Endurance and resistance training in patients with acute leukemia undergoing induction chemotherapy—a randomized pilot study
Acute leukemia (AL) and its initial treatment can impair physical functioning and capacity significantly. Exercise as a countermeasure has been investigated in few studies confirming its feasibility and safety during intensive induction chemotherapy, but the relative effects of diverse exercise programs have not been analyzed. Therefore, we aimed to investigate independent effects of endurance and resistance training on physical capacity and quality of life (QOL).
Twenty-nine adult AL patients were randomly allocated to an endurance (EG), resistance (RG), or control (CG) group. The intervention took place during induction chemotherapy with three exercise sessions per week for 30–45 min each. Endurance capacity at individual anaerobic threshold, maximum knee extension and flexion strength, standardized phase angle (SPA), and QOL were measured at baseline prior to induction chemotherapy and before discharge.
Endurance capacity changed in neither the EG, RG, or CG (P = 0.104); descriptively, the EG (− 0.05 W/kg) and RG (− 0.04 W/kg) exhibited a smaller decrease than CG (− 0.22 W/kg). We noted a significant difference in knee extension strength (P = 0.002); RG improved their maximum strength (+ 0.14 Nm/kg), while the EG’s (− 0.13 Nm/kg) and CG’s (− 0.19 Nm/kg) was significantly reduced. QOL and SPA revealed no change after the intervention.
We conclude that resistance training is a key component when exercising during induction chemotherapy: it improved maximum strength, but also influenced endurance capacity even during intensive treatment. Considering the prognostic value of physical function, we strongly propose integrating exercise, especially resistance-based training, already during induction chemotherapy to preserve AL patients’ physical capacity and functional status.
KeywordsHematologic neoplasms Hospitalization Exercise therapy Muscle strength Physical endurance Quality of life
We thank all patients who participated in this study. We are grateful to Carole Cürten (English Copy Editor) for proofreading our manuscript and we thank Manfred Baumstark for statistical assistance.
This trial was supported by Baden-Württemberg foundation.
Compliance with ethical standards
All patients gave written informed consent for the study protocol and data collection; this pilot study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Commission of the University of Freiburg, Germany.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Deschler B, Ihorst G, Platzbecker U, Germing U, Marz E, de Figuerido M, Fritzsche K, Haas P, Salih HR, Giagounidis A, Selleslag D, Labar B, de Witte T, Wijermans P, Lubbert M (2013) Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome. Haematologica 98:208–216. https://doi.org/10.3324/haematol.2012.067892 CrossRefGoogle Scholar
- 5.Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen V, Schwartz AL, American College of Sports Medicine (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42:1409–1426. https://doi.org/10.1249/MSS.0b013e3181e0c112 CrossRefGoogle Scholar
- 7.Bergenthal N, Will A, Streckmann F et al (2014) Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database Syst Rev (11):CD009075Google Scholar
- 9.Bryant AL, Deal AM, Battaglini CL, Phillips B, Pergolotti M, Coffman E, Foster MC, Wood WA, Bailey C, Hackney AC, Mayer DK, Muss HB, Reeve BB (2017) The effects of exercise on patient-reported outcomes and performance-based physical function in adults with acute leukemia undergoing induction therapy: exercise and quality of life in acute leukemia (EQUAL). Integr Cancer Ther 17:263–270. https://doi.org/10.1177/1534735417699881 CrossRefGoogle Scholar
- 10.Alibhai SMH, Durbano S, Breunis H, Brandwein JM, Timilshina N, Tomlinson GA, Oh PI, Culos-Reed SN (2015) A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy. Leuk Res 39:1178–1186. https://doi.org/10.1016/j.leukres.2015.08.012 CrossRefGoogle Scholar
- 11.Alibhai SMH, O’Neill S, Fisher-Schlombs K, Breunis H, Brandwein JM, Timilshina N, Tomlinson GA, Klepin HD, Culos-Reed SN (2012) A clinical trial of supervised exercise for adult inpatients with acute myeloid leukemia (AML) undergoing induction chemotherapy. Leuk Res 36:1255–1261. https://doi.org/10.1016/j.leukres.2012.05.016 CrossRefGoogle Scholar
- 14.Chang P-H, Lai Y-H, Shun S-C, Lin LY, Chen ML, Yang Y, Tsai JC, Huang GS, Cheng SY (2008) Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial. J Pain Symptom Manag 35:524–534. https://doi.org/10.1016/j.jpainsymman.2007.06.013 CrossRefGoogle Scholar
- 15.Padilha CS, Marinello PC, Galvão DA, Newton RU, Borges FH, Frajacomo F, Deminice R (2017) Evaluation of resistance training to improve muscular strength and body composition in cancer patients undergoing neoadjuvant and adjuvant therapy: a meta-analysis. J Cancer Surviv 11:339–349. https://doi.org/10.1007/s11764-016-0592-x CrossRefGoogle Scholar
- 20.Urbain P, Birlinger J, Ihorst G, Biesalski HK, Finke J, Bertz H (2013) Body mass index and bioelectrical impedance phase angle as potentially modifiable nutritional markers are independent risk factors for outcome in allogeneic hematopoietic cell transplantation. Ann Hematol 92:111–119. https://doi.org/10.1007/s00277-012-1573-4 CrossRefGoogle Scholar
- 26.Borg G (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381Google Scholar
- 29.Norman K, Stobäus N, Zocher D, Bosy-Westphal A, Szramek A, Scheufele R, Smoliner C, Pirlich M (2010) Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer. Am J Clin Nutr 92:612–619. https://doi.org/10.3945/ajcn.2010.29215 CrossRefGoogle Scholar
- 37.Roecker K (2013) Die sportmedizinische Laktatdiagnostik: Technische Rahmenbedingungen und Einsatzbereiche. Dtsch Z Für Sportmed 64:367–371Google Scholar