The importance of physical activity in adult lymphoma survivors—Single center's experience with the supervised aerobic and resistance training program

Abstract

Introduction: Thanks to novel agents, intensive immuno/chemotherapy and improved supportive care, the number of lymphoid malignancies survivors is increasing rapidly. However, the intensive common treatment combinations (including corticosteroids and drugs with myotoxic and neurotoxic potential) often lead to global loss of physical fitness. Based on the results of breast cancer and colorectal studies, decrease of physical strength and endurance has negative effects not only on the quality of life but also on overall and progression free survival. Yet, few similar trials have been performed in lymphoma patients. We evaluated feasibility, safety, and measurable effectiveness of regular supervised combined aerobic and resistance training on the physical fitness of lymphoma in first remission. Patients and Methods: Between the years 2013 to 2016, we assigned 33 patients with newly diagnosed Hodgkin (HL = 6) and B-non-Hodgkin lymphomas (B-NHL = 27), all Caucasians, age median 57 (19;73), undergoing conventional intensive immune-chemotherapy (B-NHL - 6 cycles RCHOP: rituximab, cyclophoshamide, doxorubicine, vincristine, prednisone, HL - 6 cycles of escalated BEACOPP: bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone) and achieved complete remission. To evaluate all main aspects of physical fitness, spiroergometry (aerobic capacity), heart rate variability (vegetative balance), and hand grip test (muscle strength) were performed prior to training initiation and again when completed. Training intervention consisted from individualized supervised 12-week exercise program. The training lesson was 3 times a week and consisted of an aerobic activity 30 minutes, 15 minutes of muscle strength exercise, and 10 minutes of stretching. Results: From the 33 patients of this prospective trial, 27 completed the program. Paired assessment was available in 23 patients (spiroergometry, hand grip). Due to technical difficulties, heart rate variability has been evaluated in 13 patients only. In spite of relatively small number of cases, significant improvement of the sympathicovagal balance and aerobic capacity was observed (P = .041). Aerobic capacity measured in all 23 patients increased significantly (P = .037). On the other hand, there was no improvement in the muscle strength of all evaluated muscle group was observed (N = 23pts, P = .92). There were no adverse events associated with the training. Conclusions: Based on the results, we conclude that combined intensive training program is feasible and despite its short duration (12 weeks), brings measurable positive results in lymphoma patients treated with intensive regimes. Whereas endurance and vegetative balance was improved, the muscle strength remained decreased. More prospective trials to find the optimal balance of frequency, duration, and the training composition will be necessary.