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Multimodal exercise training during myeloablative chemotherapy: a prospective randomized pilot trial

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Abstract

Purpose

Cancer and its treatment-related side effects induce loss of physical performance. This study evaluated the effects of multimodal aerobic and strength exercises on physical performance in hospitalized cancer patients while receiving myeloablative chemotherapy.

Methods

In this prospective pilot study, 48 evaluable patients were randomly assigned to a training (TG, n = 24) or control (CG, n = 24) group. The TG performed an individually supervised exercise program five times a week with ergometer training and strength exercises for 20 min each during the hospitalization period for chemotherapy. The CG received standard physiotherapy. Physical performance was evaluated using spiroergometry, lung function, and muscle strength testing. Treatment-related side effects were assessed by daily interviews, quality of life by EORTC-QLQ-C30, and fatigue using the Modified Fatigue Impact Scale (MFIS) questionnaire.

Results

Physical performance significantly increased in the TG (8.96 ± 24 W) and decreased in the CG (−7.24 ± 20 W, p = 0.02). At 2-mmol/ml blood lactate concentration, the TG achieved significantly increased oxygen consumption (p = 0.03) and expiratory minute ventilation (p = 0.04) compared to the CG. Furthermore, physical functioning increased significantly in the TG (p = 0.04). Patients in the TG required less antiemetics (p = 0.01) and experienced significantly less fatigue (p = 0.04), although MFIS analysis was not able to detect this beneficial effect. Patients of the CG displayed higher impairments of cognitive (p = 0.02) and psychosocial function (p = 0.03) after chemotherapy. No adverse events due to the study intervention were observed.

Conclusions

Multimodal exercise has beneficial effects on physical performance, physical functioning, and treatment-related symptoms even during myeloablative chemotherapy. We suggest an enhanced physical activity intervention program during hospitalization of cancer patients.

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References

  1. Bellizzi KM, Rowland JH, Arora NK, Hamilton AS, Miller MF, Aziz NM (2009) Physical activity and quality of life in adult survivors of non-Hodgkin's lymphoma. J Clin Oncol 27:960–966

    Article  PubMed  Google Scholar 

  2. Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS (2003) Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol 21:1660–1668

    Article  PubMed  Google Scholar 

  3. De Backer IC, Vreugdenhil G, Nijziel MR, Kester AD, van Breda E, Schep G (2008) Long-term follow-up after cancer rehabilitation using high-intensity resistance training: persistent improvement of physical performance and quality of life. Br J Cancer 99:30–36

    Article  PubMed  Google Scholar 

  4. Mustian KM, Sprod LK, Palesh OG, Peppone LJ, Janelsins MC, Mohile SG, Carroll J (2009) Exercise for the management of side effects and quality of life among cancer survivors. Curr Sports Med Rep 8:325–330

    Article  PubMed  Google Scholar 

  5. Speck RM, Courneya KS, Mâsse LC, Duval S, Schmitz KH (2010) An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 4:87–100

    Article  PubMed  Google Scholar 

  6. Elter T, Stipanov M, Heuser E, von Bergwelt-Baildon M, Bloch W, Hallek M, Baumann F (2009) Is physical exercise possible in patients with critical cytopenia undergoing intensive chemotherapy for acute leukaemia or aggressive lymphoma? Int J Hematol 90:199–204

    Article  PubMed  CAS  Google Scholar 

  7. Adamsen L, Quist M, Midtgaard J, Andersen C, Møller T, Knutsen L, Tveterås A, Rorth M (2006) The effect of a multidimensional exercise intervention on physical capacity, well-being and quality of life in cancer patients undergoing chemotherapy. Support Care Cancer 14:116–127

    Article  PubMed  Google Scholar 

  8. Adamsen L, Quist M, Andersen C, Møller T, Herrstedt J, Kronborg D, Baadsgaard MT, Vistisen K, Midtgaard J, Christiansen B, Stage M, Kronborg MT, Rørth M (2009) Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ 339:b3410

    Article  PubMed  Google Scholar 

  9. Conn VS, Hafdahl AR, Porock DC, McDaniel R, Nielsen PJ (2006) A meta-analysis of exercise interventions among people treated for cancer. Support Care Cancer 14:699–712

    Article  PubMed  Google Scholar 

  10. Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A (2007) Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol 25:1713–1721

    Article  PubMed  Google Scholar 

  11. Knols R, Aaronson NK, Uebelhardt D, Fransen J, Aufdemkampe G (2005) Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled trials. J Clin Oncol 23:3830–3842

    Article  PubMed  Google Scholar 

  12. Dimeo FC, Fetscher S, Lange W, Mertelsmann R, Keul J (1997) Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy. Blood 90:3390–3394

    PubMed  CAS  Google Scholar 

  13. Dimeo FC, Stieglitz RD, Novelli-Fischer U, Fetscher S, Keul J (1999) Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer 85:2273–2277

    Article  PubMed  CAS  Google Scholar 

  14. Dimeo FC (2001) Effects of exercise on cancer-related fatigue. Cancer 92:1689–1693

    Article  PubMed  CAS  Google Scholar 

  15. Dimeo FC, Schwartz S, Fietz T, Wanjura T, Böning D, Thiel E (2003) Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy. Support Care Cancer 11:623–628

    Article  PubMed  Google Scholar 

  16. Griffith K, Wenzel J, Shang J, Thompson C, Stewart K, Mock V (2009) Impact of a walking intervention on cardiorespiratory fitness, self-reported physical function, and pain in patients undergoing treatment for solid tumors. Cancer 115:4874–4884

