Physical exercise and quality of life in cancer patients following high dose chemotherapy and autologous bone marrow transplantation

Quality of life considerations and management in patients with myelodysplastic syndrome

INTRODUCTION

This study aimed to identify the factors affecting the quality of life (QOL) and functional status of patients with MDS.

AREAS COVERED

We reviewed the literature published in PUBMED over the past 30 years and searched for keywords such as 'quality of life' and 'myelodysplastic syndromes'. By observing the influence of their symptoms, the possibility of improving patients' QOL was considered by improving these related factors. Concurrently, the effects of related clinical treatments based on the unique disease characteristics of MDS on the patients' QOL were examined, and lifestyle factors were considered in clinical practice, providing an important path to improve the QOL and functional status of patients with MDS.

EXPERT OPINION

This review summarized several areas that can improve the quality of survival of MDS patients and discusses them in depth. Although the clinical benefits may be minimal, we still hope to improve patients' daily life outcomes and enhance their quality of life at minimal cost. Also, we hope more researchers will focus on this area in the future to find more factors that may exist to supplement the limitations of these understanding and thinking, and to provide assistance in clinical work.

Effects of Exercise Programs on Psychoemotional and Quality-of-Life Factors in Adult Patients with Cancer and Hematopoietic Stem Cell Transplantation or Bone Marrow Transplantation: A Systematic Review

This review analyzed the effects of an exercise program on psychoemotional and quality-of-life (QoL) factors in adult patients with cancer and hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). Studies were identified from the PubMed and Web of Science databases (from inception to 24 August 2022), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The methodological quality of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale, based in turn on the Delphi list. A total of 20 randomized controlled studies were included with 1219 participants. The main result of this systematic review is that exercise program interventions produce improvements on psychoemotional and QoL factors in adult patients with cancer and HSCT or BMT. Moreover, exercise programs may have a beneficial effect on health, maintaining or increasing the patient's QoL. Further, it has a positive effect on the prevention and control of transplant complications in combination with medical treatment.

Effects of Exercise Programs on Physical Factors and Safety in Adult Patients with Cancer and Haematopoietic Stem Cell Transplantation: A Systematic Review

This study looks at the effects of exercise programs on physical factors and safety in adult patients with cancer and hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). A systematic search was performed in the PubMed and Web of Science databases (from inception to 26 August 2021). A review was carried out following the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) checklist. The methodological quality of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale, based, in turn, on the Delphi list. A total of 25 randomized controlled trials studies were included, comprising 1434 patients. The most significant result of this systematic review is that exercise program interventions are safe and produce positive changes in cardiorespiratory fitness, muscle strength, and the functional mobility-state in adult patients with cancer and HSCT or BMT. Only 3 patients from the 711 participants in the exercise interventions (i.e., 0.42%) reported adverse events related to exercise interventions. Moreover, exercise training programs may have a cardiological and muscular protective effect, as well as a healthy effect on the prevention and control of transplant complications, improving health outcomes.

Lifestyle considerations in multiple myeloma

As the prognosis for multiple myeloma (MM) has significantly improved and patients remain on therapy longer, there is a need for supportive care interventions to optimize patient quality of life (QOL) and functional status over the course of cancer treatment. MM is characterized by a significant symptom burden and a relatively lower QOL compared to other cancers. This review evaluates the role of healthy lifestyle behaviors in improving both the physical functioning and psychological well-being of the MM population. We (1) describe the current literature on physical activity, weight management, diet, sleep, and substance use in the context of MM, (2) present important considerations for incorporating lifestyle factors into clinical practice, and (3) identify directions for future research. Developing MM-specific guidelines for modifiable lifestyle changes that take into account both the length of treatment and the unique disease features (i.e. osteolytic lesions and anemia) may provide a promising path for improved patient QOL and functioning.

Efficacy of physical exercise using the balance board game on physical and psychological function in patients with hematological malignancies confined to a bioclean room

OBJECTIVE

This study aimed to define the efficacy and features of physical therapy (PT) using the Nintendo Wii Fit U (Nintendo Inc., Kyoto, Japan) in patients with hematological malignancies confined to a bioclean room.

METHOD

A total of 33 patients with hematological malignancies confined to a bioclean room were enrolled in this study. This study was designed as a randomized crossover test between two weeklong interventions: PT program (Therapist PT) and Wii Fit U program (Wii PT). We compared the efficacy of Wii PT and Therapist PT with regard to physical and psychological function test scores.

RESULTS

Of the 33 patients, 22 were analyzed. The validity of the crossover design was demonstrated, as there were no significant differences in period and carryover effects between the two groups. Therapist PT resulted in significantly better improvements in fatigue scores and total mood disturbance (TMD) scores in the Profile of Mood States short-form Japanese version compared to Wii PT (fatigue score, -5.2±8.3 vs 2.7±8.2; TMD score, -22.5±32.8 vs -2.6±20.5; p<0.05). Physical function improved post-Wii PT and post-Therapist PT interventions (p<0.05), and there was no difference in treatment effect.

CONCLUSION

Improvements in physical function were clearly observed following the use of Wii PT in patients confined to a bioclean room. However, compared to Therapist PT, Wii PT was less effective in improving the psychological function of patients.

Exercise barriers and facilitators during hematopoietic stem cell transplantation: a qualitative study

OBJECTIVE

Although exercise is beneficial in patients undergoing hematopoietic stem cell transplantation (HSCT), motivating patients to exercise is challenging. We aimed to understand exercise barriers and facilitators during HSCT treatment while participating in a daily unsupervised exercise programme.

PARTICIPANTS

Patients scheduled to have HSCT.

STUDY DESIGN

6 participants were included in this descriptive qualitative study during HSCT treatment while participating in an exercise programme to identify perceived barriers and facilitators of the exercise. An average of three semi-structured interviews were conducted per patient.

SETTING

Exercise during HSCT treatment in an isolated immune room.

INTERVENTION

Daily unsupervised exercise.

