Division of Allied Health (Physiotherapy), Royal Melbourne Hospital, Parkville, VIC, 3052, Australia.
Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3052, Australia.
Support Care Cancer. 2018 Jun;26(6):1727-1736. doi: 10.1007/s00520-017-4016-x. Epub 2017 Dec 14.
The aims of this study are to investigate the feasibility of an exercise program commencing 60 days following allogeneic stem cell transplantation (alloSCT), to investigate changes in physical function and health-related quality of life (HRQoL) in patients from pre- to post-alloSCT and to explore changes in patient outcomes before and after the program.
This study is a single site, prospective case series including 43 adults undergoing alloSCT. The intervention was an 8-week outpatient and home-based exercise and education program. Outcomes included feasibility (consent, attendance, compliance and completion rates), functional exercise capacity (incremental shuttle walk test), muscle strength (hand-held dynamometry), self-efficacy for physical activity (Physical Activity Assessment Inventory) and HRQoL (Functional Assessment of Cancer Therapy-Bone Marrow Transplant). Outcomes were measured pre-alloSCT, 60 days post-alloSCT (pre-intervention) and 100 days post-alloSCT (post-intervention).
The consent rate was 93%. From baseline to 60 days post-alloSCT, there was significant decline in functional exercise capacity (mean difference 224 m, 95% CI 153-295, p < 0.0005), self-efficacy for physical activity (294 points, 95% CI 136-452, p = 0.001) and HRQoL (15 points, 95% CI 8-21, p < 0.0005). Ten participants did not commence the exercise program due to death (n = 5), illness (n = 1) or cancellation of alloSCT (n = 4). The intervention was feasible in those not affected by major medical complications or death. No adverse events occurred. From pre- to post-intervention, there was significant improvement in functional exercise capacity (p = 0.001) and HRQoL (p = 0.001).
AlloSCT results in significant decline in functional exercise capacity, self-efficacy for physical activity and HRQoL, which may be improved through an exercise program. This pilot demonstrated safety, feasibility and high patient interest. Further randomised research is required.
本研究旨在探讨在异基因干细胞移植（alloSCT）后 60 天开始运动方案的可行性，以及在 alloSCT 前后患者身体功能和健康相关生活质量（HRQoL）的变化，并探讨方案前后患者结局的变化。
本研究为单中心前瞻性病例系列研究，共纳入 43 例接受 alloSCT 的成年人。干预措施为 8 周的门诊和家庭为基础的运动和教育方案。结局包括可行性（同意、出席、依从性和完成率）、功能性运动能力（递增穿梭步行试验）、肌肉力量（手持测力计）、身体活动自我效能感（身体活动评估量表）和 HRQoL（癌症治疗-骨髓移植功能评估量表）。结局在 alloSCT 前、alloSCT 后 60 天（干预前）和 alloSCT 后 100 天（干预后）进行测量。
同意率为 93%。从基线到 alloSCT 后 60 天，功能性运动能力显著下降（平均差异 224m，95%CI 153-295，p<0.0005），身体活动自我效能感（294 分，95%CI 136-452，p=0.001）和 HRQoL（15 分，95%CI 8-21，p<0.0005）。10 名患者因死亡（n=5）、疾病（n=1）或 alloSCT 取消（n=4）而未开始运动方案。在未受重大医疗并发症或死亡影响的患者中，该干预措施是可行的。没有发生不良事件。从干预前到干预后，功能性运动能力显著改善（p=0.001），HRQoL 也显著改善（p=0.001）。
alloSCT 导致功能性运动能力、身体活动自我效能感和 HRQoL 显著下降，而运动方案可能会改善这些情况。该初步研究显示了安全性、可行性和患者的高度兴趣。需要进一步的随机研究。
