Article

Feasibility of Exercise During Treatment for Multiple Myeloma

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Abstract

Fatigue and insomnia are problems for patients with cancer. Research findings show that aerobic exercise decreases cancer-related fatigue. Because patients with cancer who have skeletal muscle wasting may not obtain maximum benefit from aerobic exercise training, exercise programs may need to include resistance training. Thus far, testing exercise as an intervention for fatigue has focused on patients with breast cancer and excluded patients with bone metastasis. There is a need to test the feasibility and effectiveness of exercise for patients with other types of cancer and with bone involvement. The effect of aerobic and strength resistance training on the sleep of patients with cancer has not been tested. A pilot/feasibility study with a randomized controlled design was conducted to investigate home-based exercise therapy for 24 patients receiving high-dose chemotherapy and autologous peripheral blood stem cell transplantation as treatment for multiple myeloma. None of the patients injured themselves. Because of the small sample size in the feasibility study, the effect of exercise on lean body weight was the only end point that obtained statistical significance. However, the results suggest that an individualized exercise program for patients receiving aggressive treatment for multiple myeloma is feasible and may be effective for decreasing fatigue and mood disturbance, and for improving sleep.

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... Exercise prior to AuSCT is safe and feasible [8,9]. Preliminary evidence demonstrates mitigation of the decline in aerobic capacity, muscle strength, HRQoL and increased fatigue that is experienced during conditioning, with the potential for improvements in post-transplant outcomes relating to survival, morbidity and resource utilisation [9,10]. Nutrition therapy is indicated and should be initiated early for patients prior to AuSCT, individualised nutrition interventions, coupled with exercise and psychological interventions are likely to be bene cial for this patient cohort [11]. ...
... The current study, conducted in real-world conditions, reports measurable improvements with allied health prehabilitation in functional exercise capacity, lower limb strength and function, grip strength, physical activity and HRQoL domains (fatigue and dyspnoea). This is consistent with two small studies in allogenic and AuSCT, where positive trends were found for prehabilitation in physical activity, physical function, HRQoL and fatigue [9,10] and a signi cant positive change in lean body weight [10]. Our ndings should be interpreted with caution due to the absence of a control group. ...
... The current study, conducted in real-world conditions, reports measurable improvements with allied health prehabilitation in functional exercise capacity, lower limb strength and function, grip strength, physical activity and HRQoL domains (fatigue and dyspnoea). This is consistent with two small studies in allogenic and AuSCT, where positive trends were found for prehabilitation in physical activity, physical function, HRQoL and fatigue [9,10] and a signi cant positive change in lean body weight [10]. Our ndings should be interpreted with caution due to the absence of a control group. ...
Preprint
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Purpose To evaluate the impact of routine multidisciplinary allied health prehabilitation care in haematologic cancer patients receiving high-dose chemotherapy with autologous stem cell transplant (AuSCT). Methods In a tertiary cancer centre, 12-months of prospectively collected data was retrospectively analysed. Patients were referred to the service for individualised exercise prescription, nutrition intervention and, if indicated through screening, psychological intervention. Impact and operational success were investigated based on the RE-AIM framework: patient uptake of the service and sample representativeness (Reach); Effectiveness in terms of changes in outcomes from initial to pre-transplant assessment; Adoption of the service by key stakeholders; fidelity of the prescribed exercise program (Implementation); and the extent to which the service had become part of routine standard care (Maintenance). Results 183 patients were referred to the AuSCT service, of whom 133 (73%) were referred into the prehabilitation service, 128 (96%) were eligible and 116 (91%) participated. Significant improvements were demonstrated between initial and pre-transplant assessments particularly six-minute walk distance (n = 45); mean difference (95% CI) 39.9m (18.8 to 61.0, p = < 0.005). Missing data were an issue for assessment of effectiveness. Fidelity of exercise prescription was moderate with 72% of eligible patients receiving the intended aerobic and resistance exercise interventions. Conclusion The prehabilitation service was well adopted by clinicians. Clinically relevant improvements in outcomes were demonstrated. Recommendations, including development of well-integrated discipline-specific assessment intervention and measurement protocols, are highlighted to improve the service. Prehabilitation should be routinely considered to support the care of patients undergoing AuSCT.