RESULTS

A total of six patients completed a 6-week exercise programme as well as all scheduled interviews, whose compliance to the exercise programme ranged from 12% to 79%. Based on interview results, three themes were identified as barriers to exercise and four themes were identified as facilitators to exercise. Patients experienced physical and psychological barriers such as nausea, vomiting, sore throat, reduced appetite, decreased willpower and anxiety due to feelings of isolation. Environmental factors included negative opinions about exercise programmes and lack of encouragement from the haematologist. Facilitators of exercise included willpower, easy and simple exercise, convincing explanations from haematologists and supervised support from exercise specialists.

CONCLUSION

Our study has identified potential barriers and facilitators associated with exercise participation during HSCT. Supervised exercise recommended by a haematologist, convincing explanation on the benefit of exercise by medical personnel, positive feedback from other HSCT survivors and supervision by exercise specialists may increase compliance to the exercise programme during HSCT.

TRIAL REGISTRATION NUMBER

ISRCTN61498391.

Individualized, Single Session Yoga Therapy to Reduce Physical and Emotional Symptoms in Hospitalized Hematological Cancer Patients

Objective: Inpatient treatment of hematological cancer is among the most physically and mentally arduous cancer treatments, and it is associated with a number of common physical, emotional, and social symptoms that can negatively affect quality of life (QOL) for years following treatment. While treating symptoms during hospitalization holds promise for improving long-term QOL, successful approaches likely require multidisciplinary interventions. In this article, we describe a 4-year effort in program enhancement that incorporated an adjunctive single yoga therapy session during treatment for hematological malignancies. Methods: Hospitalized patients receiving treatment for hematological cancer (N = 486) were provided a 40-minute individualized yoga therapy session. We evaluated feasibility and acceptance by quantifying the percentage of patients who discontinued the yoga session due to pain, discomfort, or another reason, and by comparing the intervention population to the demographic makeup of the unit more generally. Patient-reported symptoms were obtained before and after each session, and we evaluated acute symptom change for the entire sample and in subsamples that are less likely to use mindfulness-based interventions such as yoga. Results: The majority of sessions (87%) were completed, and the majority of unfinished sessions were interrupted by a medical procedure or because the patient fell asleep. No session was stopped early due to patients’ reported pain. Significant decreases were reported in all symptoms, with the greatest decrease in fatigue and anxiety. Conclusions: Yoga therapy was a feasible and effective nondrug adjunct intervention for hospitalized patients receiving treatment for hematological cancer, including bone marrow transplantation.

The Benefit of Physical Activity in Adolescent and Young Adult Cancer Patients During and After Treatment: A Systematic Review

Cancer and its associated therapies can severely impact the physical and psychosocial functioning of adolescent and young adults (AYAs), both during treatment and well into survivorship. Physical activity during and after cancer treatment could be beneficial to the AYA population, although this cohort has received little scientific attention. A systematic search of the literature was conducted to investigate current exercise interventions in AYA-specific populations. Studies were eligible for inclusion if >50% of the study population was aged between 15 and 25 years and the study included a physical activity intervention during or after cancer treatment. Studies were critically appraised using the Cochrane Risk of Bias tool. Six articles were identified as meeting the criteria, of which 2 were nonrandomized controlled studies and 4 were pilot studies, comprising a total of 135 AYA participants. The quality of studies was variable across all assessed domains. Direct comparison on intervention outcomes was not possible due to the heterogeneity of the studies; however, trends emerged on the feasibility, acceptability, and potential positive impact of physical activity in this cohort. This review highlights the lack of high-quality studies aimed to improve physical and psychosocial functioning in AYA patients across the cancer continuum. Physical activity interventions in this cohort appear to be feasible; however, larger randomized controlled trials are warranted to investigate the direct impact of interventions on health outcomes in this cohort.

Effects of preoperative and postoperative resistance exercise interventions on recovery of physical function in patients undergoing abdominal surgery for cancer: a systematic review of randomised controlled trials

Objective

To systematically review the effects of preoperative and postoperative resistance exercise training on the recovery of physical function in patients undergoing abdominal surgery for cancer.

Data sources

A systematic review of English articles using Medline, Physiotherapy Evidence Database, CINAHL and the Cochrane Library electronic databases was undertaken.

Eligibility criteria for selecting studies

Studies were included if they used a randomised, quasi-randomised or controlled trial study design and compared the effects of a muscle-strengthening exercise intervention (±other therapy) with a comparative non-exercise group; involved adult participants (≥18 years) who had elected to undergo abdominal surgery for cancer; and used muscle strength, physical function, self-reported functional ability, range of motion and/or a performance-based test as an outcome measure.

Results

Following screening of titles and abstracts of the 588 publications retrieved from the initial search, 24 studies met the inclusion criteria and were accessed for review of the full-text version of the article, and 2 eligible studies met the inclusion criteria and were included in the review. One exercise programme was undertaken preoperatively and the other postoperatively, until discharge from hospital. The exercise interventions of the included studies were performed for five and eight sessions, respectively. There were no differences between groups in either study.

Conclusion

The only two studies designed to determine whether preoperative or postoperative resistance muscle-strengthening exercise programmes improved or negatively affected physical function outcomes in patients undergoing abdominal surgery for cancer provide inconclusive results.

