Aim: People who receive a hematopoietic stem cell transplant (HSCT) experience debilitating side effects including fatigue and reduced functional capacity. Exercise has been found to be beneficial for ameliorating symptoms and improving quality of life in controlled clinical trials. This study evaluated the i) effectiveness of exercise post-HSCT in routine clinical practice and ii) influence of baseline function on response to exercise training.
Methods: This is a retrospective analysis of The Living Well Program at Chris O’Brien Lifehouse (Sydney, Australia). The Program included a tailored one-hour aerobic and resistance training program, conducted in a supervised group, once a week. From July 2014 to July 2019, 82 adults (male: 50%; autologous transplant: 51%) aged 53.7±12.6 y participated. Participants completed the six-minute walk test (6MWT), 30-sec sit-to-stand (STS) and Brief Fatigue Inventory (BFI) at baseline (10.0±6.5 weeks post-transplant) and post-intervention (11.9±6.8 weeks after baseline). Following baseline assessment, participants were categorised as high function (≥median) or low function (<median) for 6MWT.
Results: Participants attended an average of 6.4±3.6 sessions. Large effects were observed for 6MWT (+99.7± 27.0m; p<0.01; Hedge’s g=0.81) and STS (+3.3±1.2reps; p<0.01; Hedge’s g=0.77). Fatigue, measured by BFI, decreased significantly (-1.03±0.49; p<0.01; Hedge’s g=0.42). For 6MWT, a significantly better training response was observed for the low function compared to high function group (31% vs 14%, respectively; p<0.01).
Conclusion: Consistent with benefits reported in clinical trials, an exercise program embedded in routine care was effective for improving fatigue and physical function post-HSCT. These findings highlight, irrespective of baseline physical function, exercise is possible and beneficial. However, people with higher function likely require a higher exercise stimulus to obtain the same benefit as those with lower function. Tailored, progressive aerobic and resistance training programs may reduce acute and long-term treatment side effects and should be offered to HSCT recipients to support recovery.