EDITORIAL
Can a modest exercise program really improve physical functioning
and quality of life among recipients of hematopoietic SCT?
Bone Marrow Transplantation (2010) 45, 217–218;
doi:10.1038/bmt.2009.164
The short- and long-term physical and psychosocial
sequelae of hematopoietic SCT (HSCT) have been exten-
sively documented. HSCT has a range of well-recognized
acute conditioning-related toxicities (for example, GVHD,
nausea and emesis, infections, bleeding), as well as less
conspicuous but nonetheless serious effects on general
physical capacity or fitness, fatigue, and emotional and
social well-being. Since the mid 1990s, researchers have
investigated the impact of physical exercise interventions on
these outcomes. Exercise has been proposed as a means to
help individuals treated with HSCT recover from the
deconditioning and the associated loss of functional
capacity and debilitating fatigue that can occur with
prolonged lack of physical activity.
1,2
In their 2008 review, Wiskemann and Huber
3
identified
15 studies of physical exercise in the HSCT population. The
15 studies varied in design (randomized controlled trial
vs quasi-experimental), intervention (endurance training
vs resistance training), setting (inpatient vs outpatient or
home-based) and duration (5 weeks to 12 months). Several
of the studies reported modest benefits of exercise inter-
ventions on endurance, strength, and/or quality of life
outcomes. However, the studies have generally been
methodologically weak. Among the limitations, five of the
15 studies lacked a no-intervention comparison group and
10 of the studies reported data on 35 or fewer patients who
completed the study.
The need for larger randomized controlled trials of
exercise interventions in persons treated with HSCT is
apparent.
4
In this regard, Jarden et al.
5
recently reported
the results of a randomized trial of a multimodal,
supervised exercise program in adult recipients of allo-
geneic HSCT. The intervention, which began on the day of
admission and spanned the hospitalization period, con-
sisted of exercise, including stationary cycling, resistance
training, and dynamic and stretching exercises; and
progressive muscle relaxation training and psychoeduca-
tion. Jarden et al.
5
observed statistically significant effects
of the intervention on physical capacity (VO
2
max and
muscle strength), functional performance, severity of
diarrhea, and days of parenteral nutrition. There were no
statistically significant effects on quality of life, fatigue,
physical activity levels, or psychological well-being.
In this issue of Bone Marrow Transplantation, Baumann
et al.
6
report on a randomized controlled trial of the effects
of supervised exercise therapy on endurance, strength,
quality of life (primary outcomes), and on hematopoietic
parameters and lung function (secondary outcomes) in 64
patients undergoing either allogeneic or autologous HSCT.
Patients in the treatment group received exercise training,
including both therapeutic ADL (activities of daily living)
training and aerobic endurance training, from the con-
ditioning phase of HSCT until discharge from the hospital.
Patients in the control group received the hospital’s
standard mobilization program. Both groups of patients
were attended by a professional therapist. Baumann et al.
6
found statistically significant effects of their intervention on
strength, endurance, lung function, global quality of life,
and the physical functioning subscale of the EORTC QLQ-
C30 instrument.
Baumann et al.
6
provide intriguing evidence for the
effects of a structured exercise intervention on important
outcomes in the HSCT setting. We applaud this and similar
efforts to systematically evaluate a program of exercise
among HSCT patients. Although most centers in the
United States encourage increased physical activity among
HSCT patients, relatively few centers have formal pro-
grams in place to support patients in this respect. Patients
are generally instructed to ‘stay active,’ ‘walk around’, or
‘exert yourself’ over the course of HSCT, but this vague
advice should not be considered equivalent to a systematic
exercise program. Research on structured exercise pro-
grams can help guide transplant centers’ efforts to offer
more concrete and evidence-based direction to their HSCT
patients. Issues of deconditioning and fatigue have become
even more important to address with the steady rise in the
median age of transplant recipients; more patients are
entering transplant with a greater number of comorbid
conditions and functional limitations.
The intervention tested by Baumann et al.
6
offers a
potential model for other randomized controlled trials
of exercise in the HSCT setting. The ADL training and
aerobic training appear to have been moderate in
intensity and not unduly complex to implement. That said,
the requirement for close monitoring of the aerobic
training portion of the training by a professional therapist
(for example, ‘ythe WHO-endurance testywas carried
out by increasing the load by 25Watts every 2min, up
to a heart rate of 180min the patient’s age’), makes the
exercise intervention less portable to real-world vs
research transplantation settings. Clinical research on
exercise understandably attempts to standardize both the
type and the intensity of the intervention to be able to
demonstrate powerful and reproducible effects; to that
end, this research may evaluate artificial or exaggerated
interventions.
Bone Marrow Transplantation (2010) 45, 217–218
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