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.

  • Article
  • Published:

Feasibility of early-commencing group-based exercise in allogeneic bone marrow transplantation: the BOOST study

Bone Marrow Transplantation volume 56, pages 2788–2796 (2021)Cite this article

Subjects

Abstract

Increasing evidence supports that individualised exercise is safe and beneficial for adults treated with allogeneic bone marrow transplantation (alloBMT), although this is not part of standard care and no research has investigated group-based interventions. This study aimed to determine safety, feasibility and exploratory effects of a supervised group-based inpatient and subsequent home-based exercise programme in alloBMT. This single-site prospective cohort study included consecutive adults treated with alloBMT for haematological disease. All participants received usual care in addition to the protocolised exercise programme pre-transplant until 60 days post transplant. The primary outcome was feasibility; secondary outcomes included exercise capacity, frailty, health-related quality of life and strength. Consent rate was 100% (n = 42); 83% (n = 35) completed all aspects of the intervention and outcome testing; of those, 83% (n = 29) attended ≥2 group-exercise sessions per week; no adverse events occurred. Emotional well-being significantly improved over time, which may highlight benefits of group-based intervention. Other outcomes significantly declined from pre-BMT to hospital discharge, with some improvement at 60 days post-BMT. Participants with early signs of frailty demonstrated the greatest decline in outcomes. Group-based exercise was safe and feasible; observations from this study highlight the importance of baseline identification of frailty to target intervention at those who need it most.

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

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

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

Fig. 1: Participant flow diagram through phases of recruitment, intervention and outcome testing.
Fig. 2: Mean incremental shuttle walk test (ISWT) over time from baseline (pre-BMT) to 60-days post-BMT.

Similar content being viewed by others

References

  1. Baker KS, Ness KK, Weisdorf D, Francisco L, Sun C-L, Forman S, et al. Late effects in survivors of acute leukemia treated with hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study. Leukemia. 2010;24:2039–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Abo S, Ritchie D, Denehy L, Panek-Hudson Y, Irving L, Granger CL. A hospital and home-based exercise program to address functional decline in people following allogeneic stem cell transplantation. Support Care Cancer. 2018;26:1727–36.

    Article  CAS  PubMed  Google Scholar 

  3. Abo S, Denehy L, Ritchie D, Lin KY, Edbrooke L, McDonald, C et al. People with haematological malignancies treated with bone marrow transplantation have improved function, quality of life and fatigue following exercise intervention: a systematic review and meta-analysis. Phys Ther. 2021. https://doi.org/10.1093/ptj/pzab130.

  4. Knips L, Bergenthal N, Streckmann F, Monsef I, Elter T, Skoetz N. Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database Syst Rev. 2019;1:CD009075.

    PubMed  Google Scholar 

  5. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.CD003793.pub3.

  6. Golmohammadi K, Jacobs P, Sin DD. Economic evaluation of a community-based pulmonary rehabilitation program for chronic obstructive pulmonary disease. Lung. 2004;182:187–96.

    Article  PubMed  Google Scholar 

  7. Hoffmannffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.

    Article  Google Scholar 

  8. Slade SC, Dionne CE, Underwood M, Buchbinder R, Beck B, Bennell K, et al. Consensus on exercise reporting template (CERT): modified Delphi Study. Phys Ther. 2016;96:1514–24.

    Article  PubMed  Google Scholar 

  9. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355:i5239.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Patel AV, Friedenreich CM, Moore SC, Hayes SC, Silver JK, Campbell KL, et al. American College of Sports Medicine Roundtable Report on physical activity, sedentary behavior, and cancer prevention and control. Med Sci Sports Exerc. 2019;51:2391–402.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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;117:2604–13.

    Article  CAS  PubMed  Google Scholar 

  12. Parreira VF, Janaudis-Ferreira T, Evans RA, Mathur S, Goldstein RS, Brooks D. Measurement properties of the incremental shuttle walk test: a systematic review. Chest. 2014;145:1357–69.

    Article  PubMed  Google Scholar 

  13. Probst VS, Hernandes NA, Teixeira DC, Felcar JM, Mesquita RB, Gonçalves CG, et al. Reference values for the incremental shuttle walking test. Respir Med. 2012;106:243–8.

    Article  PubMed  Google Scholar 

  14. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–M94.

