Impact of the initial fitness level on the effects of a structured exercise therapy during pediatric stem cell transplantation

Abstract

Background Before and after hematopoietic stem cell transplantation (HSCT), most patients suffer from psychophysical limitations due to the treatment. Exercise interventions demonstrate beneficial effects on, for example, strength, endurance, or health‐related quality of life during and after HSCT, but with a great variation among patients concerning the response to exercise. This study examines the influence of the initial fitness on the effects of an exercise therapy in pediatric HSCT. Procedure Fifty‐three children and adolescents (10.9 ± 3.5 years) scheduled for HSCT were randomized into an exercise intervention group (IG) or a control group (CG). During hospitalization, the IG performed endurance, strength, and flexibility training three times per week. The CG included a nonexercise program. A 6‐min walk test was completed before and after the inpatient period. Baseline results (6‐min walking distance [6MWD]) were used to split both groups into the following: IGUNFIT, n = 14; IGFIT, n = 12; CGUNFIT, n = 16; CGFIT, n = 11. Differences in outcome changes between groups were analyzed with H‐test. Result Intergroup comparison revealed significant differences between IGUNFIT and CGUNFIT (P < 0.05). The IGUNFIT increased their 6MWD by +8% (vs. IGFIT, +1%); both CGs presented a decline in 6MWD (CGUNFIT, –14%; CGFIT, –16%). At discharge, the IGFIT achieved 85.5 ± 10.3% of healthy reference values. Conclusions The current results indicate that exercise during pediatric HSCT is feasible and contributes to prevention of treatment‐related loss of physical function. As seen in healthy persons, patients’ benefits might depend on their initial fitness level. As a diminished physical capability may result in higher training effects, impaired especially patients should engage in exercise.

Transplant Energize Me Patient Outcome (TEMPO): A Quality Improvement Project that Maintains Functional Mobility in Pediatric Patients Admitted for Allogeneic Hematopoietic Cell Transplantation

“…To our knowledge, TEMPO is the first multidisciplinary team approach for pediatric patients undergoing HCT that provides regular therapy intervention with a strong focus on developmentally appropriate education and establishing a culture of mobility. TEMPO confirms results of prior pediatric studies emphasizing the importance and positive effect of exercise and physical activity during HCT admission [2,7,11,14]. Whereas current literature highlights the effect of single discipline exercise programs, we present the success of a multidisciplinary project that focuses on exercise, functional mobility, strength, and physical activity; incorporates regular interventions 3 to 5 times per week for 60 minutes [2]; and uses validated assessment tools (ie, FMS) to track patient progress and task-specific sustainability.…”

“…In addition, studies including physical activity have documented benefits including less fatigue, improved strength and cardiorespiratory fitness, and higher quality of life, and exercise intervention has been shown to decrease the loss of functional performance during admission for HCT [6,15,16]. Specifically, cardiorespiratory fitness, as assessed by measures such as the 6-minute walk test (6MWT), has been shown to Biology of Blood and Marrow Transplantation journal homepage: www.bbmt.org have a stabilizing effect or statistically significant improvements in endurance with the use of exercise intervention during HCT for pediatric patients compared with control subjects from admission to follow-up [11,14]. The assessment of hand grip strength in pediatric patients undergoing HCT has shown similar statistically significant improvements in strength at time of discharge [17].…”

Effect of physical exercise on the functional capacity of children and adolescents submitted to transplantation of hematopoietic stem cells—A systematic review with meta-analysis

“…The analysis stratified by the initial level of fitness was performed in only one study (Wallek et al, 2018). There were no reported problems or health risks associated with the exercise programs used in the studies in question.…”

Role of Physical Therapy before and after Hematopoietic Stem Cell Transplantation: White Paper Report

“…1. Pretransplant fitness level can have a positive influence on recovery and QoL [9]. The physical therapist can evaluate pretransplant fitness levels and design an exercise program to possibly help influence recovery.…”