... Of those, 2389 participants (98%) had an underlying hematological malignancy; 43 participants had various nonmalignant hematological conditions (eg, aplastic anemia), other malignancies, or an unspecified diagnosis. In terms of treatment type, 13 studies 23,25,[32][33][34]40,42,43,45,48,50,52 included only recipients of allogeneic BMT or published subgroup analyses with an allogeneic BMT cohort 54 ; 5 36,38,39,44,46 included an autologous BMT population; and 10 24,26,31,35,37,41,47,49,51,53 included a mixed population of allogeneic or autologous BMT and did not provide subgroup data according to treatment type. ...
... Timing of intervention was solely in the pretransplantation phase in 2 studies, 26,48 during hospital stay for transplantation in 10 studies, [23][24][25][31][32][33]49,55 after hospital discharge or posttransplantation in 6 studies, [34][35][36][37]45,46 and across the continuum of (before, during, and/or after) transplantation in 10 studies. [38][39][40][41][42][43]47,53 Intervention was supervised in 13 studies, [24][25][26][31][32][33]37,42,45,46,49 partially supervised in 8 studies, 23,34,35,41,43,44,53 and self-directed in 6 studies. 36,[38][39][40]47,48 Sessions were supervised or partially supervised by a physical therapist (9 studies), [23][24][25][26]34,44,46,49 a specially trained nurse or research assistant (4 studies), 32,33,35,41 an exercise specialist (5 studies), 31,43,50 either a physical therapist or an assistant 45 (1 study), a personal trainer 37 (1 study), or unspecified 42 (1 study). ...
... [38][39][40][41][42][43]47,53 Intervention was supervised in 13 studies, [24][25][26][31][32][33]37,42,45,46,49 partially supervised in 8 studies, 23,34,35,41,43,44,53 and self-directed in 6 studies. 36,[38][39][40]47,48 Sessions were supervised or partially supervised by a physical therapist (9 studies), [23][24][25][26]34,44,46,49 a specially trained nurse or research assistant (4 studies), 32,33,35,41 an exercise specialist (5 studies), 31,43,50 either a physical therapist or an assistant 45 (1 study), a personal trainer 37 (1 study), or unspecified 42 (1 study). Interventions were conducted at least partially in an outpatient hospital setting (7 studies) 26,34,35,41,42,44,45 or fitness center (2 studies) 37,46 or solely in a home-based setting (4 studies). ...
Article
Objective For people with hematological malignancies treated with bone marrow transplantation (BMT), this systematic review aimed to identify, evaluate, and synthesize the evidence examining the effect of exercise training on the outcomes of exercise capacity, health-related quality of life (HRQoL), and hospital length of stay and to identify any difference in the effect on people treated with allogeneic versus autologous transplantation. Methods Five electronic databases were systematically searched from inception to December 5, 2020. Prospective studies with a comparator group, with or without randomization, were included if they investigated the effects of an exercise intervention compared with usual care or another intervention in adults who had a hematological malignancy and were undergoing BMT. Primary outcomes of interest were functional exercise capacity and HRQoL; secondary outcomes included strength, fatigue, hospital length of stay, and feasibility. Only randomized controlled trials were included in the meta-analyses. Risk of bias was evaluated using the Physiotherapy Evidence Database or Newcastle-Ottawa Scale; quality of evidence for meta-analyses was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results Twenty-four randomized controlled trials and 3 prospective nonrandomized experimental trials were included (n = 2432). There was moderate-quality evidence that exercise improves functional exercise capacity (mean difference [MD] = 29 m; 95% CI = 12.59 to 45.4), global HRQoL (MD = 3.38 points; 95% CI = 0.37 to 6.39), and fatigue (MD = 2.52 points; 95% CI = 0.42 to 4.63) and low-quality evidence for reduced hospital length of stay (MD = 2.07 days; 95% CI = 0.43 to 3.72). These effects were more pronounced in recipients of allogeneic transplantation. No serious adverse events were associated directly with exercise in the included studies. Conclusions Exercise is safe and improves outcomes, including functional exercise capacity, HRQoL, and hospital length of stay, in adults undergoing BMT. Impact The results of this systematic review support the implementation of exercise programs in adults undergoing BMT, particularly recipients of allogeneic transplantation.
