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Effects of pulmonary rehabilitation in hematopoietic stem cell transplantation recipients: a randomized controlled study

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A Correspondence to this article was published on 18 May 2024

Abstract

Purpose

During hematopoietic stem cell transplantation (HSCT), patients’ exercise capacity and quality of life (QOL) are impaired. Exercise training is recommended to preserve cardiorespiratory fitness during the compelling HSCT period. However, studies investigating the effects of pulmonary rehabilitation (PR) in HSCT recipients are limited. Therefore, this study aimed to investigate the effects of two different PR programs on maximal exercise capacity, respiratory muscle strength and endurance, pulmonary function, and QOL.

Methods

This is a prospective, randomized, controlled, triple-blinded study. Thirty hospitalized patients undergoing HSCT were randomized to the pulmonary rehabilitation plus inspiratory muscle training (PR + IMT) group and the PR group. PR group performed upper extremity aerobic exercise training (AET) and progressive resistance exercise training (PRET), PR + IMT group performed IMT in addition to the upper extremity AET and PRET. Maximal exercise capacity (cardiopulmonary exercise testing), respiratory muscle strength (mouth pressure device, (MIP and MEP)) and respiratory muscle endurance (threshold loading test), pulmonary function (spirometry), and QOL (European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) were evaluated before HSCT and after discharge.

Results

Changes in pulmonary function, respiratory muscle strength and endurance, and QOL were similar within groups (p > 0.05). The MEP, peak oxygen consumption, and oxygen pulse significantly decreased in both groups (p < 0.05).

Conclusion

Pulmonary function, inspiratory muscle strength and endurance, and QOL preserved after HSCT. Expiratory muscle strength and maximal exercise capacity decreased even though PR during HSCT. Breathing reserve and restriction improved in the PR + IMT group. In addition, minute ventilation and dyspnea were preserved in the PR + IMT group, while these values were worsened during two structured PR programs. Therefore, PR should be applied in accordance with the patient’s current clinical and hematologic status to patients undergoing HSCT.

ClinicalTrials.gov (19/07/2018, NCT03625063).

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Data availability

The data of the current study and supplementary materials are available from the corresponding author (SB) upon reasonable request.

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Acknowledgements

This study, of which only a part is presented here (due to word limitation), is a master’s thesis titled Investigation of exercise capacity, physical activity levels, respiratory muscle strength and endurance during hematopoietic stem cell transplantation. The abstract of this study was presented as a poster in the “Best posters in respiratory physiotherapy” session at the European Respiratory Society International 2023 Congress and published in European Respiratory Journal 2023, 62: Suppl. 67, PA345. DOI: 10.1183/13993003.congress-2023.

The authors thank the Gazi University Academic Writing Application and Research Center for English editing. We would like to thank the Grammarly artificial intelligence writing assistance that the authors used to improve language and readability.

Funding

This study was supported by Gazi University Projects of Scientific Investigation (Grant number 9.11.2022/0131).

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Authors and Affiliations

  1. Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Gazi University, 06490, Emek, Ankara, Turkey

    Selin Bayram, Zeliha Çelik & Meral Boşnak Güçlü

  2. Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Izmir Democracy University, Izmir, Turkey

    Gülşah Barğı

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  1. Selin Bayram
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  2. Gülşah Barğı
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Contributions

All authors contributed significantly to the concept, design, analysis, interpretation, and data acquisition. MBG and SB prepared the work and critically reviewed it for important intellectual content. Evaluation measurements and pulmonary rehabilitation programs were performed in various combination of the researchers by SB, GB and ZÇ in order to ensure proper blinding. All authors have agreed on the final manuscript. All authors agreed to be responsible for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are adequately investigated and resolved.

Corresponding author

Correspondence to Selin Bayram.

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Ethics approval

The study was approved by the Gazi University Clinical Research Ethics Committee (approval date and number: 23/10/2017–500), and all the patients provided written informed consent. The study was registered at ClinicalTrials.gov (NCT03625063). The research was conducted in compliance with the ethical guidelines established by the 1964 Helsinki Declaration and its subsequent modifications. All the patients gave their written, informed consent to participate in the trial.

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The authors declare no competing interests.

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Bayram, S., Barğı, G., Çelik, Z. et al. Effects of pulmonary rehabilitation in hematopoietic stem cell transplantation recipients: a randomized controlled study. Support Care Cancer 32, 72 (2024). https://doi.org/10.1007/s00520-023-08236-x

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