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

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Abstract

Purpose

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.

Methods

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).

Results

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).

Conclusions

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.

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Acknowledgements

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

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

Author information

Authors and Affiliations

  1. Division of Allied Health (Physiotherapy), Royal Melbourne Hospital, Parkville, VIC, 3052, Australia

    S. Abo & C. L. Granger

  2. Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3052, Australia

    S. Abo, L. Denehy & C. L. Granger

  3. Department of Clinical Haematology and Bone Marrow Transplant, Royal Melbourne Hospital, Parkville, VIC, 3052, Australia

    D. Ritchie

  4. Haematology Service, Peter MacCallum Cancer Centre, Parkville, VIC, 3052, Australia

    Y. Panek-Hudson

  5. Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, VIC, 3052, Australia

    L. Irving

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  1. S. Abo
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Correspondence to S. Abo.

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Appendix 1: Safety guidelines for the exercise program.

Appendix 1: Safety guidelines for the exercise program.

Participants were assessed prior to commencing and at the completion of exercise testing and training, using a blood pressure monitor and pulse oximeter measuring heart rate and oxygen saturation, and monitored during exercise using the pulse oximeter as well as the Borg scale for breathlessness and rating of perceived exertion.

The following adverse events were to be reported if they occurred during or up to 1-h post study outcome assessment or exercise training for all participants.

If any of these events occurred during exercise/testing, exercise would cease and the appropriate response taken:

  • Heart rate is < 50 or > 140 beats/min and/or a new arrhythmia developed (including frequent ventricular ectopics or new onset atrial fibrillation).

  • Blood pressure < 90 or > 180 mm/Hg

  • Patient suffers a fall or collapse

  • Patient becomes pale and sweaty and/or the patient specifically requested to stop due to feeling acutely unwell

  • Patient complained of new onset chest pain

  • If patient has an SpO2 < 90% at rest, exercise should not commence. If SpO2 < 90% during exercise, exercise should be ceased. Exercise/testing can be recommenced when SpO2 returns to resting level of the same FiO2

  • If patient’s respiratory rate is > 20 breaths/min at rest, exercise should not commence. Exercise RR > 35 breaths/min, exercise should be ceased. Exercise/testing can be recommenced when the respiratory rate is within five breaths of resting rate

  • Patient temperature > 38°

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Abo, S., Ritchie, D., Denehy, L. et al. A hospital and home-based exercise program to address functional decline in people following allogeneic stem cell transplantation. Support Care Cancer 26, 1727–1736 (2018). https://doi.org/10.1007/s00520-017-4016-x

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  • DOI: https://doi.org/10.1007/s00520-017-4016-x

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