... The analyzed studies included a total of 1434 oncologic patients (age range 18 to 75 years). They were distributed into an EXP with 711 patients (274 women) or a CT with 723 patients (250 women), although there were studies [37,39] that did not reflect the exact number of women in the experimental or control group so, there, more women could be involved. The most common cancers in the participants were leukemia, lymphoma, and myeloma. ...
... The characteristics of the exercise interventions (Tables 2 and 3) were very diverse. In total, 15 studies [23,30,31,36,[38][39][40]42,[45][46][47][48][49]54,55] analysed the effects of an exercise program intervention in cancer patients before and after HSCT treatment, and 10 studies analysed the effects after HSCT [34,35,37,41,43,44,[50][51][52][53]. ...
... Frequency: A total of 13 studies (52%) performed exercise intervention 5 times per week [23,31,36,38,40,42,[44][45][46][47]52,54,55]; 5 studies (20%) performed intervention 3 times per week [34,37,48,49,51]; 3 studies (12%) increased the exercise frequency to 7 times per week [30,35,41]; and 3 studies (12%) exercised twice per week [43,50,53]. Only 1 study (4%) did not report exercise frequency [39]. ...
Article
Full-text available
This study looks at the effects of exercise programs on physical factors and safety in adult patients with cancer and hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). A systematic search was performed in the PubMed and Web of Science databases (from inception to 26 August 2021). A review was carried out following the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) checklist. The methodological quality of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale, based, in turn, on the Delphi list. A total of 25 randomized controlled trials studies were included, comprising 1434 patients. The most significant result of this systematic review is that exercise program interventions are safe and produce positive changes in cardiorespiratory fitness, muscle strength, and the functional mobility-state in adult patients with cancer and HSCT or BMT. Only 3 patients from the 711 participants in the exercise interventions (i.e., 0.42%) reported adverse events related to exercise interventions. Moreover, exercise training programs may have a cardiological and muscular protective effect, as well as a healthy effect on the prevention and control of transplant complications, improving health outcomes.
... An overview of all study and intervention characteristics is shown in Table 3. Median sample size was 60 (minimum = 12; maximum = 269), and mean age of participants across all trials was 61 years (SD = 6.9). Six trials involved participants with lung cancer (n = 6, 27%; [33][34][35][36][37][38]), three trials involved breast cancer (n = 3, 14%; [39][40][41]); two trials involved prostate cancer (n = 2, 9%; [42,43]), one trial involved multiple myeloma (n = 1, 5%; [44]) and ten trials involved samples with mixed cancer types (n = 10, 45%; [45][46][47][48][49][50][51][52][53][54]). Time since cancer diagnosis was reported in seven trials [36,40,42,43,49,53,55] and ranged between 0.2 and 9.8 years (median 2.8 years). ...
... Four trials involved resistance exercise (n = 4, 18%; [42,45,50,54]), three trials involved aerobic exercise (n = 3, 14%; [36,37,40]) and one trial involved other exercise (n = 1, 5%; [41]). Most interventions were supervised (n = 16, 76%; [33, 35-38, 40-43, 49-55]), with five trials involving unsupervised interventions (n = 5, 24%; [34,[44][45][46][47]) and one trial involved one supervised arm and one unsupervised arm (n = 1, 5%; [48]). Therefore, there was a total of 23 intervention arms across the 22 included studies. ...
... Two trials specifically reported that no adverse events had occurred [52,55] and one trial made no comments around whether adverse events occurred or not [37]. Furthermore, two trials reported brief details about the occurrence of adverse events, which included fatigue, body discomfort, falls and hospitalisation due to pericardial effusion and death [36,44]; however, the specific number of adverse events [36] and the group in which the events occurred [44] was not reported. Therefore, these two studies [36] [36] were excluded from the meta-analysis. ...
