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Clinical Trials

Effects of an outpatient physical exercise program on hematopoietic stem-cell transplantation recipients: a randomized clinical trial

Bone Marrow Transplantation volume 46, pages 1245–1255 (2011)Cite this article

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Abstract

Patients who undergo hematopoietic SCT (HSCT) often experience physical and psychological problems, even long after treatment has been completed. This study was performed to evaluate the effects of a 12-week outpatient physical exercise (PE) program, incorporating aerobic and strength exercises, as compared with a usual care control condition on patients’ physical performance and psychosocial well-being. Patients who had completed HSCT up to 6 months earlier were randomly assigned to a supervised PE program (n=64) or a usual care control group (n=67). Primary outcomes were quantified physical performance and self-reported physical functioning. Secondary outcomes were body composition measurement, quantified walking activity and patient-reported outcomes (physical activity, fatigue and health-related quality of life). Assessments were at baseline, immediately after program completion and at 3-month follow-up. Significant intervention effects were observed at both posttreatment and follow-up on physical performance measures. No other outcomes yielded statistically significant group differences. PE should be considered in the management of HSCT recipients to improve physical performance after discharge from the hospital. Further research is needed to determine how the program can be enhanced so that improved physical performance also translates into improved physical and psychosocial functioning in daily life.

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References

  1. Mosher CE, Redd WH, Rini CM, Burkhalter J, Duhamel K . Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature. Psychooncology 2009; 18: 113–127.

    Article  Google Scholar 

  2. Wiskemann J, Huber G . Physical exercise as adjuvant therapy for patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 2008; 41: 321–329.

    Article  CAS  Google Scholar 

  3. Hjermstad MJ, Knobel H, Brinch L, Fayers PM, Loge JH, Holte H et al. A prospective study of health-related quality of life, fatigue, anxiety and depression 3-5 years after stem cell transplantation. Bone Marrow Transplant 2004; 34: 257–266.

    Article  CAS  Google Scholar 

  4. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365–376.

    Article  CAS  Google Scholar 

  5. McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS . Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 2006; 175: 34–41.

    Article  Google Scholar 

  6. Thorsen L, Courneya KS, Stevinson C, Fosså SD . A systematic review of physical activity in prostate cancer survivors: outcomes, prevalence, and determinants. Support Care Cancer 2008; 16: 987–997.

    Article  Google Scholar 

  7. McNeely ML, Parliament MB, Seikaly H, Jha N, Magee DJ, Haykowsky MJ et al. Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: a randomized controlled trial. Cancer 2008; 113: 214–222.

    Article  Google Scholar 

  8. Jarden M, Baadsgaard MT, Hovgaard DJ, Boesen E, Adamsen L . 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. Bone Marrow Transplant 2009; 43: 725–737.

    Article  CAS  Google Scholar 

  9. Baumann FT, Kraut L, Schüle K, Bloch W, Fauser AA . A controlled randomized study examining the effects of exercise therapy on patients undergoing haematopoietic stem cell transplantation. Bone Marrow Transplant 2010; 45: 355–362.

    Article  CAS  Google Scholar 

  10. Shelton ML, Lee JQ, Morris GS, Massey PR, Kendall DG, Munsell MF et al. A randomized control trial of a supervised versus a self-directed exercise program for allogeneic stem cell transplant patients. Psychooncology 2008; 18: 353–359.

    Article  Google Scholar 

  11. Somerfield MR, Rizzo JD . Can a modest exercise program really improve physical functioning and quality of life among recipients of hematopoietic SCT? Bone Marrow Transplant 2010; 45: 217–218.

    Article  CAS  Google Scholar 

  12. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, CONSORT Group. Methods and processes of the CONSORT Group: example of an extension for trials assessing nonpharmacologic treatments. Ann Intern Med 2008; 148: W60–W66.

    Article  Google Scholar 

  13. Schneider CM, Dennehy CA, Carter S . Exercise and cancer recovery, 1st edn. Human Kinetics: Leeds, UK, 2003.

    Google Scholar 

  14. Scott NW, McPherson GC, Ramsay CR, Campbell MK . The method of minimization for allocation to clinical trials. A review. Control Clin Trials 2002; 23: 662–674.

    Article  Google Scholar 

  15. Oldervoll LM, Kaasa S, Hjermstad MJ, Lund JA, Loge JH . Physical exercise results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients? Eur J Cancer 2004; 40: 951–962.

    Article  CAS  Google Scholar 

  16. Saltin B, Grimby G . Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same age. Circulation 1968; 38: 1104–1115.

    Article  CAS  Google Scholar 

  17. Knols R, Aufdemkampe G, de Bruin ED, Uebelhart D, Aaronson NK . Hand-held dynamometry in patients with hematological malignancies: measurement error in the clinical assessment of knee extension strength. BMC Musculoskelet Disord 2009; 10: 31.

    Article  Google Scholar 

  18. Bellace JV, Healy D, Besser MP, Byron T, Hohman L . Validity of the Dexter Evaluation System's Jamar dynamometer attachment for assessment of hand grip strength in a normal population. J Hand Ther 2000; 13: 46–51.

    Article  CAS  Google Scholar 

  19. Simmonds MJ . Physical function in patients with cancer: psychometric characteristics and clinical usefulness of a physical performance test battery. J Pain Symptom Manage 2002; 24: 404–414.

    Article  Google Scholar 

  20. Visser M, Fuerst T, Lang T, Salamone L, Harris TB . Validity of fan-beam dual-energy X-ray absorptiometry for measuring fat-free mass and leg muscle mass. Health, Aging and Body Composition Study—Dual-Energy X-ray Absorptiometry and Body Composition Working Group. J Appl Physiol 1999; 87: 1513–1520.

