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

Abstract

IntroductionHaematopoietic stem cell transplant (HSCT) in adults is an intensive medical procedure for a variety of haematological malignancies. Although there is a large body of evidence demonstrating the negative effects of HSCT on physical function and psychosocial parameters, there is limited evidence on the impact of HSCT on body composition and bone health. Further, aerobic and resistance-training exercise interventions aimed at improving physical function and patient-reported outcomes largely take place during the peritransplant and post-transplant period. Prehabilitative exercise, or exercise prior to medical treatment, has been successfully deployed in presurgical candidates and other tumour sites, yet there is a paucity of evidence on the effect of prehabilitation in HSCT patients. The aim of this study is to investigate the feasibility, acceptability and safety of a resistance training exercise programme in patients with haematological malignancies prior to HSCT.Methods and analysisIMpact of PRehabilitation in Oncology Via Exercise-Bone Marrow Transplant is a single-site, pilot randomised controlled trial of an exercise intervention compared with usual care. The primary aim is to assess the feasibility, acceptability and safety of the resistance-training exercise intervention prior to HSCT. Secondary aims include evaluating the differences in physical function, body composition, bone mineral density and patient-reported outcomes between the exercise group and usual care control group. Outcome measurements will be assessed: prior to HSCT, on/around day of HSCT admission, +30 days post-HSCT and +100 days post-HSCT. The exercise intervention is a home-based resistance training exercise programme that incorporates resistance band and body weight exercises. The primary outcomes will be reported as percentages and/or mean values. The secondary outcomes will be analysed using appropriate statistical methods to portray within-group and between-group differences.Ethics and disseminationThe study has Penn State College of Medicine approval. Results will be disseminated through scientific publication and presentation at exercise-related and oncology-related scientific meetings.Trial registration numberNCT03886909.

“Prehabilitation” for Pediatric Patients With Cancer Before Undergoing Hematopoietic Stem Cell Transplantation

“…Studies in adults have started to show the benefit of prehabilitation in cancer patients undergoing oncological surgeries, as well as HSCT. [12][13][14][15]17 Studies have shown improvement in fatigue, 6 MWT, and QOL in adult patients participating in exercise before, during, and after allogeneic HSCT. 29,30 Thus, it is logical to conclude that studying the effects of prehabilitation on preventing deconditioning in pediatric patients has the potential to provide benefits to these patients.…”

“…Studies in adults have started to show the benefit of prehabilitation in cancer patients undergoing oncological surgeries, as well as HSCT 12–15,17 . Studies have shown improvement in fatigue, 6 MWT, and QOL in adult patients participating in exercise before, during, and after allogeneic HSCT 29,30 .…”

“…12 Studies on the use of prehabilitation in adults undergoing HSCT have even started to be conducted. 17 Specific data on prehabilitation duration in pediatric patients is similarly limited. However, for adults undergoing cancer surgery, it appears that a course of 6 to 8 weeks provides the maximum amount of benefit without risking compliance.…”

“…For example, a review article found that implementing prehabilitation before surgery for head and neck cancers led to positive outcomes in 18 of the 19 papers reviewed 12 . Studies on the use of prehabilitation in adults undergoing HSCT have even started to be conducted 17 . Specific data on prehabilitation duration in pediatric patients is similarly limited.…”

Tripartite prehabilitation of patients with acute myeloid leukaemia and high-risk myelodysplastic syndromes during intensive chemotherapy before allogeneic haematopoietic stem cell transplantation (COHABILIT): protocol for an innovating prospective multicentre study

“…However, the feasibility of a multimodal prehabilitation is not yet well defined, especially among haematology patients treated with intensive chemotherapy and allo-HSCT. 56 Despite the promising results of prehabilitation before surgery, 57 the complexity of therapeutic trajectories in oncohaematology has so far made it difficult to set up prehabilitation interventions, as shown by the scarcity of studies over the last 10 years. The few recent studies of pre-HSCT prehabilitation are often unimodal, based on physical preparation alone.…”