DeFor Todd E, Burns Linda J, Gold Eva-Maria A, Weisdorf Daniel J
Blood and Marrow Transplant Program of the Department of Pediatrics, University of Minnesota, Cancer Center and School of Medicine, Minneapolis, Minnesota 55455, USA.
Biol Blood Marrow Transplant. 2007 Aug;13(8):948-55. doi: 10.1016/j.bbmt.2007.04.008. Epub 2007 May 29.
To investigate the impact of exercise on adult allogeneic hematopoietic cell transplant recipients, we randomized 100 patients to either a structured walking regimen or to a control group with no formal exercise program. Starting on the day of admission for transplant, patients in the exercise arm were asked to walk on a treadmill twice a day for 15 minutes while in the hospital. After discharge, they were asked to walk once a day for 30 minutes. The effect of the exercise program was primarily measured by the change in the Karnofsky score (KPS) from transplant admission to day 100 posttransplant, which was scored by the attending physician who was blinded to the assigned exercise regimen. The decline in KPS was smaller in the exercise group than in the control group: 10 points versus 20 points. This difference was not statistically significant in the total study population (P=.21) but was statistically significant among the subset of older and less fit patients receiving nonmyeloablative pretransplant conditioning (P=.04). Sixty-four percent of patients on the exercise arm who had a baseline KPS<90 had a score>or=90 by day 100 compared to 18% of the control arm (P=.03). Thirty-two percent of patients with a baseline score>or=90 had a score>or=90 by day 100 in both groups (P=.99). Analyses of patients' self reported scores at the time of discharge for physical and emotional well-being showed that the exercise arm had better scores for physical well-being (P<.01). Among the subset of nonmyeloablative patients, scores for physical and emotional well-being were both higher in the exercise arm (P=.02). Length of hospitalization and survival were not different between the 2 study arms. We conclude that assignment of a structured walking regimen to patients can lead to better physical performance during the recovery period and by patient assessment, a better perceived physical and emotional state. In addition, exercise has a greater impact among patients who are less fit coming into transplant. Structured exercise may have a positive impact on physical and emotional recovery following transplant therapy and may accelerate patients' return to health and function.
为研究运动对成年异基因造血细胞移植受者的影响，我们将100名患者随机分为两组，一组采用结构化步行方案，另一组为无正式运动计划的对照组。从移植入院当天开始，运动组的患者在住院期间被要求每天在跑步机上步行两次，每次15分钟。出院后，他们被要求每天步行一次，每次30分钟。运动计划的效果主要通过从移植入院到移植后第100天卡诺夫斯基评分（KPS）的变化来衡量，该评分由对指定运动方案不知情的主治医生进行。运动组KPS的下降幅度小于对照组：分别为10分和20分。在整个研究人群中，这种差异无统计学意义（P = 0.21），但在接受非清髓性移植前预处理的老年和身体状况较差的患者亚组中具有统计学意义（P = 0.04）。运动组中基线KPS<90的患者，到第100天时64%的患者评分≥90，而对照组这一比例为18%（P = 0.03）。两组中基线评分≥90的患者，到第100天时均有32%的患者评分≥90（P = 0.99）。对患者出院时自我报告的身体和情绪健康评分进行分析显示，运动组的身体幸福感评分更高（P<0.01）。在非清髓性患者亚组中，运动组的身体和情绪健康评分均更高（P = 0.02）。两个研究组的住院时间和生存率没有差异。我们得出结论，为患者安排结构化步行方案可使患者在恢复期有更好的身体表现，并经患者评估有更好的身体和情绪状态感受。此外，运动对移植时身体状况较差的患者影响更大。结构化运动可能对移植治疗后的身体和情绪恢复有积极影响，并可能加速患者恢复健康和功能。