    Article  CAS  Google Scholar 

  21. Knols RH, de Bruin ED, Aufdemkampe G, Uebelhart D, Aaronson NK . Reliability of ambulatory walking activity in patients with hematological malignancies. Arch Phys Med Rehabil 2009; 90: 58–65.

    Article  Google Scholar 

  22. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007; 21: 2296–2304.

    Article  Google Scholar 

  23. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35: 1381–1395.

    Article  Google Scholar 

  24. Cella D . The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 1997; 34 (Suppl 2): 13–19.

    CAS  PubMed  Google Scholar 

  25. Field A . Discovering statistics using SPSS, 3rd edn. SAGE publications: London, UK, 2009.

    Google Scholar 

  26. Cohen J . Statistical Power Analysis for the Behavioral Sciences, 2nd ed. Lawrence Erlbaum Assoc: Hillsdale, NJ, 1988.

    Google Scholar 

  27. Habing B . Contrasts and multiple comparisons. University of South Carolina (last updated 20 July 2001). From http://www.stat.sc.edu/~habing/courses/516cmsup3.pdf.

  28. Enright PL, Sherrill DL . Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998; 158: 1384–1387.

    Article  CAS  Google Scholar 

  29. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S . Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 1985; 66: 69–74.

    CAS  PubMed  Google Scholar 

  30. White AC, Terrin N, Miller KB, Ryan HF . Respiratory and skeletal muscle strength in patients prior to hematopoietic stem-cell transplantation. Chest 2005; 128: 145–152.

    Article  Google Scholar 

  31. Kovalszki A, Schumaker GL, Klein A, Terrin N, White AC . Reduced respiratory and skeletal muscle strength in survivors of sibling or unrelated donor hematopoietic stem cell transplantation. Bone Marrow Transplant 2008; 41: 965–969.

    Article  CAS  Google Scholar 

  32. Coleman EA, Coon S, Hall-Barrow J, Richards K, Gaylor D, Stewart B . Feasibility of exercise during treatment for multiple myeloma. Cancer Nurs 2003; 26: 410–419.

    Article  Google Scholar 

  33. Hayes S, Davies PS, Parker T, Bashford J . Total energy expenditure and body composition changes following peripheral blood stem cell transplantation and participation in an exercise programme. Bone Marrow Transplant 2003; 31: 331–338.

    Article  CAS  Google Scholar 

  34. DeFor TE, Burns LJ, Gold EM, Weisdorf DJ . A randomized trial of the effect of a walking regimen on the functional status of 100 adult allogeneic donor hematopoietic cell transplant patients. Biol Blood Marrow Transplant 2007; 13: 948–955.

    Article  Google Scholar 

  35. Hayes S, Davies PS, Parker T, Bashford J, Newman B . Quality of life changes following peripheral blood stem cell transplantation and participation in a mixed-type, moderate-intensity, exercise program. Bone Marrow Transplant 2004; 33: 553–558.

    Article  CAS  Google Scholar 

  36. Courneya KS, Sellar CM, Stevinson C, McNeely ML, Peddle CJ, Friedenreich CM et al. Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. J Clin Oncol 2009; 27: 4605–4612.

    Article  Google Scholar 

  37. Speck RM, Courneya KS, Mâsse LC, Duval S, Schmitz KH . An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 2010; 4: 87–100.

    Article  Google Scholar 

  38. Knols RH, de Bruin ED, Shirato K, Uebelhart D, Aaronson NK . Physical activity interventions to improve daily walking activity in cancer survivors. BMC Cancer 2010; 10: 406.

    Article  Google Scholar 

  39. May AM, Duivenvoorden HJ, Korstjens I, van Weert E, Hoekstra-Weebers JE, van den Borne B et al. The effect of group cohesion on rehabilitation outcome in cancer survivors. Psychooncology 2008; 17: 917–925.

    Article  Google Scholar 

  40. Feise RJ . Do multiple outcome measures require P-value adjustment? BMC Med Res Methodol 2002; 2: 8.

    Article  Google Scholar 

  41. Vallance JK, Courneya KS, Plotnikoff RC, Yasui Y, Mackey JR . Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. J Clin Oncol 2007; 25: 2352–2359.

    Article  Google Scholar 

  42. Vallance JK, Courneya KS, Plotnikoff RC, Mackey JR . Analyzing theoretical mechanisms of physical activity behavior change in breast cancer survivors: results from the activity promotion (ACTION) trial. Ann Behav Med 2008; 35: 150–158.

    Article  Google Scholar 

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Acknowledgements

We gratefully thank the Zürcher Krebsliga (Zurich) and the Eidgenössische Sportkommission, (Magglingen) for their financial support.

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Authors and Affiliations

  1. Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Zurich, Switzerland

    R H Knols & D Uebelhart

  2. Institute of Human Movement Sciences and Sport, ETH, Zurich, Switzerland

    E D de Bruin

  3. Research Department of Lifestyle and Health, University of Applied Sciences, Faculty of Health Care, Utrecht, The Netherlands

    G Aufdemkampe

  4. Clinic of Hematology, University Hospital Zurich, Zurich, Switzerland

    U Schanz

  5. Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland

    F Stenner-Liewen

  6. Division of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    F Hitz

  7. Division of Oncology and Hematology, Cantonal Hospital Muensterlingen, Muensterlingen, Switzerland

    C Taverna

  8. Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    N K Aaronson

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  1. R H Knols
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Correspondence to R H Knols.

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Knols, R., de Bruin, E., Uebelhart, D. et al. Effects of an outpatient physical exercise program on hematopoietic stem-cell transplantation recipients: a randomized clinical trial. Bone Marrow Transplant 46, 1245–1255 (2011). https://doi.org/10.1038/bmt.2010.288

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  • DOI: https://doi.org/10.1038/bmt.2010.288

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