Lessons learned from a pilot randomized clinical trial of home-based exercise prescription before allogeneic hematopoiet
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ORIGINAL ARTICLE
Lessons learned from a pilot randomized clinical trial of home-based exercise prescription before allogeneic hematopoietic cell transplantation William A. Wood 1 & M. Weaver 2 & A. E. Smith-Ryan 1,3 & E. D. Hanson 1,3 & T. C. Shea 1 & C. L. Battaglini 1,3 Received: 10 November 2019 / Accepted: 19 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Allogeneic hematopoietic cell transplantation (alloHCT) is a life-saving technology that can cure otherwise incurable diseases, but imposes significant physiologic stress upon recipients. This stress leads to short-term toxicity and mid- to long-term physical function impairment in some recipients. Exercise interventions have demonstrated preliminary efficacy in preserving physical function in HCT recipients, but the role of these interventions prior to HCT (prehabilitative) is less known. We tested a 5- to 12week, prehabilitative higher intensity home-based aerobic exercise intervention in a randomized study of alloHCT candidates. Of 113 patients screened, 34 were randomized to control or intervention groups, 16 underwent pre- and post-intervention peak oxygen consumption (VO2peak) testing, and 12 underwent pre- and post-intervention 6-min walk distance (6MWD) testing. No significant differences in VO2peak or 6MWD were seen pre- to post-intervention between intervention and control groups, but final numbers of evaluable participants in each group were too small to draw inferences regarding the efficacy of the intervention. We conclude that the design of our prehabilitative intervention was not feasible in this pilot randomized study, and make recommendations regarding the design of future exercise intervention studies in alloHCT. Keywords Allogeneic transplants . Hematopoietic stem cell transplantation . Exercise . Exercise therapy . Exercise test . High-intensity interval training
Introduction Allogeneic hematopoietic-cell transplantation (alloHCT) cures otherwise incurable diseases [1]. However, physiologic stress from alloHCT results in early toxicities that can lead to transplant-related complications and long-term physical impairments in some survivors [2–5]. Stressors related to alloHCT include chemotherapy or radiation-related organ dysfunction, infection, and graft versus host disease. These stressors cause symptoms, which are prevalent before
* William A. Wood [email protected] 1
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
2
Department of Mathematics and Statistics, Elon University, Elon, NC, USA
3
Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
transplant from prior disease and therapy, and increase significantly in the early post-transplant period. Symptoms are associated with physical function impairment [6–8]. Transplant patients, caregivers and health care providers consistently identify preservation of physical function as an important long-term goal following transplant [9, 10
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