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A pilot phase II RCT of a home-based exercise intervention for survivors of AML

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Abstract

Background

Fatigue is the most common and disabling symptom affecting quality of life (QOL) and daily function in patients who have completed treatment for acute myeloid leukemia (AML). Although trials in patients with various solid tumors have reported improved fatigue and QOL following exercise interventions, there have been no studies in AML patients post treatment.

Methods

Forty patients aged ≥40 years who had completed treatment for AML were enrolled in a 12-week randomized phase II exercise intervention to determine feasibility (recruitment, retention, and adherence), efficacy, and safety of the intervention. Patients assigned to the exercise group received an individualized, moderate-intensity, 12-week home-based exercise program with weekly telephone support from a certified exercise physiologist. QOL, fatigue, and fitness outcomes were measured at baseline, 6 weeks, and 12 weeks. Between-group differences in 12-week change scores were calculated using linear regression adjusting for age and baseline function.

Results

Recruitment and retention rates were 38 % and 91 %, respectively. Adherence was low at 28 %. Analyses did not suggest statistically significant or clinically important benefits in QOL, fatigue, or physical fitness with the intervention. The level of adherence did not appear to impact outcomes. There were no adverse events.

Conclusion

A home-based exercise program for post-treatment AML patients age 40 years or older can be safely delivered with reasonable recruitment and high retention. However, feasibility was hampered by low adherence. Further research and program modification are needed to better understand and overcome barriers to exercise delivery and adherence in AML survivors.

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References

  1. 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  CAS  PubMed  Google Scholar 

  2. Alibhai SM, Leach M, Kowgier ME, Tomlinson GA, Brandwein JM, Minden MD (2007) Fatigue in older adults with acute myeloid leukemia: predictors and associations with quality of life and functional status. Leukemia 21:845–848

    CAS  PubMed  Google Scholar 

  3. Alibhai SM, Leach M, Minden MD, Brandwein J (2009) Outcomes and quality of care in acute myeloid leukemia over 40 years. Cancer 115:2903–2911

    Article  PubMed  Google Scholar 

  4. Alibhai SMH, Leach M, Gupta V, Tomlinson GA, Brandwein JM, Saiz FS, Minden MD (2009) Quality of life beyond 6 months after diagnosis in older adults with acute myeloid leukemia. Crit Rev Oncol Hematol 69:168–174

    Article  PubMed  Google Scholar 

  5. Alibhai SMH, Leach M, Kermalli H, Gupta V, Kowgier ME, Tomlinson GA, Brandwein J, Buckstein R, Minden MD (2007) The impact of acute myeloid leukemia and its treatment on quality of life and functional status in older adults. Crit Rev Oncol Hematol 64:19–30

    Article  PubMed  Google Scholar 

  6. Baumann FT, Zopf EM, Bloch W (2012) Clinical exercise interventions in prostate cancer patients—a systematic review of randomized controlled trials. Support Care Cancer 20:221–233

    Article  PubMed  Google Scholar 

  7. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9

    CAS  PubMed  Google Scholar 

  8. Canadian Society of Exercise Physiology (2002) Physical activity readiness questionnaire. Canadian Society of Exercise Physiology, Ottawa

    Google Scholar 

  9. Canadian Society of Exercise Physiology (2011) Canadian physical activity guidelines. Health Canada, Ottawa

    Google Scholar 

  10. Carron AV, Hausenblas HA, Mack D (1996) Social influence and exercise: a meta-analysis. J Sport Exerc Psychol 18:1–16

    Google Scholar 

  11. Cella D, Lai JS, Chang CH, Peterman A, Slavin M (2002) Fatigue in cancer patients compared with fatigue in the general United States population. Cancer 94:528–538

    Article  PubMed  Google Scholar 

  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  13. Courneya KS, Friedenreich CM (1997) Relationship between exercise pattern across the cancer experience and current quality of life in colorectal cancer survivors. J Altern Complement Med 3:215–226

    Article  CAS  PubMed  Google Scholar 

  14. Courneya KS, Friedenreich CM, Sela RA, Quinney HA, Rhodes RE, Handman M (2003) The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Psychooncology 12:357–374

    Article  PubMed  Google Scholar 

  15. Culos-Reed SN, Robinson JL, Lau H, O'Connor K, Keats MR (2007) Benefits of a physical activity intervention for men with prostate cancer. J Sport Exerc Psychol 29:118–127

    PubMed  Google Scholar 

  16. Culos-Reed SN, Robinson JW, Lau H, Stephenson L, Keats M, Norris S, Kline G, Faris P (2010) Physical activity for men receiving androgen deprivation therapy for prostate cancer: benefits from a 16-week intervention. Support Care Cancer 18:591–599

    Article  PubMed  Google Scholar 

  17. Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS (2010) Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ 340:b5631

    Article  PubMed Central  PubMed  Google Scholar 

  18. 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

    CAS  PubMed  Google Scholar 

  19. Fong DY, Ho JW, Hui BP, Lee AM, Macfarlane DJ, Leung SS, Cerin E, Chan WY, Leung IP, Lam SH, Taylor AJ, Cheng KK (2012) Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ 344:e70

