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Supportive Care in Cancer

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01-01-2014 | Original Article

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

Authors: Karin Oechsle, Zeynep Aslan, Yvonne Suesse, Wiebke Jensen, Carsten Bokemeyer, Maike de Wit

Published in: Supportive Care in Cancer | Issue 1/2014

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.

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 27:960–966PubMedCrossRef

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 21:1660–1668PubMedCrossRef

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 99:30–36PubMedCrossRef

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 8:325–330PubMedCrossRef

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 4:87–100PubMedCrossRef

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 90:199–204PubMedCrossRef

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 14:116–127PubMedCrossRef

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:b3410PubMedCrossRef

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 14:699–712PubMedCrossRef

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 25:1713–1721PubMedCrossRef

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 23:3830–3842PubMedCrossRef

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 90:3390–3394PubMed

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 85:2273–2277PubMedCrossRef

14.

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

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 11:623–628PubMedCrossRef

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 115:4874–4884PubMedCrossRef

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 27:4605–4612PubMedCrossRef

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 25:4396–4404PubMedCrossRef

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):1229–1235PubMedCrossRef

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 15:1237–1242PubMedCrossRef

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 27:55–64PubMedCrossRef

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):1159–1166PubMedCrossRef

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 18:113–127PubMedCrossRef

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 37:945–954PubMedCrossRef

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 18:1157–1160PubMed

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 19:1495–1499PubMedCrossRef

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 45:355–362PubMedCrossRef

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 87:148–156PubMedCrossRef

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 43:725–737PubMedCrossRef

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 38:174–190CrossRef

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 28:79–83PubMedCrossRef

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 32:723–728PubMedCrossRef

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 117:2604–13PubMedCrossRef

34.

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

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 85:365–376PubMedCrossRef

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–S83PubMedCrossRef

Title: Multimodal exercise training during myeloablative chemotherapy: a prospective randomized pilot trial
Authors: Karin Oechsle
Zeynep Aslan
Yvonne Suesse
Wiebke Jensen
Carsten Bokemeyer
Maike de Wit
Publication date: 01-01-2014
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 1/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-013-1927-z

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