Anxiety, fatigue, and attentional bias toward threat in patients with hematopoietic tumors

Cancer patients with hematopoietic tumors exhibit particularly high rates of anxiety disorders and depression, and often develop negative affect. In addition, psychological problems experienced by cancer patients impair their quality of life. When cancer patients feel anxious, they tend to direct their attention toward stimuli associated with threat in the surrounding environment. If attentional bias occurs in patients with hematopoietic tumors, who are at particular risk of developing negative affect, resolution of the bias could be useful in alleviating their anxiety. The current study examined the association between attentional bias and negative affect in patients with hematopoietic tumors and tested the hypothesis that negative affect would be more severe in those who exhibited greater attentional bias. Twenty-seven patients with hematopoietic tumors participated in the study. Reaction time (RT) was measured as the time between the presentation of the threatening and neutral images, and the subject’s button press to indicate choice (neutral expressions). Eight combinations of “threatening” expressions with high emotional valence and “neutral” expressions with low emotional valence were presented. The images used to measure attentional bias were taken from the Japanese Female Facial Expression Database and had been rated as expressive of anger, sadness, or neutrality, with predetermined emotional valence. Psychological testing was performed with the Profile of Mood States (POMS). To examine the association between attentional bias and negative affect, we calculated Spearman's rank correlation coefficients for RTs and POMS. Subjects’ mean RT was 882.9 (SD = 100.9) ms, and 19 of the 27 subjects exhibited slower RTs relative to healthy individuals. RT was significantly positively correlated with Tension-Anxiety (r = .679, p < .01) and Fatigue (r = .585, p < .01) subscale scores. The results of the study suggested that attentional bias toward threatening expressions could be positively correlated with the mental intensity of anxiety and fatigue in patients with hematopoietic tumors.

Physical Activity Preferences for People Living With Multiple Myeloma: A Qualitative Study

BACKGROUND

Although physical activity (PA) has significant benefits for people living with multiple myeloma (MM), participation rates are low. Examination of PA preferences will provide important information to clinicians and assist in the development of interventions to increase participation in PA for people living with MM.

OBJECTIVE

The aim of this study is to gain an in-depth understanding of the PA preferences for people living with MM, including the preferred role of clinicians.

METHODS

Semistructured interviews were conducted with patients treated for MM within the preceding 2 to 12 months. Interviews were analyzed using content analysis, where coding categories were derived directly from the text data.

RESULTS

Twenty-four interviews were conducted (women, 54%; age: mean [SD], 62 [8.8] years); 16 (67%) participants had an autologous stem cell transplant. Light- to moderate-intensity PA during and after treatment was feasible, with the strongest preference for a program 2 to 8 months after treatment. The timing of information delivery was important, as was input from clinicians and organizations with knowledge of MM. Preferences for location, structure, and timing of programs varied.

CONCLUSIONS

Low- to moderate-intensity PA after treatment is likely to interest people with MM. Programs need to be flexible and consider individual differences in PA preferences, functional status, and treatment schedules.

IMPLICATIONS

An individually tailored PA program should form part of clinical care, involving clinicians and organizations with expertise in MM. Options for home-based PA are also important. Further research, including a population-based study of people living with MM, is necessary to further quantify PA preferences.

The effects of music therapy in patients with high-dose chemotherapy and stem cell support: a randomized pilot study

OBJECTIVE

Patients with high dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) are highly distressed. Psycho-oncological support might be beneficial but is not routinely provided. Our aim was to investigate whether music therapy (MT) in addition to standard supportive treatment had any effect on quality of life, depression, anxiety, side effects of therapy, medication, and immunological changes during and within three months after HDC plus ASCT.

METHODS

Patients (n = 66) with HDC plus ASCT were randomly assigned to either MT (Intervention Group = IG) or standard supportive treatment (Control Group = CG). Quality of life was measured by EORTC QLQ-C30. Depression and anxiety were measured by the HADS-D before transplantation, during and after the inpatient stay. In addition, adverse events (AE), medication, and immunological parameters were observed.

RESULTS

There was no improvement of global quality of life for patients receiving additional MT, but their perception of pain significantly changed (p = 0.027). Patients were neither depressed nor anxious on admission, therefore no improvements were found. IG patients had less 3-4° toxicities (e.g., mucositis). Aprepitant for antiemetic therapy was administered significantly more often in the CG (p = 0.040). The IgA decline and T4 count was less in IG, T8, and NK count decreased most in IG. These findings failed significance.

CONCLUSIONS

MT may improve pain perception in patients receiving HDC plus ASCT. Additionally positive effects on toxicities, use of antiemetic medication, and immunological changes were observed. As some of these findings failed significance, studies with larger sample sizes are needed. Copyright © 2016 John Wiley & Sons, Ltd.

Beliefs about physical activity in sedentary cancer patients: an in-depth interview study in France

This study was designed to identify beliefs about physical activity in cancer patients. Semi- structured interviews were conducted with 20 patients under treatment, who were invited to identify perceived barriers for not adopting a physically active lifestyle and to express their beliefs about physical activity. Content analyses revealed five main categories of beliefs including four types of barriers: (a) barriers related to the side effects of treatment; (b) barriers related to a lack of perceived physical abilities; (c) barriers related to a lack of interest for physical activity; (d) beliefs about the negative effects of physical activity, and (e) beliefs about the positive effects of physical activity. These findings extend the existing literature by indicating how stereotypes may play a role in explaining sedentary lifestyles in cancer patients.

The role of physical rehabilitation in stem cell transplantation patients

The purpose of this paper is to review the evidence for the role of physical rehabilitation in stem cell transplantation patients. We will also review the literature and discuss professional experiences on how rehabilitation can play a role in stem cell transplant care and survivorship. Hematopoietic stem cell transplantation (HCT) is a procedure that has evolved substantially over the years to help treat multiple conditions, particularly hematologic malignancies. HCT can be very stressful on the body and can leave patients weakened and sometimes quite debilitated. Supportive care measures have advanced to improve the quality of life and overall survival of HCT survivors. One key component of improved supportive care is gaining increased attention, and that is physical medicine and rehabilitation. Its role in HCT survivorship care is expanding, and new insight and research within the discipline have focused on fatigue, inflammation, exercise, and the development of structured rehabilitation programs to improve the musculoskeletal sequelae of transplantation. This literature review has demonstrated the utility of physical rehabilitation in HCT, its impact on cancer-related fatigue, and to outline the current state of the literature on these topics. The paper delves into a background of HCT. Cancer-related fatigue in HCT is then discussed and summarized, and the role that exercise plays in modifying such fatigue is outlined. We then outline the models and the impact that physical rehabilitation may play in HCT recipients.

