Development of an in-patient exercise program for children undergoing Haematopoietic Stem Cell Transplantation (HSCT) (#146)
Background: Impairments in muscle strength, aerobic capacity and bone mineral density in children following HSCT have been observed and have a significant impact on function and quality of life. An in-patient exercise programme may help mitigate the deterioration in fitness and strength which occurs following HSCT. Adult HSCT patients have responded to exercise interventions during treatment with a decrease in severity of treatment-induced symptoms1 maintenance or a reduced decline in strength compared to controls 2,3, higher reported QOL measures4,5 , reduced decline in aerobic fitness6 and better lymphocyte counts7 compared to controls. However, few studies have investigated if an exercise intervention is feasible for the pediatric population and if the benefits of exercise therapy are similar in children.
Purpose: To develop and assess the feasibility of an in-patient exercise intervention for children following Haematopoietic Stem Cell Transplantation (HSCT).
Method: A feasibility study involving 16 children between the ages of 6 and 18 years who were undergoing HSCT were recruited from the Sydney Children's Hospital Network. A baseline exercise assessment including 6-minute walk test, hand-held dynamometry, single leg balance, ankle range of motion was conducted. Psychosocial measures of fatigue (Peds-Multidimensional Fatigue Scale) and Quality of life (PedsQL - Cancer Module) were also assessed during pre-transplant workup, Day 42 and at Day 100. An individualised exercise therapy program was provided by an Accredited Exercise Physiologist daily. This consisted of a variety of aerobic, strengthening, balance and flexibility exercises for a period of 10-60 minutes, depending on the participants' daily capacity. The intensity and duration of exercises performed were recorded and daily Visual Analogue Scales taken for mood/anxiety/fatigue/pain to understand barriers towards exercise. Missed sessions were recorded and the reasons cited.
Result: Thirteen children to date have completed the exercise intervention with 3 still undergoing the intervention. Children have completed 42-95% of available exercise sessions, with a 60% mean uptake rate (13/21 sessions offered), an average of 40 minutes per session. The average weekly minutes varied from 67-114 minutes across the 6 week period, with a median of 107 min. Primary reasons cited for non-exercise were fatigue (47%), medical (28%), mood-related (14%) and pain (11%).
Conclusion: At present, it appears feasible to exercise at least 2-3 times per wk and for a minimum of 60 minutes per week during the hospitalization period. In the development of an exercise program for this population group, flexibility in time and availability is essential. The most commonly cited reasons for non-adherence to the exercise program include fatigue, medical reasons (fever, nausea, medical treatments), low mood and pain. Designing activities that are sufficiently active and interesting for children and can be performed within the space restrictions is also challenging.
- 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 M
- Mello, M., Tanaka, C., & Dulley, F. L. (2003). Effects of an exercise program on muscle performance in patients undergoing allogeneic bone marrow transplantation. Bone marrow transplantation, 32(7), 723-728.
- Wiskemann, J., Dreger, P., Schwerdtfeger, R., Bondong, A., Huber, G., Kleindienst, N., Bohus, M. (2011). Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood, 117(9), 2604-2613
- Baumann, F. T., Kraut, L., Schule, K., Bloch, W., & Fauser, A. A. (2010). A controlled randomized study examining the effects of exercise therapy on patients undergoing haematopoietic stem cell transplantation. Bone marrow transplantation, 45(2), 355-362.
- Hayes, S., Davies, P. S., Parker, T., Bashford, J., & Newman, B. (2004). Quality of life changes following peripheral blood stem cell transplantation and participation in a mixed-type, moderate-intensity, exercise program. Bone marrow transplantation, 33(
- Wiskemann, J., Dreger, P., Schwerdtfeger, R., Bondong, A., Huber, G., Kleindienst, N., . . . Bohus, M. (2011). Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood, 117(9), 2604-2613
- Kim, S. D., & Kim, H. S. (2006). A series of bed exercises to improve lymphocyte count in allogeneic bone marrow transplantation patients. European journal of cancer care, 15(5), 453-457.