Article
Full-text available
Purpose The purpose of this systematic review with meta-analysis was to evaluate the safety, feasibility and effectiveness of exercise in the palliative care phase for people with advanced cancer. Methods Electronic databases were searched for exercise randomised controlled trials involving individuals with incurable cancer that were published prior to April 14, 2021. Meta-analyses were performed to evaluate the effects of exercise on health outcomes. Subgroup effects for exercise mode, supervision, intervention duration and cancer diagnosis were assessed. Results Twenty-two trials involving interventions ranging between 2 weeks and 6 months were included. Interventions comprised of aerobic (n = 3), resistance (n = 4), mixed-mode (n = 14) and other exercise (n = 1) modalities. Cancer types consisted of lung (n = 6), breast (n = 3), prostate (n = 2), multiple myeloma (n = 1) and mixed cancer types (n = 10). Meta-analysis of 20 RCTs involving 1840 participants showed no difference in the risk of a grade 2–4 adverse event between exercise and usual care (n = 110 adverse events (exercise: n = 66 events; usual care: n = 44 events), RD = − 0.01 (91% CI = − 0.01, 0.02); p = 0.24). Overall median recruitment, retention and adherence rates were 56%, 80% and 69%, respectively. Meta-analysis of health outcomes showed effects in favour of exercise for quality of life, fatigue, aerobic fitness and lower-body strength (SMD range = 0.27–0.48, all p < 0.05). Conclusions Participants who engaged in exercise experienced an increase in quality of life, fitness and strength and a decrease in fatigue. Implications for Cancer Survivors Physical activity programs were found to be safe and feasible for people with advanced cancer in the palliative care phase.
... wystąpienie wyżej wymienionych objawów skutkuje obniżeniem jakości życia pacjenta, podnosi również poziom stresu towarzyszącego chorobie [20]. regularna aktywność fizyczna może przyczynić się do znaczącej poprawy stanu pacjenta w opisanych aspektach [20][21][22]. ...
... w literaturze znaleźć można wiele doniesień dotyczących zalecanych typów aktywności fizycznej u chorych ze szpiczakiem polecanych do wykonywania w domu [22]. wśród najczęściej pojawiających się aktywności wymienić można: Nordic walking, ćwiczenia rozciągające, siłowe z taśmami oporowymi [22], wytrzymałościowe, aerobowe o niskim lub średnim natężeniu [23]. ...
... w literaturze znaleźć można wiele doniesień dotyczących zalecanych typów aktywności fizycznej u chorych ze szpiczakiem polecanych do wykonywania w domu [22]. wśród najczęściej pojawiających się aktywności wymienić można: Nordic walking, ćwiczenia rozciągające, siłowe z taśmami oporowymi [22], wytrzymałościowe, aerobowe o niskim lub średnim natężeniu [23]. ...
Article
In recent years, thanks to the use of novel treatment protocols based on new drugs and autologous bone marrow cells transplants, as well as more accurate diagnostic methods, there has been a significant increase in life expectancy of patients with multiple myeloma. Nowadays, this cancer can be considered a chronic disease, and there is hope for a permanent cure. Extending the patients' survival rates results in the increasing need for their broadly understood rehabilitation. Patients in remission stage of the disease expect an active lifestyle and also to return to their previous private and professional responsibilities. In response to these needs, it is necessary to develop unified guidelines for effective rehabilitation adapted to the specific needs of patients with multiple myeloma. Any actions taken should be individualized and adapted to the problems of a particular patient (myeloma bone disease, renal failure, complications of myeloma, of treatment and any accompanying conditions). Rehabilitation should be conducted by a team of specialists in various fields and focused on general improvement of patient’s functioning, which has a positive effect on the quality of life in all its aspects. Essential elements of rehabilitation are physiotherapy, occupational therapy, as well as health training adapted to the patients' capacity. Systematization of the approach to the rehabilitation of patients with myeloma and providing them with appropriate, safe care will significantly contribute to improving their comfort of life.
