Department of Hematology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia.
Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
BMC Cancer. 2020 Nov 24;20(1):1142. doi: 10.1186/s12885-020-07637-z.
Prehabilitation with regular exercise and nutritional care for patients undergoing surgeries for malignant disease was recently introduced to increase physiologic reserve prior to the procedure, accelerate recovery and improve outcomes. This study aimed to investigate the feasibility and safety of combined exercise training and nutritional support in patients with haematologic malignancies prior to haematopoietic stem cell transplantation (HSCT).
In this single-arm pilot study, 34 HSCT candidates were enrolled at least two weeks before admission for the procedure. Patients performed aerobic exercises at least 4 days per week for 20-30 min and strength exercises 3 days per week for 10-20 min. They received daily supplements of whey protein (0.3-0.4 g/kg body weight) and oral nutritional supplements if needed. The primary endpoints were feasibility (acceptability > 75%, attrition < 20%, adherence > 66%) and safety. The secondary endpoints were fat-free mass (FFM), muscle strength, physical performance and health-related quality of life (HRQoL) at HSCT.
The rate of acceptability, attrition and adherence to aerobic exercise, strength exercise and protein supplement consumption was 82.4, 17.8, 71, 78 and 80%, respectively. No severe adverse events were reported. Twenty-eight patients participated in the study for a median of 6.0 weeks (range, 2-14). They performed aerobic exercises 4.5 days per week for 132 min per week and strength exercises 3.0 times per week. Patients consumed 20.7 g of extra protein daily. At the end of the programme, we recorded increases of 1.1 kg in FFM (p = 0.011), 50 m in walking distance in the 6-min walking test (6MWT) (p < 0.001), 3.3 repetitions in the 30-s chair-stand test (30sCST) score (p < 0.001) and 2.6 kg in handgrip strength (p = 0.006). The EORTC QLQ-C30 scores improved by 8.6 (p < 0.006) for global health status, 8.3 (p = 0.009) for emotional functioning, and 12.1 (p = 0.014) for social functioning. There was less fatigue, nausea and insomnia (p < 0.05).
Our study shows that a multimodal intervention programme with partially supervised exercise training combined with nutritional support prior to HSCT is feasible and safe. Patients showed improvements in FFM, physical performance and HRQoL. Additional research is needed to assess the possible positive effects of such interventions.
针对恶性疾病手术患者，定期运动和营养护理的预康复治疗最近被引入，以增加术前的生理储备，加速恢复并改善预后。本研究旨在调查在接受造血干细胞移植（HSCT）之前，血液恶性肿瘤患者进行联合运动训练和营养支持的可行性和安全性。
在这项单臂试点研究中，在入院前至少两周，34 名 HSCT 候选者被纳入研究。患者每周至少进行 4 天、每次 20-30 分钟的有氧运动，每周进行 3 天、每次 10-20 分钟的力量训练。如果需要，他们每天补充乳清蛋白（0.3-0.4g/kg 体重）和口服营养补充剂。主要终点是可行性（接受度>75%，脱落率<20%，依从性>66%）和安全性。次要终点是 HSCT 时的去脂体重（FFM）、肌肉力量、身体表现和健康相关生活质量（HRQoL）。
有氧运动、力量训练和蛋白质补充摄入的接受度、脱落率和依从率分别为 82.4%、17.8%、71%、78%和 80%。没有严重的不良事件报告。28 名患者平均参加了 6.0 周的研究（范围，2-14 周）。他们每周进行 4.5 天、每次 132 分钟的有氧运动和 3 次力量训练，每天额外摄入 20.7 克蛋白质。在项目结束时，我们记录到 FFM 增加了 1.1 公斤（p=0.011），6 分钟步行测试（6MWT）的步行距离增加了 50 米（p<0.001），30 秒椅站测试（30sCST）评分增加了 3.3 次（p<0.001），握力增加了 2.6 公斤（p=0.006）。EORTC QLQ-C30 全球健康状况评分提高了 8.6（p<0.006），情绪功能提高了 8.3（p=0.009），社会功能提高了 12.1（p=0.014）。疲劳、恶心和失眠的发生率降低（p<0.05）。
我们的研究表明，在 HSCT 前进行部分监督的运动训练和营养支持的多模式干预方案是可行和安全的。患者的 FFM、身体表现和 HRQoL 均有所改善。需要进一步研究以评估此类干预措施的可能积极影响。