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report

The 2006 National Institutes of Health (NIH) Consensus paper presented recommendations by the Ancillary Therapy and Supportive Care Working Group to support clinical research trials in chronic graft-versus-host disease (GVHD). Topics covered in that inaugural effort included the prevention and management of infections and common complications of chronic GVHD, as well as recommendations for patient education and appropriate follow-up. Given the new literature that has emerged during the past 8 years, we made further organ-specific refinements to these guidelines. Minimum frequencies are suggested for monitoring key parameters relevant to chronic GVHD during systemic immunosuppressive therapy and, thereafter, referral to existing late effects consensus guidelines is advised. Using the framework of the prior consensus, the 2014 NIH recommendations are organized by organ or other relevant systems and graded according to the strength and quality of supporting evidence.

Exercise compliance among patients with multiple myeloma undergoing chemotherapy: a retrospective study

PURPOSE

Multiple myeloma (MM) is often associated with osteolytic bone disease and anemia, resulting in skeletal fragility and persistent fatigue, pain, and reduced quality of life. Exercise is considered safe and beneficial for this population. Our objectives were to evaluate the extent to which MM patients undergoing chemotherapy complied with exercise recommendations and to identify factors associated with noncompliance.

METHODS

This retrospective study included 41 MM patients referred to a hospital-based rehabilitation program while undergoing chemotherapy. Variables collected at baseline (T1) and follow-up (T2) included: (a) demographics and medical history, (b) exercise levels (MET-hours/week), preferences and barriers, and (c) fatigue severity scores (0-10). Statistical analyses included logistic regression to identify factors associated with exercise noncompliance and t-tests and chi-squared tests to compare outcomes between the groups according to compliance.

RESULTS

The mean age of the participants was 61 years; 73 % were male and 81 % had bone lesions. Overall exercise compliance at T2 was 71 %, with an observed increase in exercise levels (mean group difference: 6.5 MET-hours/week; p < 0.001) and decrease in fatigue severity scores (mean group difference -1.2; p = 0.003). Factors associated with exercise noncompliance included history of pathological fracture (odds ratio [OR] 4.7; p = 0.049), spinal cord compression (SCC) (OR 14.1; p = 0.023), and radiation (OR 28.0; p < 0.001).

CONCLUSIONS

In this sample of MM patients, high compliance with exercise and associated improvements in fatigue were observed. However, participants with a history of pathological fracture, SCC, or radiation are at increased risk of noncompliance and may require additional supervision to improve exercise compliance.

Acute physiological responses to physiotherapy applications pre and post autologous stem cell transplantation: an experimental study

OBJECTIVE

We aimed to investigate the acute physiological responses (APR) to physiotherapy applications in patients undergoing autologous stem cell transplantation (ASCT), the difference between pre- and post-ASCT according to APR.

METHODS

Twenty-six patients who were hospitalized for ASCT attended regular physiotherapy program. APR was recorded in the beginning and at the end of each exercise session. The differences in APR were calculated for each session. The mean values of the differences in APR were computed in pre-conditioning, pre-, and post-ASCT. Daily complete blood counts were also recorded during ASCT.

RESULTS

Hemoglobin and platelet counts were significantly lower pre- and post-ASCT. Neutrophil counts were significantly lower post-ASCT. The difference in systolic blood pressure (SBP) in the beginning and at the end of the exercise sessions was significantly higher post-ASCT in comparison to pre-ASCT.

CONCLUSION

There was no significant change in APR except the SBP which suggests that similar level of exercise intensity could be tolerated in pre- and post-ASCT periods as well as preconditioning.

"EXHALE": exercise as a strategy for rehabilitation in advanced stage lung cancer patients: a randomized clinical trial comparing the effects of 12 weeks supervised exercise intervention versus usual care for advanced stage lung cancer patients

Background

Lung cancer is the leading cause of cancer death in North America and Western Europe. Patients with lung cancer in general have reduced physical capacity, functional capacity, poor quality of life and increased levels of anxiety and depression. Intervention studies indicate that physical training can address these issues. However, there is a lack of decisive evidence regarding the effect of physical exercise in patients with advanced lung cancer. The aim of this study is to evaluate the effects of a twelve weeks, twice weekly program consisting of: supervised, structured training in a group of advanced lung cancer patients (cardiovascular and strength training, relaxation).

Methods/Design

A randomized controlled trial will test the effects of the exercise intervention in 216 patients with advanced lung cancer (non-small cell lung cancer (NSCLC) stage IIIb - IV and small cell lung cancer (SCLC) extensive disease (ED)). Primary outcome is maximal oxygen uptake (VO₂peak). Secondary outcomes are muscle strength (1RM), functional capacity (6MWD), lung capacity (Fev1) and patient reported outcome (including anxiety, depression (HADS) and quality of life (HRQOL)).

Discussion

The present randomized controlled study will provide data on the effectiveness of a supervised exercise intervention in patients receiving systemic therapy for advanced lung cancer. It is hoped that the intervention can improve physical capacity and functional level, during rehabilitation of cancer patients with complex symptom burden and help them to maintain independent function for as long as possible.

Trial registration

http://ClinicalTrials.gov, NCT01881906

Patient Activation through Counseling and Exercise--Acute Leukemia (PACE-AL)--a randomized controlled trial

Background

Patients with acute leukemia experience a substantial symptom burden and are at risk of developing infections throughout the course of repeated cycles of intensive chemotherapy. Physical activity in recent years has been a strategy for rehabilitation in cancer patients to remedy disease and treatment related symptoms and side effects. To date, there are no clinical practice exercise guidelines for patients with acute leukemia undergoing induction and consolidation chemotherapy. A randomized controlled trial is needed to determine if patients with acute leukemia can benefit by a structured and supervised counseling and exercise program.