... Three randomized controlled trials [22][23][24] and one single-arm pilot study [25] investigating the effect of exercise in patients with MM have been conducted and summarized in the review by Gan et al. [7]. The exercise interventions comprised stretching, aerobic exercise, and strength resistance exercises [22][23][24][25], lasted between 18 and 26 weeks, and started either approximately 10 weeks after the start of induction [22][23][24] or after HDT-SCT [25]. ...
... Three randomized controlled trials [22][23][24] and one single-arm pilot study [25] investigating the effect of exercise in patients with MM have been conducted and summarized in the review by Gan et al. [7]. The exercise interventions comprised stretching, aerobic exercise, and strength resistance exercises [22][23][24][25], lasted between 18 and 26 weeks, and started either approximately 10 weeks after the start of induction [22][23][24] or after HDT-SCT [25]. The studies found exercise to be feasible and safe, whereas efficacy data showed mixed results. ...
... Three randomized controlled trials [22][23][24] and one single-arm pilot study [25] investigating the effect of exercise in patients with MM have been conducted and summarized in the review by Gan et al. [7]. The exercise interventions comprised stretching, aerobic exercise, and strength resistance exercises [22][23][24][25], lasted between 18 and 26 weeks, and started either approximately 10 weeks after the start of induction [22][23][24] or after HDT-SCT [25]. The studies found exercise to be feasible and safe, whereas efficacy data showed mixed results. ...
Article
Full-text available
Background: The study evaluated the feasibility and safety of the exercise intervention and physical test procedures of our ongoing randomized controlled trial, examining the effect of physical exercise in newly diagnosed patients with multiple myeloma. Methods: Patients are randomized 1:1 to a control group (usual care) or an intervention group (usual care and exercise) by block randomization with stratification of planned treatment, WHO performance status, and study site. The exercise intervention consists of eight supervised exercise sessions combined with home-based exercise over a 10-week period. Bone disease is systematically evaluated to determine limitations regarding physical testing and/or exercise. Feasibility outcome measures were study eligibility, acceptance, and attrition, and furthermore attendance, adherence, tolerability, and safety to the exercise intervention. Additionally, test completion, pain, and adverse events during the physical test procedures were evaluated. Outcome assessors were blinded to allocation. Results: Of 49 patients screened, 30 were included. The median age was 69 years, range 38-90, 77% were males, and 67% had bone disease. Study eligibility was 82%, acceptance 75%, and attrition 20%. Attendance at supervised exercise sessions was 92%, and adherence to supervised exercise sessions and home-based exercise sessions was 99% and 89%, respectively. No serious adverse events attributed to exercise or physical tests were reported. All patients completed the physical tests, except for two patients, where physical test procedures were modified due to bone disease. Discussion: The exercise intervention and physical test procedures were feasible and safe in patients with multiple myeloma, even in older patients with multiple myeloma and in patients with myeloma bone disease. Trial registration: ClinicalTrials.gov. ID NCT02439112. Registered on May 7, 2015.
... Exercise prior to AuSCT is safe and feasible [8,9]. Preliminary evidence demonstrates mitigation of the decline in aerobic capacity, muscle strength, HRQoL and increased fatigue that is experienced during conditioning, with the potential for improvements in post-transplant outcomes relating to survival, morbidity and resource utilisation [9,10]. Individualised nutrition interventions, coupled with exercise and psychological interventions are likely to be beneficial for this patient cohort [11]. ...
... The current study, conducted in real-world conditions, reports measurable improvements with allied health prehabilitation in functional exercise capacity, lower limb strength and function, grip strength, physical activity and HRQoL domains (fatigue and dyspnoea). This is consistent with two small studies in allogenic and AuSCT, where positive trends were found for prehabilitation in physical activity, physical function, HRQoL and fatigue [9,10] and a significant positive change in lean body weight [10]. Our findings should be interpreted with caution due to the absence of a control group. ...