    Article  CAS  PubMed  Google Scholar 

  15. Pavasini R, Guralnik J, Brown JC, di Bari M, Cesari M, Landi F, et al. Short physical performance battery and all-cause mortality: systematic review and meta-analysis. BMC Med. 2016;14:215.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Martin H. Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? A comparison with the gold standard biodex dynamometry. Gerontology. 2006;52:154–9.

    Article  CAS  PubMed  Google Scholar 

  17. Bohannon RW, Bubela DJ, Magasi SR, Gershon RC. Relative reliability of three objective tests of limb muscle strength. Isokinet Exerc Sci. 2011;19:77–81.

    Article  Google Scholar 

  18. Bohannon RW. Quantitative testing of muscle strength: issues and practical options for the geriatric population. Top Geriatr Rehab. 2002;18:1–17.

    Article  Google Scholar 

  19. Bohannon RW, Schaubert KL. Test–retest reliability of grip-strength measures obtained over a 12-week interval from community-dwelling elders. J Hand Ther. 2005;18:426–7.

    Article  PubMed  Google Scholar 

  20. Schaubert KL, Bohannon RW. Reliability and validity of three strength measures obtained from community-dwelling elderly persons. J Strength Cond Res. 2005;19:717–20.

    PubMed  Google Scholar 

  21. McQuellon RP, Russell GB, Cella DF, Craven BL, Brady M, Bonomi A, et al. Quality of life measurement in bone marrow transplantation: development of the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) scale. Bone Marrow Transpl. 1997;19:357–68.

    Article  CAS  Google Scholar 

  22. 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;35:1381–95.

    Article  PubMed  Google Scholar 

  23. Santos-Lozanoantos-Lozano A, Hernández-Vicente A, Pérez-Isaac R, Santín-Medeiros F, Cristi-Montero C, Casajús JA, et al. Is the SenseWear Armband accurate enough to quantify and estimate energy expenditure in healthy adults? Ann Transl Med. 2017;5:97-–97.

    Article  Google Scholar 

  24. Haas BK, Northam S. Measuring self-efficacy: development of the Physical Activity Assessment Inventory. South Online J Nurs Res. 2010;10:35–51.

    Google Scholar 

  25. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.

    Article  CAS  PubMed  Google Scholar 

  26. Hegde A, Murthy HS. Frailty: the missing piece of the pre-hematopoietic cell transplantation assessment? Bone Marrow Transpl. 2018;53:3–10.

    Article  CAS  Google Scholar 

  27. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  28. McLester CN, Nickerson BS, Kliszczewicz BM, McLester JR. Reliability and agreement of various InBody body composition analyzers as compared to dual-energy X-ray absorptiometry in healthy men and women. J Clin Densitom. 2020;23:443–50.

    Article  PubMed  Google Scholar 

  29. Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, et al. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10:1.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Australasian Bone Marrow Transplant Recipient Registry. Australasian Bone Marrow Transplant Recipient Registry Annual Data Summary 2018. Darlinghurst, NSW, Australia: ABMTRR; 2019.

  31. 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 Transpl. 2009;43:725–37.

    Article  CAS  Google Scholar 

  32. 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 Transpl. 2007;13:948–55.

    Article  Google Scholar 

  33. Hacker ED, Mjukian M. Review of attrition and adherence in exercise studies following hematopoietic stem cell transplantation. Eur J Oncol Nurs. 2014;18:175–82.

    Article  PubMed  Google Scholar 

  34. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51:2375–90.

    Article  PubMed  PubMed Central  Google Scholar 

  35. van Dongen JM, Persoon S, Jongeneel G, Bosmans JE, Kersten MJ, Brug J, et al. Long-term effectiveness and cost-effectiveness of an 18-week supervised exercise program in patients treated with autologous stem cell transplantation: results from the EXIST study. J Cancer Surviv. 2019;13:558–69.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Persoon S, Chin APaw MJM, Buffart LM, Liu RDK, Wijermans P, Koene HR, et al. Randomized controlled trial on the effects of a supervised high intensity exercise program in patients with a hematologic malignancy treated with autologous stem cell transplantation: results from the EXIST study. PLoS ONE [Electron Resour]. 2017;12:e0181313.