Methods/design

This paper presents the study protocol: Patient Activation through Counseling and Exercise – Acute Leukemia (PACE-AL) trial, a two center, randomized controlled trial of 70 patients with acute leukemia (35 patients/study arm) following induction chemotherapy in the outpatient setting. Eligible patients will be randomized to usual care or to the 12 week exercise and counseling program. The intervention includes 3 hours + 30 minutes per week of supervised and structured aerobic training (moderate to high intensity 70 - 80%) on an ergometer cycle, strength exercises using hand weights and relaxation exercise. Individual health counseling sessions include a self directed home walk program with a step counter. The primary endpoint is functional performance/exercise capacity (6 minute walk distance). The secondary endpoints are submaximal VO₂ max test, sit to stand and bicep curl test, physical activity levels, patient reported outcomes (quality of life, anxiety and depression, symptom prevalence, intensity and interference). Evaluation of clinical outcomes will be explored including incidence of infection, hospitalization days, body mass index, time to recurrence and survival. Qualitative exploration of patients’ health behavior and experiences.

Discussion

PACE-AL will provide evidence of the effect of exercise and health promotion counseling on functional and physical capacity, the symptom burden and quality of life in patients with acute leukemia during out patient management. The results will inform clinical practice exercise guidelines and rehabilitation programs for patients undergoing treatment for acute leukemia. Optimizing the treatment and care pathway may ease the transition for patients from illness to the resumption of everyday activities.

Trial registration

ClinicalTrials.gov Identifier: NCT01404520.

The positive impact of regular exercise program on stem cell mobilization prior to autologous stem cell transplantation

AIM

The present study was planned to determine the effects of regular exercise program on hematopoietic stem cell (HSC) mobilization prior to autologous stem cell transplantation.

METHOD

Twenty-two consecutive patients were enrolled in the study. A regular 20 min exercise program was administered to the patients. The hematopoietic stem cell mobilization outcome, number of Granulocyte Colony-Stimulating Factor (G-CSF) and aphaeresis application days were compared with 20 case-matched controls who did not receive exercise program during HSC mobilization.

RESULTS

The median number of CD34(+) stem cells collected in the exercise and control groups were 8.15 × 10(6)/kg (range: 2.85-33.06 × 10(6)/kg) and 7.3 × 10(6)/kg (range: 1.78-25.9 × 10(6)/kg), respectively (p=0.696). G-CSF was administered for a median of 8 days (range, 5-10) in the exercise group and 8 days (range, 5-12) in the control group (p=0.848). The median apheresis duration was 1 day (range, 1-3) in both exercise and control groups (p=0.226).

CONCLUSION

Exercise seems to have a positive impact on stem cell mobilization though without statistical significance.

Physical exercise for patients undergoing hematopoietic stem cell transplantation: systematic review and meta-analyses of randomized controlled trials

BACKGROUND

The treatment-related burden for patients undergoing hematopoietic stem cell transplantation (HSCT) may be relieved by physical exercises.

PURPOSE

The purpose of this study was to summarize and analyze the evidence provided by randomized controlled trials (RCTs) on physical exercise interventions among patients with cancer undergoing HSCT.

DATA SOURCES

PubMed, CINAHL, EMBASE, the Cochrane Library, and PEDro were searched for relevant RCTs up to October 1, 2011.

STUDY SELECTION

Two reviewers screened articles on inclusion criteria and indentified relevant RCTs.

DATA EXTRACTION

Two authors assessed the selected articles for risk of bias. Data extraction was performed by 1 reviewer. Meta-analyses were undertaken to estimate the outcomes quality of life (QOL), psychological well-being and distress, and fatigue.

DATA SYNTHESIS

Eleven studies were included, with study populations consisting of recipients undergoing either an allogeneic or autologous HSCT (n=734). Four studies had low risk of bias. The exercise interventions were performed before, during, and after hospitalization for the HSCT. Different exercise programs on endurance, resistance and/or activities of daily living training, progressive relaxation, and stretching were used. Meta-analyses showed that exercise during hospitalization led to a higher QOL (weighted mean difference=8.72, 95% confidence interval=3.13, 14.31) and less fatigue (standardized mean difference=0.53, 95% confidence interval=0.16, 0.91) in patients with an allogeneic HSCT at the moment of discharge from the hospital. No marked effects were found for psychological well-being and distress. Individual study results suggested significant positive effects on QOL, fatigue, psychological well-being and distress, and physical functioning.

LIMITATIONS

Prevalent shortcomings in the included studies were the heterogeneity among studies and the lack of blinding of participants, personnel, and outcome assessment.

CONCLUSIONS

The results suggest that recipients of HSCT may benefit from physical exercise.

Feasibility of an Isometric Maximal Voluntary Contraction Test in Hematological Cancer Patients during Thrombocytopenia

Introduction. Resistance training is rarely offered to hemato-oncological patients in the daily clinical routine due to its potential harmful impact on the cardiovascular system and the long periods of thrombocytopenia experienced by these patients. Therefore, it is important to determine a valid assessment to define and control resistance training. In this study, the feasibility of a maximal voluntary contraction (MVC) test was investigated in hemato-oncological patients. This inexpensive assessment may be a practicable alternative to the one repetition maximum test which is currently described as the gold standard. Methods. 29 hemato-oncological patients with platelet counts between 30000/μL and 70000/μL were recruited for this pilot study. Complications like petechial bleedings, muscle convulsion, and pain were assessed using the Brief Pain Inventory before and 48 hours after the MVC test, which was performed unidirectionally for the quadriceps muscle. Results. We did not detect any statistically significant test-related exacerbations or pain development. Discussion. MVC testing seems to be a feasible method to control a resistance training program in hemato-oncological patients. Further studies need to extend their methods and, for example, compare the MVC test with the one repetition maximum test.