... The current study, conducted in real-world conditions, reports measurable improvements with allied health prehabilitation in functional exercise capacity, lower limb strength and function, grip strength, physical activity and HRQoL domains (fatigue and dyspnoea). This is consistent with two small studies in allogenic and AuSCT, where positive trends were found for prehabilitation in physical activity, physical function, HRQoL and fatigue [9,10] and a significant positive change in lean body weight [10]. Our findings should be interpreted with caution due to the absence of a control group. ...
Article
Full-text available
PurposeEvaluate the impact of a new multidisciplinary allied health prehabilitation service in haematologic cancer patients receiving high-dose chemotherapy with autologous stem cell transplant (AuSCT).Methods In a tertiary cancer centre, 12 months of prospectively collected data was retrospectively analysed. Patients were referred to an allied health service for individualised exercise prescription, nutrition intervention and, if indicated through screening, psychological intervention. Impact and operational success were investigated using the RE-AIM framework: patient uptake of the service and sample representativeness (reach); effectiveness in terms of changes in outcomes from initial to pre-transplant assessment; adoption of the service by key stakeholders; fidelity of the prescribed exercise program (implementation); and the extent to which the new service had become routine practice (maintenance).ResultsOne hundred and eighty-three patients were referred to the AuSCT service over 12 months, of whom 133 (73%) were referred into the prehabilitation service, 128 (96%) were eligible and 116 (91%) participated. Patients were representative of Australian AuSCT patients. Eighty-nine patients reached pre-transplant assessment by data censoring; 6-min walk distance (n = 45/89, 51%) improved a mean (95% CI) of 39.9 m (18.8 to 61.0, p = < 0.005) from baseline. Fidelity of exercise prescription was moderate with 72% of eligible patients receiving the intended exercise interventions. The referral trend over time (maintenance) was high after the initiation period.Conclusion The prehabilitation service was well adopted by clinicians. Clinically relevant improvements in outcomes were demonstrated. Recommendations, including development of well-integrated discipline-specific assessment intervention and measurement protocols, are highlighted for service improvement. Prehabilitation should be routinely considered to support patients undergoing AuSCT.
... Exercise prior to AuSCT is safe and feasible [8,9]. Preliminary evidence demonstrates mitigation of the decline in aerobic capacity, muscle strength, HRQoL and increased fatigue that is experienced during conditioning, with the potential for improvements in post-transplant outcomes relating to survival, morbidity and resource utilisation [9,10]. Individualised nutrition interventions, coupled with exercise and psychological interventions are likely to be beneficial for this patient cohort [11]. ...
... The current study, conducted in real-world conditions, reports measurable improvements with allied health prehabilitation in functional exercise capacity, lower limb strength and function, grip strength, physical activity and HRQoL domains (fatigue and dyspnoea). This is consistent with two small studies in allogenic and AuSCT, where positive trends were found for prehabilitation in physical activity, physical function, HRQoL and fatigue [9,10] and a significant positive change in lean body weight [10]. Our findings should be interpreted with caution due to the absence of a control group. ...
... The current study, conducted in real-world conditions, reports measurable improvements with allied health prehabilitation in functional exercise capacity, lower limb strength and function, grip strength, physical activity and HRQoL domains (fatigue and dyspnoea). This is consistent with two small studies in allogenic and AuSCT, where positive trends were found for prehabilitation in physical activity, physical function, HRQoL and fatigue [9,10] and a significant positive change in lean body weight [10]. Our findings should be interpreted with caution due to the absence of a control group. ...
... Cunningham et al. (15) had carried out exercise training for the first time in patients with acute leukemia after bone marrow transplantation and proved that exercise training improved patients' physical function. After that, the number of reports of physical exercise programs as a non-pharmacologic adjuvant therapy has been increased before, during or after transplantation in HSCT patients (7,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Previous systematic reviews of Persoon (26) and van Haren et al. (27) have confirmed that exercise seems to have a beneficial effect on physical fitness, QOL and fatigue when compared with usual care in patients treated with a HSCT for a HM. ...
... Our initial search revealed a total of 5087 records, and the screening progress is shown in Fig. 1. Ten RCTs (16)(17)(18)(19)(20)(21)(22)(23)(24)(25) were ultimately included. Literature screening and quality assessment were conducted by two researchers, and the results of the methodological quality assessment are shown in Fig. 2. None of the studies was free from risk of bias. ...
