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

Abstract

The aim of this randomized controlled trial was to investigate the effect of a 4-to 6-week multimodal program of exercise, relaxation and psychoeducation on physical capacity, functional performance and quality of life (QOL) in allogeneic hematopoietic cell transplantation (allo-HSCT) adult recipients. In all, 42 patients were randomized to a supervised multimodal intervention or to a control group receiving usual care. The primary end point was on aerobic capacity measured in VO 2 max. Secondary end points were muscle strength, functional performance, physical activity level, QOL, fatigue, psychological well-being and clinical outcomes. The multimodal intervention had a significant effect on physical capacity: VO 2 max (Po0.0001) and muscle strength: chest press (Po0.0001), leg extension (P ¼ 0.0003), right elbow flexor (P ¼ 0.0009), right knee extensor (Po0.0001) and functional performance (stair test) (0.0008). Moreover, the intervention group showed significantly better results for the severity of diarrhea (P ¼ 0.014) and fewer days of total parenteral nutrition (P ¼ 0.019). Longitudinal changes in QOL, fatigue and psychological well-being favored the intervention group, but did not reach statistical significance. Assignment of a multimodal intervention during allo-HSCT did not cause untoward events, sustained aerobic capacity and muscle strength and reduced loss of functional performance during hospitalization.

Effect of physical exercise on muscle mass and strength in cancer patients during treatment—A systematic review

“…Of these, three trials used aerobic exercise (AE) alone { [29];Mello, 2003 #17;Monga, 2007 #7}, while seven trials used AE and resistance exercise (RE) in a combined intervention (CAE) [30][31][32][33][34][35][36]. Four trials compared AE or RE against UC [37][38][39][40].One trial compared two different RE interventions (three or five days per week) against usual care [41].…”

“…Effect sizes in favour of AE compared to UC were small in two trials by Courneya and colleagues [37] and Segal and colleagues [40] for the outcomes chest press (SMD 0.0; CI -0. Effect sizes were moderate to small both for upper and lower body strength in favour of CAE compared with UC in three trials [30,33,36]. Effect sizes were largest in the study by Jarden and colleagues [33] for both leg extension (SMD 1.7; CI -3.5 to 6.9) and chest press (0.8; CI -5.5 to 7.1).…”

“…Effect sizes were moderate to small both for upper and lower body strength in favour of CAE compared with UC in three trials [30,33,36]. Effect sizes were largest in the study by Jarden and colleagues [33] for both leg extension (SMD 1.7; CI -3.5 to 6.9) and chest press (0.8; CI -5.5 to 7.1).…”

“…Four trials reported statistically significant differences in change between groups on muscle strength for CAE compared with usual care (UC): These studies included Jarden and colleagues [33] (five days per week for 4-6 weeks) for 1 RM chest press (2.6 kg ↑ versus 8.7 kg ↓; p<0.001) and 1 RM leg extension (3 kg ↑ versus 17.2 kg ↓; p=0.0003); Adamsen and colleagues (3 days per week for six weeks) for chest press (7.3 kg ↑ versus 0.5 kg ↓; p<0.0001), pull down (7.6 kg ↑versus 0.8 kg ↑; p<0.0001) and leg press (31.6 kg ↑versus 2.8 kg ↑); Battaglini and colleagues for total upper and body muscle strength (2.4 kg ↑ versus 12.6 kg ↓; p<0.05), and Oldervoll and colleagues for grip strength (1.1 kg ↑ versus 1.3 kg ↓; p<0.05). No statistically significant group differences in change in muscle strength were reported by Mustian and colleagues [34]; Coleman and colleagues [32] and Wiskemann and colleagues [36].…”

“…A few trials included some other cancer diagnoses, such as bowel or colon cancer [30, 31, 34, 37-40, 42, 43]. Six trials included patients with various haematological malignancies, mainly acute or chronic leukaemia or lymphomas, undergoing hematopoietic stem cell transplants (HSCT) [29,33,36,41]. Only one trial included patients with advanced stage IV cancer undergoing palliative cancer treatment.…”