness during exercise in patients with respiratory disease. Med Sci Sports Exerc 26(9):1078–1081CrossRefGoogle Scholar
  20. 20.
    Crisafulli E, Clini EM (2010) Measures of dyspnea in pulmonary rehabilitation. Multidiscip Respir Med 5(3):202–210. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Borg G (1970) Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 2(2):92–98PubMedGoogle Scholar
  22. 22.
    Bender R, Lange S (2002) Adjusting for multiple testing—when and how? J Clin Epidemiol 54:343–349CrossRefGoogle Scholar
  23. 23.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, HillsdaleGoogle Scholar
  24. 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. CrossRefPubMedGoogle Scholar
  25. 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. CrossRefPubMedGoogle Scholar
  26. 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. CrossRefPubMedGoogle Scholar
  27. 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. CrossRefPubMedGoogle Scholar
  28. 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. CrossRefPubMedGoogle Scholar
  29. 29.
    Mello M, Tanaka C, Dulley F (2003) Effects of an exercise program on muscle performance in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant 32(7):723–728. CrossRefPubMedGoogle Scholar
  30. 30.
    Hayes SC, Davies PS, Parker TW, Bashford J, Green A (2004) Role of a mixed type, moderate intensity exercise programme after peripheral blood stem cell transplantation. Br J Sports Med 38(3):304–309. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 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
  32. 32.
    Wiskemann J, Kleindienst N, Kuehl R, Dreger P, Schwerdtfeger R, Bohus M (2015) Effects of physical exercise on survival after allogeneic stem cell transplantation. Int J Cancer 137(11):2749–2756. CrossRefPubMedGoogle Scholar
  33. 33.
    Cavalheri V, Granger CL (2017) Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev 6:CD012020. CrossRefPubMedGoogle Scholar
  34. 34.
    Granger CL (2016) Physiotherapy management of lung cancer. J Physiother 62(2):60–67. CrossRefPubMedGoogle Scholar
  35. 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. CrossRefPubMedGoogle Scholar
  36. 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. CrossRefPubMedGoogle Scholar
  37. 37.
    Wiskemann J, Kuehl R, Dreger P, Schwerdtfeger R, Huber G, Ulrich CM, Jaeger D, Bohus M (2014) Efficacy of exercise training in SCT patients—who benefits most? Bone Marrow Transplant 49(3):443–448. CrossRefPubMedGoogle Scholar
  38. 38.
    Hung YC, Bauer JD, Horsely P, Coll J, Bashford J, Isenring EA (2014) Telephone-delivered nutrition and exercise counselling after auto-SCT: a pilot, randomised controlled trial. Bone Marrow Transplant 49(6):786–792. CrossRefPubMedGoogle Scholar
  39. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  40. 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. CrossRefPubMedGoogle Scholar
  41. 41.
    Floyd A, Moyer A (2009) Group vs. individual exercise interventions for women with breast cancer: a meta-analysis. Health Psychol Rev 4(1):22–41. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • S. Abo
    • 1
    • 2
    Email author
  • D. Ritchie
    • 3
  • L. Denehy
    • 2
  • Y. Panek-Hudson
    • 4
  • L. Irving
    • 5
  • C. L. Granger
    • 1
    • 2
  1. 1.Division of Allied Health (Physiotherapy)Royal Melbourne HospitalParkvilleAustralia
  2. 2.Department of PhysiotherapyThe University of MelbourneParkvilleAustralia
  3. 3.Department of Clinical Haematology and Bone Marrow TransplantRoyal Melbourne HospitalParkvilleAustralia
  4. 4.Haematology Service, Peter MacCallum Cancer CentreParkvilleAustralia
  5. 5.Department of Respiratory and Sleep MedicineRoyal Melbourne HospitalParkvilleAustralia

Personalised recommendations