Assessment of Voluntary Exercise Behavior and Active Video Gaming Among Adolescent and Young Adult Patients During Hematopoietic Stem Cell Transplantation

This pilot study sought to examine the exercise behavior and preferences among adolescent and young adult (AYA) hematopoietic stem cell transplant (HSCT) recipients. Eighteen patients aged 19 to 25 years were recruited to engage in unsupervised exercise activities lasting at least 60 minutes/week during hospitalization for HSCT. Enrolled patients had access to standard exercise activities (walking, resistance training, and basketball) and active video gaming equipment. Physical function (6-Minute Walk Test and Timed-Up-and-Go test) and quality of life (Behavioral, Affective, and Somatic Experiences Scale) were assessed at different time points during admission. Participants exercised an average of 76% of the days during admission and spent an average of 36.5 minutes per day exercising. The Nintendo Wii was the preferred active video gaming equipment, but standard exercises accounted for 73% of all exercise time. Neither functional capacity nor quality of life improved. Results suggest that AYAs voluntarily exercise during HSCT admission, prefer to use standard exercise activities, and may require supervision in order to derive maximum benefits from their efforts. These results provide guidance for developing rehabilitation interventions for AYA HSCT recipients.

The emerging role of exercise and health counseling in patients with acute leukemia undergoing chemotherapy during outpatient management

This study investigates the feasibility, safety and benefits of a 6-week exercise and health counseling intervention in patients with acute leukemia undergoing consolidation chemotherapy during outpatient management. Seventeen of twenty patients completed study requirements (85%), adherence to exercise was 73% and for health counseling 92%. There were improvements in the 6-min-walk-distance (p=0.0013), sit-to-stand test (p=0.0062), the right and left biceps arm-curl tests p=0.0002 and p=0.0002, respectively; health-related quality of life (p=0.0209) (FACT-An), vitality (p=0.0015), mental health (p=0.0471) and physical component scale (p=0.0295) (SF36). Significant reduction in the symptom burden (p=0.0021) and symptom interference on daily life activities (p=0.0069) (MDASI). No adverse reactions were observed.

Life events and change in leisure time physical activity: a systematic review

The global epidemic of chronic non-communicable diseases is closely related to changes in lifestyle, including decreasing leisure time physical activity (PA). Physical inactivity is a major public health challenge. To respond to that challenge, it is essential to know which personal and environmental factors affect PA behaviour. Certain life events may be one contributing factor, by creating emotional distress and disrupting a person's daily routine. The aim was to examine the literature concerning the effects of life events on changes in PA. A systematic literature search was performed on studies that assessed at least one major change in life circumstances and a change in PA. To be included, studies had to assess PA at two timepoints at least (before and after the event). Diseases as life events were excluded from this review. Thirty-four articles met the inclusion criteria. The studies examined the following life-change events: transition to university; change in employment status; marital transitions and changes in relationships; pregnancy/having a child; experiencing harassment at work, violence or disaster; and moving into an institution. The studies reviewed showed statistically significant changes in leisure PA associated with certain life events. In men and women, transition to university, having a child, remarriage and mass urban disaster decreased PA levels, while retirement increased PA. In young women, beginning work, changing work conditions, changing from being single to cohabiting, getting married, pregnancy, divorce/separation and reduced income decreased PA. In contrast, starting a new personal relationship, returning to study and harassment at work increased PA. In middle-aged women, changing work conditions, reduced income, personal achievement and death of a spouse/partner increased PA, while experiencing violence and a family member being arrested or jailed decreased PA. In older women, moving into an institution and interpersonal loss decreased PA, while longer-term widowhood increased PA. In addition, experiencing multiple simultaneous life events decreased PA in men and women. Major life events have a strong effect on leisure PA behaviour. Consequently, people experiencing life events could be an important target group for PA promotion. More research is needed to examine the short- and long-term effects of different life events on PA, gender differences in the effects of life events and the specific determinants of PA change during life events.

Evaluation of a social cognitive theory-based email intervention designed to influence the physical activity of survivors of breast cancer

OBJECTIVE

The aim of this study is to evaluate a 12-week social cognitive theory (SCT)-based email intervention designed to influence the physical activity of survivors of breast cancer.

METHODS

Seventy-four volunteers (intervention group, n = 36; control group, n = 38) were recruited by mass email and written letter solicitation. Participants completed a series of online questionnaires measuring demographic characteristics, physical activity readiness, level of physical activity and selected SCT variables at baseline, 6 and 12 weeks. The intervention group received email messages based on SCT designed specifically for breast cancer survivors and targeting physical activity. For the first 6 weeks of the intervention, participants assigned to the intervention group received messages weekly, from weeks 7 to 12, participants received messages every other week and had access to an e-counselor. The control group did not receive email messages, nor did they have access to an e-counselor.

RESULTS

Significant differences in levels of self-reported vigorous physical activity were found between groups at 6 and 12 weeks. Significant differences were also found for self-reported moderate physical activity at 12 weeks.

CONCLUSION

Email-based interventions based on SCT can significantly influence levels of self-reported physical activity of breast cancer survivors.

Sleep quality, fatigue and physical activity following a cancer diagnosis

Research on physical activity for cancer survivors suggests a relationship with improved quality of life. The aim of this study was to explore if there was also a relationship of physical activity with sleep difficulties and fatigue, common effects of cancer and its treatments. Recruitment was by posters and flyers in medical waiting rooms and by letter of invitation. Thirty-two breast and 59 prostate cancer survivors completed the questionnaire. Poor sleep quality was reported by 57.8%. A greater proportion of breast cancer (36.7%) than prostate cancer survivors (15.5%) reported poor sleep latency, and sleep disturbance (48.4% vs. 17.2%). The mean minutes of moderate physical activity was lower among participants reporting poor sleep quality [F(1,89) = 11.36, P < 0.001]. A greater proportion of breast cancer (65.7%) than prostate cancer survivors (43.1%) reported high fatigue. Participants who reported no physical activity had significantly greater fatigue (M = 31) than those reporting high physical activity levels (M = 42). While at an early stage of research, results are suggestive of a relationship of physical activity with sleep problems among cancer survivors. Findings have implications for improving quality of life as poor sleep was associated with greater fatigue and regular physical activity shows promise as an aid to alleviating these problems.