    Article  PubMed  Google Scholar 

  17. Courneya KS, Sellar CM, Stevinson C, McNeely ML, Peddle CJ, Friedenreich CM, Tankel K, Basi S, Chua N, Mazurek A, Reiman T (2009) Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. J Clin Oncol 27:4605–4612

    Article  PubMed  Google Scholar 

  18. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, Ladha AB, Proulx C, Vallance JK, Lane K, Yasui Y, McKenzie DC (2007) Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol 25:4396–4404

    Article  PubMed  Google Scholar 

  19. Jacobsen PB, Phillips KM, Jim HS, Small BJ, Faul LA, Meade CD, Thompson L, Williams CC Jr, Loftus LS, Fishman M, Wilson RW (2013) Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial. Psychooncology 22(6):1229–1235

    Article  PubMed  Google Scholar 

  20. Dimeo F, Schmittel A, Fietz T, Schwartz S, Köhler P, Böning D, Thiel E (2004) Physical performance, depression, immune status and fatigue in patients with hematological malignancies after treatment. Ann Oncol 15:1237–1242

    Article  PubMed  CAS  Google Scholar 

  21. Larsen J, Nordstrom G, Ljungman P, Gardulf A (2004) Symptom occurrence, symptom intensity, and symptom distress in patients undergoing high-dose chemotherapy with stem-cell transplantation. Cancer Nurs 27:55–64

    Article  PubMed  Google Scholar 

  22. Morishita S, Kaida K, Yamauchi S, Wakasugi T, Yoshihara S, Taniguchi K, Ishii S, Ikegame K, Kodama N, Ogawa H, Domen K (2013) Gender differences in health-related quality of life, physical function and psychological status among patients in the early phase following allogeneic haematopoietic stem cell transplantation. Psychooncology 22(5):1159–1166

    Article  PubMed  Google Scholar 

  23. Mosher CE, Redd WH, Rini CM, Burkhalter JE, DuHamel KN (2009) Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature. Psychooncology 18:113–127

    Article  PubMed  Google Scholar 

  24. Carlson LE, Smith D, Russell J, Fibich C, Whittaker T (2006) Individualized exercise program for the treatment of severe fatigue in patients after allogeneic hematopoietic stem-cell transplant: a pilot study. Bone Marrow Transplant 37:945–954

    Article  PubMed  CAS  Google Scholar 

  25. Dimeo F, Bertz H, Finke J, Fetscher S, Mertelsmann R, Keul J (1996) An aerobic exercise program for patients with haematological malignancies after bone marrow transplantation. Bone Marrow Transplant 18:1157–1160

    PubMed  CAS  Google Scholar 

  26. Dimeo F, Schwartz S, Wesel N, Voigt A, Thiel E (2008) Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol 19:1495–1499

    Article  PubMed  CAS  Google Scholar 

  27. Baumann FT, Kraut L, Schule K, Bloch W, Fauser AA (2010) A controlled randomized study examining the effects of exercise therapy on patients undergoing haematopoietic stem cell transplantation. Bone Marrow Transplant 45:355–362

    Article  PubMed  CAS  Google Scholar 

  28. Baumann FT, Zopf EM, Nykamp E, Kraut L, Schüle K, Elter T, Fauser AA, Bloch W (2011) Physical activity for patients undergoing allogeneic hematopoietic stem cell transplantation: benefits of a moderate exercise intervention. Eur J Haematol 87:148–156

    Article  PubMed  Google Scholar 

  29. Jarden M, Baadsgaard MT, Hovgaard DJ, Boesen E, Adamsen L (2009) A randomized trial on the effect of a multimodal intervention on physical capacity, functional performance and quality of life in adult patients undergoing allogeneic SCT. Bone Marrow Transplant 43:725–737

    Article  PubMed  CAS  Google Scholar 

  30. Jarden M, Nelausen K, Hovgaard D, Boesen E, Adamsen L (2009) The effect of a multimodal intervention on treatment-related symptoms in patients undergoing hematopoietic stem cell transplantation: a randomized controlled trial. J Pain Symptom Manag 38:174–190

    Article  Google Scholar 

  31. Kim SD, Kim HS (2005) Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients. Cancer Nurs 28:79–83

    Article  PubMed  Google Scholar 

  32. Mello M, Tanaka C, Dulley F (2003) Effects of an exercise program on muscle performance in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant 32:723–728

    Article  PubMed  CAS  Google Scholar 

  33. Wiskemann J, Dreger P, Schwerdtfeger R, Bondong A, Huber G, Kleindienst N, Ulrich CM, Bohus M (2011) Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood 117:2604–13

    Article  PubMed  CAS  Google Scholar 

  34. Borg G (1998) Borg’s perceived exertion and pain scales. Human Kinetics, Champaign

    Google Scholar 

  35. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    Article  PubMed  CAS  Google Scholar 

  36. Fisk JD, Ritvo PG, Ross L, Haase DA, Marrie TJ, Schlech WF (1994) Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clin Infect Dis 18:S79–S83

    Article  PubMed  Google Scholar 

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Acknowledgments

The study was sponsored by the “Hamburger Krebsgesellschaft”.

Conflict of interest

We do not have any conflicts of interests. We have full control of all primary data and would allow the journal to review the data if requested.

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Correspondence to Maike de Wit.

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Oechsle, K., Aslan, Z., Suesse, Y. et al. Multimodal exercise training during myeloablative chemotherapy: a prospective randomized pilot trial. Support Care Cancer 22, 63–69 (2014). https://doi.org/10.1007/s00520-013-1927-z

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  • DOI: https://doi.org/10.1007/s00520-013-1927-z

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