Feasibility and benefits of a structured prehabilitation programme prior to autologous stem cell transplantation (ASCT) in patients with myeloma; a prospective feasibility study

Abstract

Evidence supports the benefits of exercise-based rehabilitation in promoting recovery in myeloma patients following autologous stem-cell transplantation (ASCT). However, 'prehabilitation' has never been evaluated prior to ASCT, despite evidence of effectiveness in other cancers. Utilising a mixed method approach the authors investigated the feasibility of a mixed strength and cardiovascular exercise intervention pre-ASCT. Quantitative data were collected to determine feasibility targets; rates of recruitment, adherence and adverse events, including 6 minute walking distance (6MWD) test and patient reported outcome measures (PROMs). Qualitative interviews were undertaken with a purposive sample of patients to capture their experiences of the study and the intervention. The authors recruited 23 patients who attended a mean percentage of 75% scheduled exercise sessions. However, retention rates were limited, with only 14/23 (62%) completing the programme. In these patients, the 6MWD increased from a mean of 346 to 451 m (i.e. by 105 m, 95% CI 62 to 148 m) with no serious adverse events. Whist participants found the exercise programme acceptable and reported improvement in their physical fitness and overall mental health and wellbeing prior to ASCT, the study identified challenges in hospital attendance for the prehabilitation schedule whilst receiving induction or re-induction chemotherapy. Evaluation of digitally-enhanced directed but remote prehabilitation models for this patient group is warranted.

IMPROVE-BMT: A Pilot Randomized Controlled Trial of Prehabilitation Exercise for Adult Hematopoietic Stem Cell Transplant Recipients

“…Allowance for these accommodations allows exercise to fit the patient's lifestyle, rather than making a patient's lifestyle fit the exercise program, mimicking "real world" exercise habits. Further, there were zero intervention-related adverse or serious adverse events, consistent with previous trials investigating pre-HSCT exercise, regardless of transplant and hematologic malignancy type [28][29][30]32,33]. This further supports the assertion that if exercise is pragmatically programed and prescribed to accommodate the patients clinicopathologic history while also targeting functional improvements, exercise is safe to be performed unsupervised for a large proportion of AUTO and ALLO HSCT recipients.…”

“…Exercise adherence in our trial was high (91.98%, range: 33-190%), regardless of transplant. Previous reports of exercise adherence have ranged from 55% to 99% [29][30][31][32][33], while other trials were unable to report on exercise adherence due to failure of study participants to return exercise logs [28]. The high exercise adherence rate seen in this trial could be attributed to the pragmatic design of the exercise program.…”

IMPROVE-BMT: a protocol for a pilot randomised controlled trial of prehabilitation exercise for adult haematopoietic stem cell transplant recipients

“…The trials by van Haren et al and Rupnik et al are non-randomised feasibility trials, which do not allow for comparison to a non-exercising group 27 28. In addition, the PREeMPT trial,29 the PERCEPT trial30 and the feasibility trial by Mawson et al 31 focus on patients diagnosed with multiple myeloma who are receiving an AUTO transplant, while Wood et al 32 used only aerobic exercise for ALLO patients. Finally, the trials completed by Wiskemann et al 33 and Santa Mina et al 34 included exercise for ALLO patients during multiple phases of the transplant process, making it more difficult to discern the impact of the pretransplant exercise intervention.…”

Enablers and barriers to referral and delivery of multidisciplinary prehabilitation in the Autologous Stem Cell Transplant population: A theory-based interview study

“…It supports patients to prepare for treatment by promoting healthy behaviours and needs-based prescribing of exercise, nutrition and psychological interventions [7]. There is emerging evidence to support cancer prehabilitation prior to AuSCT, with studies reporting that it is safe and feasible [8,9] and may mitigate the decline in functional exercise capacity, muscle strength and HRQoL that is experienced prior to and during AuSCT [10][11][12]. However, feasibility and observational studies reported issues with acceptability, attrition, data collection and intervention delivery [11,12].…”

“…Qualitative research in cancer prehabilitation primarily focuses on the patient experience or barriers to implementation [13][14][15]. Although there are reported di culties delivering prehabilitation prior to AuSCT [11,12], there is a gap in current literature regarding clinicians' perceptions of enablers and barriers to prehabilitation delivery.…”