S. Abo1,2, L. Denehy1,3, D. Ritchie4, K.-Y. Lin5,6, L. Edbrooke1,3, C. McDonald1,2, C. Granger1,2
1University of Melbourne, Physiotherapy, Melbourne, Australia, 2Royal Melbourne Hospital, Physiotherapy, Melbourne, Australia, 3Peter MacCallum Cancer Centre, Allied Health, Melbourne, Australia, 4Royal Melbourne Hospital, Bone Marrow Transplantation, Melbourne, Australia, 5National Cheng Kung University, Physical Therapy, Tainan, Taiwan, 6National Cheng Kung University, Allied Health Sciences, College of Medicine, Tainan, Taiwan
Background: Medical advances in bone marrow transplantation have led to increased survivorship for people with haematological cancer, however this aggressive treatment comes with the potential for significant side-effects that can affect quality-adjusted life years. Exercise interventions may have potential to improve outcomes following bone marrow transplantation, yet is not used in routine clinical practice.
Purpose: This systematic review aimed to answer the following questions: In people with haematological malignancies treated with bone marrow transplantation, what effect does exercise have on outcomes including exercise capacity, health-related quality of life (HRQoL) and hospital length of stay (LOS)? Is there a different effect in people treated with allogeneic compared to autologous transplantation?
Methods: Design: Systematic review of prospective studies with a comparator group, with or without randomisation; meta-analysis of randomised control trials (RCTs). Participants: Adults with a haematological malignancy undergoing bone marrow transplantation.
Intervention: Exercise interventions including aerobic and resistance training and/or other with the aim to increase physical activity levels.
Outcome measures: Primary outcomes of interest were functional exercise capacity and HRQoL; secondary outcomes included strength, fatigue, hospital LOS and feasibility. Risk of bias was evaluated using the PEDro or Newcastle-Ottawa scale, and overall quality of evidence for each meta-analysis was assessed using the Grades of Research, Assessment, Development and Evaluation approach.
Intervention: Exercise interventions including aerobic and resistance training and/or other with the aim to increase physical activity levels.
Outcome measures: Primary outcomes of interest were functional exercise capacity and HRQoL; secondary outcomes included strength, fatigue, hospital LOS and feasibility. Risk of bias was evaluated using the PEDro or Newcastle-Ottawa scale, and overall quality of evidence for each meta-analysis was assessed using the Grades of Research, Assessment, Development and Evaluation approach.
Results: Nineteen RCTs and four prospective non-randomised experimental trials involving 2305 participants were included. There was moderate quality evidence that exercise improves functional exercise capacity (MD 27.69m, 95% CI 8.59 to 46.79), global HRQoL (MD 3.51, 95% CI 0.29 to 6.73) and fatigue (MD 2.52, 95% CI 0.42 to 4.63); low quality evidence of improvements in lower-limb strength (SMD 0.47, 95% CI 0.25 to 0.69); and very low-quality evidence for reduced hospital LOS (MD 2.13days, 95% CI 0.24 to 4.02). There was low quality evidence that these effects were more pronounced in recipients of allogeneic transplantation.
Conclusion(s): Exercise is safe and appears to improve functional exercise capacity, HRQoL, fatigue, strength and hospital LOS in bone marrow transplantation.
Implications: The results support implementation of exercise programs in this population, particularly in recipients of allogeneic transplantation.
Funding, acknowledgements: Nil.
Keywords: bone marrow transplantation, stem cell transplantation, exercise
Topic: Oncology, HIV & palliative care
Did this work require ethics approval? No
Institution: Systematic review, thus not applicable. Registered on PROSPERO CRD42018096742.
Committee: Not applicable.
Reason: Systematic review.
All authors, affiliations and abstracts have been published as submitted.