Physical activity motivation and cancer survivorship

Physical activity (PA) participation has been shown to be helpful in improving physical and mental well-being among cancer survivors. The purpose of this chapter is to review the literature on the determinants of physical activity motivation and behavior among cancer survivors. Using theories of behavior change, researchers have sought to identify the correlates of motivation that predict the participation in regular physical activity in observational studies, while intervention studies have focused on manipulating those factors to support the initiation of physical activity. The majority of this work has been conducted with breast cancer survivors, and there is an interest in expanding this work to survivors of others cancers (e.g., prostate, lung, and colorectal cancer). Results suggest that constructs from the Theory of Planned Behavior (TPB), Transtheoretical Model (TTM), and Social Cognitive Theory (SCT) are associated with greater motivation for physical activity, and some of these constructs have been used in interventions to promote physical activity adoption. There is scope for understanding the determinants of physical activity adoption in various cancer survivor populations. Much more needs to done to identify the determinants of maintenance of physical activity.

Effect of adapted physical activity sessions in the hospital on health-related quality of life for children with cancer: a cross-over randomized trial

BACKGROUND

To assess the efficacy of adapted physical activity (APA) on health-related quality of life (HRQoL) of hospitalized children and adolescents with cancer between 9 and 18 years of age.

PROCEDURE

A two-sequence, four-period cross-over study, Activités Physiques en Oncologie Pédiatrique (APOP), compared hospital stay with APA sessions versus hospital stay without APA sessions on children's HRQoL. Children and parents completed the child and parent forms, respectively, of a HRQoL questionnaire, the Child Health Questionnaire, on the last day of hospitalization. We used mixed linear regression to determine the effect of treatment, of treatment order and whether response to previous treatment influenced HRQoL.

RESULTS

Thirty children were included (mean age 13.6 ± 2.9 years; 18 males). Cross-over analysis revealed no effect of period or interaction between APA and period. HRQoL was higher when children practiced than did not practice APA during their hospitalization, as reported by both children and parents, for the dimensions physical functioning (P < 0.0001), role/social-physical (P = 0.001), self-esteem (P < 0.0001), and mental health (P < 0.0001). In addition, APA had a significant effect on the behavior dimension (P = 0.01), as reported by children, and on the bodily pain dimension (P = 0.0004), as reported by parents. The highest significant difference in scores between with and without APA was observed for the self-esteem dimension (P < 0.0001) for both children and parents.

CONCLUSION

APA during hospitalization for children with cancer was associated with better HRQoL for most of the HRQoL psychological and physical dimensions. Whether this effect is specific for children with cancer should be explored.

Cancer prevention, aerobic capacity, and physical functioning in survivors related to physical activity: a recent review

According to recent published reports, over 12 million new cases of cancer were estimated worldwide for 2007. Estimates from 2008 predict that cancer will account for 22.8% of all deaths in the US. Another report stated 50% to 75% of cancer deaths in the US are related to smoking, poor dietary choices, and physical inactivity. A 2004 report indicated obesity and/or a sedentary lifestyle increases the risk of developing several types of cancer. Conversely, several large-scale cohort studies point to the positive relationship between physical activity and a reduction in cancer risk. In addition, research over the last few years has clearly shown cardiorespiratory benefits, increases in quality of life (QOL), and increases in physical functioning for cancer survivors who engage in exercise programs. Thus, the purpose of this review is to highlight three areas related to cancer and physical activity. First, information concerning the prevention of cancer through physical activity is addressed. Second, recent studies identifying changes in volume of oxygen uptake (VO(2)) and/or cardiorespiratory functioning involving exercise with cancer survivors is presented. Third, studies identifying changes in cancer survivors' physical functional capacity and QOL are presented. Finally, a summary of the review is offered.

Exercise in adult and pediatric hematological cancer survivors: an intervention review

Observational research has shown that the physical activity levels of survivors of hematological cancer are low, with deleterious health consequences. This review summarizes the research on exercise interventions in adult and pediatric hematological cancer survivors. We searched MEDLINE, SPORTDiscus, CINAHL, Embase, Cochrane and PEDro through September 2009 for exercise intervention studies in children and adults with any type of hematological cancer. In the 24 adult intervention studies reviewed, we found strong evidence (that is, > or =3 high-quality studies and > or =75% reporting a significant benefit) for a benefit on body composition. Weak, but promising, evidence (> or =3 high-quality studies, but <75% reporting a significant benefit) was found for cardiorespiratory fitness, fatigue, muscle strength, physical functioning and quality of life. In pediatric interventions (13 studies), we found strong evidence for a benefit on muscle strength and cardiorespiratory fitness, particularly, if training was conducted in the hospital setting. Evidence is weak for ankle dorsiflexion, physical functioning and body composition. No exercise-related risks were identified in adults or children studies. Though more randomized controlled trials are needed, a growing body of literature supports the notion that regular physical activity is safe and has potential benefits for both adult and pediatric hematological cancer survivors.

Powerful signals for weak muscles

The aim of the present review is to summarise, evaluate and critique the different mechanisms involved in anabolic growth of skeletal muscle and the catabolic processes involved in cancer cachexia and sarcopenia of ageing. This is highly relevant, since they represent targets for future promising clinical investigations. Sarcopenia is an inevitable process associated with a gradual reduction in muscle mass and strength, associated with a reduction in motor unit number and atrophy of muscle fibres, especially the fast type IIa fibres. The loss of muscle mass with ageing is clinically important because it leads to diminished functional ability and associated complications. Cachexia is widely recognised as severe and rapid wasting accompanying disease states such as cancer or immunodeficiency disease. One of the main characteristics of cancer cachexia is asthenia or lack of strength, which is directly related to the muscle loss. Indeed, apart from the speed of loss, muscle wasting during cancer and ageing share many common metabolic pathways and mediators. In healthy young individuals, muscles maintain their mass and function because of a balance between protein synthesis and protein degradation associated with rates of anabolic and catabolic processes, respectively. Muscles grow (hypertrophy) when protein synthesis exceeds protein degradation. Conversely, muscles shrink (atrophy) when protein degradation dominates. These processes are not occurring independently of each other, but are finely coordinated by a web of intricate signalling networks. Such signalling networks are in charge of executing environmental and cellular cues that ultimately determine whether muscle proteins are synthesised or degraded. Increasing our understanding for the pathways involved in hypertrophy and atrophy and particularly the interaction of these pathways is essential in designing therapeutic strategies for both prevention and treatment of muscle wasting conditions with age and with disease.