    Article  PubMed Central  PubMed  Google Scholar 

  20. Godin G, Shephard RJ (1985) A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 10:141–146

    CAS  PubMed  Google Scholar 

  21. Heyward VH (2010) Advanced fitness assessment and exercise prescription. Human Kinetics Publishers, Windsor

    Google Scholar 

  22. Hopwood P (1992) Progress, problems and priorities in quality of life research. Eur J Cancer 28A:1748–1752

    Article  CAS  PubMed  Google Scholar 

  23. Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS (1993) A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc 25:81–91

    Article  PubMed  Google Scholar 

  24. Janssen KJ, Donders AR, Harrell FE Jr, Vergouwe Y, Chen Q, Grobbee DE, Moons KG (2010) Missing covariate data in medical research: to impute is better than to ignore. J Clin Epidemiol 63:721–727

    Article  PubMed  Google Scholar 

  25. Katzmarzyk PT, Leon AS, Wilmore JH, Skinner JS, Rao DC, Rankinen T, Bouchard C (2003) Targeting the metabolic syndrome with exercise: evidence from the HERITAGE Family Study. Med Sci Sports Exerc 35:1703–1709

    Article  CAS  PubMed  Google Scholar 

  26. Lemmink KA, Kemper HC, de Greef MH, Rispens P, Stevens M (2003) The validity of the sit-and-reach test and the modified sit-and-reach test in middle-aged to older men and women. Res Q Exerc Sport 74:331–336

    Article  PubMed  Google Scholar 

  27. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S (1985) Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 66:69–74

    CAS  PubMed  Google Scholar 

  28. Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16:139–144

    CAS  PubMed  Google Scholar 

  29. Pinto A, Zagonel V, Ferrara F (2001) Acute myeloid leukemia in the elderly: biology and therapeutic strategies. Crit Rev Oncol Hematol 39:275–287

    Article  CAS  PubMed  Google Scholar 

  30. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42:1409–1426

    Article  PubMed  Google Scholar 

  31. Schmitz KH, Holtzman J, Courneya KS, Masse LC, Duval S, Kane R (2005) Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 14:1588–1595

    Article  PubMed  Google Scholar 

  32. Schumacher A, Kessler T, Buchner T, Wewers D, van de Loo J (1998) Quality of life in adult patients with acute myeloid leukemia receiving intensive and prolonged chemotherapy — a longitudinal study. Leukemia 12:586–592

    Article  CAS  PubMed  Google Scholar 

  33. Schumacher A, Wewers D, Heinecke A, Sauerland C, Koch OM, van de Loo J, Buchner T, Berdel WE (2002) Fatigue as an important aspect of quality of life in patients with acute myeloid leukemia. Leuk Res 26:355–362

    Article  PubMed  Google Scholar 

  34. Sevick MA, Miller GD, Loeser RF, Williamson JD, Messier SP (2009) Cost-effectiveness of exercise and diet in overweight and obese adults with knee osteoarthritis. Med Sci Sports Exerc 41:1167–1174

    Article  PubMed  Google Scholar 

  35. Sim J, Lewis M (2012) The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. J Clin Epidemiol 65:301–308

    Article  PubMed  Google Scholar 

  36. Singh MA (2002) Exercise comes of age: rationale and recommendations for a geriatric exercise prescription. J Gerontol A Biol Sci Med Sci 57:M262–M282

    Article  PubMed  Google Scholar 

  37. Solway S, Brooks D, Lacasse Y, Thomas S (2001) A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest 119:256–270

    Article  CAS  PubMed  Google Scholar 

  38. Spring B, Schneider K, McFadden HG, Vaughn J, Kozak AT, Smith M, Moller AC, Epstein LH, Demott A, Hedeker D, Siddique J, Lloyd-Jones DM (2012) Multiple behavior changes in diet and activity: a randomized controlled trial using mobile technology. Arch Intern Med 172:789–796

    Article  PubMed Central  PubMed  Google Scholar 

  39. Stalfelt AM (1994) Quality of life of patients with acute myeloid leukaemia. Leuk Res 18:257–267

    Article  CAS  PubMed  Google Scholar 

  40. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N (2004) Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 116:682–692

    Article  PubMed  Google Scholar 

  41. Wagner LI, Cella D (2004) Fatigue and cancer: causes, prevalence and treatment approaches. Br J Cancer 91:822–828

    CAS  PubMed Central  PubMed  Google Scholar 

  42. Walker J, Postma K, McHugh GS, Rush R, Coyle B, Strong V, Sharpe M (2007) Performance of the hospital anxiety and depression scale as a screening tool for major depressive disorder in cancer patients. J Psychosom Res 63:83–91

    Article  PubMed  Google Scholar 

  43. Watson T, Mock V (2004) Exercise as an intervention for cancer-related fatigue. Phys Ther 84:736–743

    PubMed  Google Scholar 

  44. 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 117:2604–2613

    Article  CAS  PubMed  Google Scholar 

  45. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E (1997) Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage 13:63–74

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Shabbir M. H. Alibhai.

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Alibhai, S.M.H., O’Neill, S., Fisher-Schlombs, K. et al. A pilot phase II RCT of a home-based exercise intervention for survivors of AML. Support Care Cancer 22, 881–889 (2014). https://doi.org/10.1007/s00520-013-2044-8

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