Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Quality of Life

Efficacy of exercise training in SCT patients-who benefits most?

Abstract

Patients undergoing allo-HCT often experience a substantial loss in physical performance. We have recently published the general effectiveness of an exercise intervention in 105 allo-HCT patients on physical performance and psychosocial well-being. However, predictor variables for differentiated treatment response remained unclear. To determine the impact of basic physical performance on treatment response, we assessed muscle strength and endurance performance at four assessment points before and after allo-HCT. The exercise group started training 2 weeks before admission and ended 6–8 weeks after discharge. Comparing initially fit with unfit classified patients, the fit patients lost 31% of the strength of the knee-extensors, whereas the unfit patients lost only 1% (P<0.05). For endurance capacity, fit patients lost 4% of their walking capability, whereas unfit patients gained 13% (P<0.05). The individual percent change was statistically different at the 0.05 level in all measures of physical performance. Individual training response in allo-HCT patients strongly depends on the initial physical performance level. Unfit patients can be trained safely and may benefit more from this exercise intervention than fit patients. This result is of major clinical relevance and should encourage hematologists to promote exercise even more in impaired/unfit allo-HCT patients.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Copelan EA . Hematopoietic stem-cell transplantation. N Engl J Med 2006; 354: 1813–1826.

    Article  CAS  Google Scholar 

  2. Morishita S, Kaida K, Ikegame K, Yoshihara S, Taniguchi K, Okada M et al. Impaired physiological function and health-related QOL in patients before hematopoietic stem-cell transplantation. Support Care Cancer 2012; 20: 821–829.

    Article  Google Scholar 

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

    Article  Google Scholar 

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

    Article  Google Scholar 

  5. Mitchell SA, Leidy NK, Mooney KH, Dudley WN, Beck SL, LaStayo PC et al. Determinants of functional performance in long-term survivors of allogeneic hematopoietic stem cell transplantation with chronic graft-versus-host disease (cGVHD). Bone Marrow Transplant 2010; 45: 762–769.

    Article  CAS  Google Scholar 

  6. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010; 42: 1409–1426.

    Article  Google Scholar 

  7. 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 

  8. Coleman EA, Coon SK, Kennedy RL, Lockhart KD, Stewart CB, Anaissie EJ et al. Effects of exercise in combination with epoetin alfa during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for multiple myeloma. Oncol Nurs Forum 2008; 35: E53–E61.

    Article  Google Scholar 

  9. 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 

  10. 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 

  11. Hacker ED, Larson J, Kujath A, Peace D, Rondelli D, Gaston L . Strength training following hematopoietic stem cell transplantation. Cancer Nurs 2011; 34: 238–249.

    Article  Google Scholar 

  12. 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 

  13. Wiskemann J, Dreger P, Schwerdtfeger R, Bondong A, Huber G, Kleindienst N et al. Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood 2011; 117: 2604–2613.

    Article  CAS  Google Scholar 

  14. Skinner JS, Jaskolski A, Jaskolska A, Krasnoff J, Gagnon J, Leon AS et al. Age, sex, race, initial fitness, and response to training: the HERITAGE Family Study. J Appl Physiol 2001; 90: 1770–1776.

    Article  CAS  Google Scholar 

  15. Gruber W, Orenstein DM, Braumann KM . Do responses to exercise training in cystic fibrosis depend on initial fitness level? Eur Respir J 2011; 38: 1336–1342.

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  17. Mello M, Tanaka C, Dulley FL . Effects of an exercise program on muscle performance in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant 2003; 32: 723–728.

    Article  CAS  Google Scholar 

  18. Bohannon RW . Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20–79 years. Arch Phys Med Rehabil 1997; 78: 26–32.

    Article  CAS  Google Scholar 

  19. Enright PL . The six-minute walk test. Respir Care 2003; 48: 783–785.

    PubMed  Google Scholar 

  20. Crapo R, Casaburi R, Coaties A, Enright P, MacIntyre N, McKay P et al. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111–117.

    Article  Google Scholar 

  21. Smets EM, Garssen B, Bonke B, de Haes JC . The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995; 39: 315–325.

    Article  CAS  Google Scholar 

  22. 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 

  23. Holland JC, Andersen B, Breitbart WS, Dabrowski M, Dudley MM, Fleishman S et al. Distress management. J Natl Compr Canc Netw 2007; 5: 66–98.

    Article  Google Scholar 

  24. Enright PL, Sherrill DL . Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998; 158 (5 Pt 1): 1384–1387.

    Article  CAS  Google Scholar 

  25. Baumann FT, Zopf EM, Nykamp E, Kraut L, Schule K, Elter T et al. Physical activity for patients undergoing an allogeneic hematopoietic stem cell transplantation: benefits of a moderate exercise intervention. Eur J Haematol 2011; 87: 148–156.

    Article  Google Scholar 

  26. 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 

  27. 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 

  28. Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Bone Marrow Transplant 2012; 47: 337–341.

    Article  CAS  Google Scholar 

  29. De Lisio M, Baker JM, Parise G . Exercise promotes bone marrow cell survival and recipient reconstitution post-bone marrow transplantation, which is associated with increased survival. Exp Hematol 2013; 41: 143–154.

    Article  Google Scholar 

  30. Weiss BM, Vogl DT, Berger NA, Stadtmauer EA, Lazarus HM . Trimming the fat: obesity and hematopoietic cell transplantation. Bone Marrow Transplant 2013; 48: 1152–1160.

    Article  CAS  Google Scholar 

  31. Urbain P, Birlinger J, Lambert C, Finke J, Bertz H, Biesalski HK . Longitudinal follow-up of nutritional status and its influencing factors in adults undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2013; 48: 446–451.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The study was funded by the German Jose Carreras Leukemia Foundation (2006–2008; project no. R05/33p).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J Wiskemann.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wiskemann, J., Kuehl, R., Dreger, P. et al. Efficacy of exercise training in SCT patients-who benefits most?. Bone Marrow Transplant 49, 443–448 (2014). https://doi.org/10.1038/bmt.2013.194

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2013.194

Keywords

This article is cited by

Search

Quick links