The effect of a multimodal intervention on treatment-related symptoms in patients undergoing hematopoietic stem cell transplantation: a randomized controlled trial

Studies applying exercise, relaxation training, and psychoeducation have each indicated a positive impact on physical performance and/or psychological factors in patients diagnosed with cancer. We explored the longitudinal effect of a combination of these interventions on treatment-related symptoms in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT). Forty-two patients (18-65 years) were randomized either to an intervention or a control group. The intervention group received standard treatment and care, and a supervised four- to six-week structured exercise program, progressive relaxation, and psychoeducation during hospitalization, one hour per day for five days per week. The control group received standard treatment, care, and physiotherapy. A 24-item symptom assessment questionnaire was completed weekly during hospitalization, and at three and six months after allo-HCST. Through principal component analysis with varimax rotation, individual symptoms were grouped into five symptom clusters: mucositis, cognitive, gastrointestinal, affective, and functional symptom clusters. Then, a subsequent general estimate equation analysis revealed similar longitudinal patterns of intensity in all symptom clusters for intervention and control groups, but in the intervention group, there was an overall significant reduction (P<0.05) in symptom intensity over time for all clusters except the affective symptom cluster. This study provides beginning evidence for the efficacy of an exercise-based multimodal intervention in reducing the intensity of a spectrum of symptoms in this small sample of patients undergoing allo-HSCT.

A structured exercise program for patients with advanced non-small cell lung cancer

INTRODUCTION

Exercise improves functional outcome and symptoms for certain cancer populations, but the feasibility, efficacy, and safety of structured exercise in patients with lung cancer is unknown. In this study, we examined the feasibility of a hospital-based exercise program for patients with advanced non-small cell lung cancer.

METHODS

This study included patients with newly diagnosed advanced stage non-small cell lung cancer and Eastern Cooperative Oncology Group performance status 0-1. A physical therapist facilitated twice-weekly sessions of aerobic exercise and weight training over an 8-week period. The primary end point was feasibility of the intervention, defined as adherence to the exercise program. Secondary endpoints included functional capacity, measured by the 6-minute walk test and muscle strength, as well as quality of life, lung cancer symptoms and fatigue, measured by the Functional Assessment of Cancer Therapy-lung and Functional Assessment of Cancer Therapy-fatigue scales.

RESULTS

Between October 2004 and August 2007, 25 patients enrolled in the study. All participants received anticancer therapy during the study period. Twenty patients (80%) underwent the baseline physical therapy evaluation. Eleven patients (44%) completed all 16 sessions. An additional 6 patients attended at least 6 sessions (range, 6-15), and 2 patients only attended one session. Study completers experienced a significant reduction in lung cancer symptoms and no deterioration in their 6-minute walk test or muscle strength.

CONCLUSIONS

Although the majority of participants attempted the exercise program, less than half were able to complete the intervention. Those who completed the program experienced an improvement in their lung cancer symptoms. Community-based or briefer exercise interventions may be more feasible in this population.

A controlled randomized study examining the effects of exercise therapy on patients undergoing haematopoietic stem cell transplantation

A haematopoietic SCT (HSCT) can cause severe side effects, which may have a profound impact on a patient's life both physically and psychologically. Some studies have shown that physical activity has positive effects for inpatients after an HSCT. Therefore, the question arises whether a controlled exercise programme right from the beginning of the conditioning phase could help contribute to a patient's physical and psychological recovery. To evaluate the different effects of specific, moderate physical activities on the physical and psychological condition of HSCT patients we performed a controlled randomized study with 64 inpatients undergoing an allogeneic or autologous HSCT. The patients were randomly assigned to two groups. Although the training group took part in a specific programme of exercise therapy twice a day throughout the entire hospitalization phase, patients in the control group were offered the hospital's standard mobilization programme. The results of this study showed significant differences in favour of the training group regarding strength, endurance, lung function and quality of life. However, further studies are needed to confirm these results.

Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise

Cancer represents a major public health concern in Australia. Causes of cancer are multifactorial with lack of physical activity being considered one of the known risk factors, particularly for breast and colorectal cancers. Participating in exercise has also been associated with benefits during and following treatment for cancer, including improvements in psychosocial and physical outcomes, as well as better compliance with treatment regimens, reduced impact of disease symptoms and treatment-related side-effects, and survival benefits for particular cancers. The general exercise prescription for people undertaking or having completed cancer treatment is of low to moderate intensity, regular frequency (3-5 times/week) for at least 20 min per session, involving aerobic, resistance or mixed exercise types. Future work needs to push the boundaries of this exercise prescription, so that we can better understand what constitutes optimal, desirable and necessary frequency, duration, intensity and type, and how specific characteristics of the individual (e.g., age, cancer type, treatment, presence of specific symptoms) influence this prescription. What follows is a summary of the cancer and exercise literature, in particular the purpose of exercise following diagnosis of cancer, the potential benefits derived by cancer patients and survivors from participating in exercise programs, and exercise prescription guidelines and contraindications or considerations for exercise prescription with this special population. This report represents the position stand of the Australian Association of Exercise and Sport Science on exercise and cancer recovery and has the purpose of guiding exercise practitioners in their work with cancer patients.