    Article  CAS  Google Scholar 

  37. Baumann FT, Kraut L, Schule K, Bloch W, Fauser AA. A controlled randomized study examining the effects of exercise therapy on patients undergoing haematopoietic stem cell transplantation. Bone Marrow Transpl. 2010;45:355–62.

    Article  CAS  Google Scholar 

  38. Hacker ED, Collins E, Park C, Peters T, Patel P, Rondelli D. Strength training to enhance early recovery after hematopoietic stem cell transplantation. Biol Blood Marrow Transpl. 2017;23:659–69.

    Article  Google Scholar 

  39. Morishita S, Kaida K, Setogawa K, Kajihara K, Ishii S, Ikegame K, et al. Safety and feasibility of physical therapy in cytopenic patients during allogeneic haematopoietic stem cell transplantation. Eur J Cancer Care. 2013;22:289–99.

    Article  CAS  Google Scholar 

  40. Schumacher H, Stüwe S, Kropp P, Diedrich D, Freitag S, Greger N, et al. A prospective, randomized evaluation of the feasibility of exergaming on patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transpl. 2018;53:584–90.

    Article  Google Scholar 

  41. Limbach M, Kuehl R, Dreger P, Luft T, Rosenberger F, Kleindienst N, et al. Influencing factors of cardiorespiratory fitness in allogeneic stem cell transplant candidates prior to transplantation. Support Care Cancer. 2021;29:359–67.

    Article  PubMed  Google Scholar 

  42. Lee SJ, Kim HT, Ho VT, Cutler C, Alyea EP, Soiffer RJ, et al. Quality of life associated with acute and chronic graft-versus-host disease. Bone Marrow Transpl. 2006;38:305–10.

    Article  CAS  Google Scholar 

  43. Hamada R, Kondo T, Murao M, Miyasaka J, Yoshida M, Nankaku M, et al. Effect of the severity of acute graft-versus-host disease on physical function after allogeneic hematopoietic stem cell transplantation. Support Care Cancer. 2020;28:3189–96.

    Article  PubMed  Google Scholar 

  44. Wiskemann J, Kuehl R, Dreger P, Schwerdtfeger R, Huber G, Ulrich CM, et al. Efficacy of exercise training in SCT patients—who benefits most? Bone Marrow Transpl. 2014;49:443–8.

    Article  CAS  Google Scholar 

  45. Friedenreich CM, Stone CR, Cheung WY, Hayes SC. Physical activity and mortality in cancer survivors: a systematic review and meta-analysis. JNCI Cancer Spectr. 2019;4:pkz080.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge the funding received from Royal Melbourne Hospital, Mary Elizabeth Watson Fellowship to conduct this research, and the allied health, nursing and medical staff and patients who facilitated this research.

Author information

Authors and Affiliations

  1. Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia

    Shaza Abo, Linda Denehy & Catherine L. Granger

  2. Department of Physiotherapy, Royal Melbourne Hospital, Parkville, VIC, Australia

    Shaza Abo & Catherine L. Granger

  3. Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC, Australia

    David Ritchie & Yvonne Panek-Hudson

  4. Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Linda Denehy

  5. Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia

    Louis Irving

Authors
  1. Shaza Abo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Ritchie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Linda Denehy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yvonne Panek-Hudson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Louis Irving
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Catherine L. Granger
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SA, DR, LD, CLG: Conception, design; data acquisition, analysis, interpretation; drafting and revising manuscript. YPH, LI: Conception, design; data interpretation; revising manuscript. All authors: Final approval of manuscript to be published.

Corresponding author

Correspondence to Shaza Abo.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

41409_2021_1411_MOESM1_ESM.docx

Supplementary Table 1: Change in outcomes over time using linear mixed model analysis except for self-reported PA which used Wilcoxon Signed-Rank tests.

41409_2021_1411_MOESM2_ESM.docx

Supplementary Table 2: Demographic and baseline outcomes of the six participants who had to cease the group-based inpatient intervention due to transplant complications.

Supplement Files 1 and 2

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abo, S., Ritchie, D., Denehy, L. et al. Feasibility of early-commencing group-based exercise in allogeneic bone marrow transplantation: the BOOST study. Bone Marrow Transplant 56, 2788–2796 (2021). https://doi.org/10.1038/s41409-021-01411-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-021-01411-w

This article is cited by

Search

Advanced search

Quick links