Physical Activity Clinical Trial
Official title:
Feasibility and Safety of a Novel Individualized In-hospital Exercise Training Program for Patients Undergoing Hematopoietic Stem Cell Transplantation
Objective: To evaluate whether a novel individualized exercise training program for
hospitalized patients undergoing hematopoietic stem cell transplantation (HSCT) is feasible
and safe and whether it would improve functional capacity, muscle strength and health-related
quality of life (HRQoL).
Design: Prospective, within-group, feasibility intervention study. Setting: Bone marrow
transplant unit in a general hospital. Subjects: Patients electively hospitalized for HSCT
who were admitted to the bone marrow transplant unit.
Intervention: Participants performed the individualized in-hospital exercise training program
on a daily basis during their hospital admission. The exercise training program was performed
once a day for 20 to 40 minutes and included a warm-up period, moderate-intensity aerobic
exercise (10 to 20 minutes ), muscle strengthening exercise and cool-down activities.
Outcome measures: The primary outcomes were feasibility (consent rate, attrition rate and
exercise adherence) and the safety of the exercise program. Secondary outcomes included
functional capacity (step test), peripheral muscle strength (sit-to-stand test) and HRQoL
(QLQ-C30) were evaluated at baseline (on admission to hospital) and prior to hospital
discharge.
This was a prospective, within-group, feasibility intervention study which took place at the
Juiz de Fora University Hospital (HU-JF) between June 2016 and June 2017.
Patients were screened in the Bone Marrow Transplant Unit (BMTU) admission and recruited to
the study after avaliation in the first-day internation. However, included at study or no,
all patients that had the indication (at any time during internation) received the
intervention. This study was approved by the Institutional Ethics Committee (protocol:
2,030,132). All participants provided written informed consent prior to participation.
The exercise training program was performed once daily during the hospital stay. The program
included 2- to 5-minute warm-up session which consisted of stretching, coordination and
balance exercises, followed by 10 to 20 minutes of moderate-intensity aerobic exercise using
a lower limb cycle ergometer (Live up Sports, 1023, Araucária, Paraná, LS9055). Participants
also performed three sets of five to ten repetitions of sit-to-stand exercises with a
1-minute rest interval between each set. A cool-down period of 2- to 5-minutes of stretching
and breathing exercises was delivered at the end of the exercise session. All exercises were
performed within the participant's room. The aerobic training target zone was set at 50% to
70% of heart rate (HR) reserve. The HR reserve was estimated using the following equation:
[(220-age in years) - resting HR] x [50 to 70%] + resting HR.
The indication, contraindication or interruption criteria of the exercise training program
were evaluated daily based on the participant's clinical, hemodynamic and hematological
parameters as described in Table 1. These parameters were recorded at rest and monitored
during the intervention. The daily clinical assessment for exercise performance is described
in the flowchart shown in Figure 1. A platelet count of < 10,000 cells/mm3 (cells per cubic
millimeter), hemoglobin (Hb) < 7 g/dL (grams per deciliter) and/or hematocrit (Ht) < 20% were
considered contraindications for the exercise program. If participants were clinically
stable, they were encouraged to perform breathing exercises in bed; maintain Basic Activity
of Daily Living (BADLs), which consist mostly of self-care tasks including showering,
dressing and feeding; perform the individualized in-hospital exercise training program,
including a moderate intensity aerobic training without or with cycle ergometer load, based
on platelets, hematocrit and hemoglobin count.
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