... There are seven studies (16)(17)(18)(20)(21)(22)(23) Fig. 3B), no effect among patients starting exercise after transplantation (ES = 0.32, 95%CI = −0.50 to 1.14, Fig. 3B). ...
Article
Objectives: The objective of this meta-analysis is to systematically review the evidence on effects of exercise interventions in comparison to usual care with respect to physical fitness, fatigue, quality of life, anxiety and depression in hematopoietic stem cell transplantation patients for a hematological malignancies. And we are more focused on the optimal opportunity to exercise in hematopoietic stem cell transplantation recipients. Method: Databases were searched up to June 2018. We included randomized controlled trials comparing exercise with usual care in adult patients who had a hematologic malignancy. Standard mean differences were calculated and pooled to generate summary effect sizes and 95% confidence intervals. The Cochrane Collaboration Risk of Bias Tool was used to assess the methodological quality of the studies. Results: This meta-analysis showed that exercise had a positive effect on lower muscle strength, fatigue and quality of life and had no effects on patients' cardiorespiratory fitness, upper muscle strength, psychosocial fitness and adverse events. Subgroup analysis showed that exercise had a favorable effect on upper/lower muscle strength, fatigue and quality of life when starting exercise pre-transplant, but exercise had no effects, except on quality of life when starting exercise after transplant. And patients in the pre-transplant exercise group did not exercise more graft vs host disease events nor deaths. Conclusion: Therefore, we can conclude that the optimal timing for the hematopoietic stem cell transplantation recipients to begin exercise training is before transplantation.
... Studies evaluating the effect of physical exercise on skeletal muscle mass as a primary outcome in hematological cancer patients during active treatment are quite rare. Evidence of the effectiveness of physical exercise to improve skeletal muscle mass in hematological cancer was provided by a study of Coleman et al. (2003), demonstrating a higher muscle mass for multiple myeloma patients after a 12-week aerobic/resistance exercise program compared to a control group who only received advices for an active lifestyle (Coleman et al., 2003). In contrast, a mixed exercise program consisting of homebased, gym-based and group-based exercises showed no effect on fat-free mass index in myeloma patients (Groeneveldt et al., 2013). ...
... Studies evaluating the effect of physical exercise on skeletal muscle mass as a primary outcome in hematological cancer patients during active treatment are quite rare. Evidence of the effectiveness of physical exercise to improve skeletal muscle mass in hematological cancer was provided by a study of Coleman et al. (2003), demonstrating a higher muscle mass for multiple myeloma patients after a 12-week aerobic/resistance exercise program compared to a control group who only received advices for an active lifestyle (Coleman et al., 2003). In contrast, a mixed exercise program consisting of homebased, gym-based and group-based exercises showed no effect on fat-free mass index in myeloma patients (Groeneveldt et al., 2013). ...
... Many exercise studies were conducted with solid cancer patients, especially breast and prostate cancer patients that are relatively fit. However, treatment toxicities including anemia-induced fatigue, insomnia, and psychological distress hinders hematologic patients from regular exercise (Coleman et al., 2003). The high dropout rate in our physical exercise group of 59.1% underlines this difficulty. ...
Article
Full-text available
Patients undergoing the complex treatment for hematological malignancies are exposed to a high physiological and psychological distress inducing fatigue and physical inactivity. In line with cancer-related metabolic changes patients are predisposed for skeletal muscle mass loss that leads to a functional decline, affects therapeutic success, and quality of life. Benefits of physical exercise and nutritional interventions on muscle maintenance are observed in solid cancer patients, but marginally investigated in patients with hematological cancer. We here studied the effects of a combined supportive exercise and nutrition intervention using whole-body electromyostimulation (WB-EMS) training and individualized nutritional support in patients actively treated for hematological malignancy. In a controlled pilot trial, 31 patients (67.7% male; 58.0 ± 16.7 years) with various hematological cancers were allocated to a control group (n = 9) receiving nutritional support of usual care regarding a high protein intake (>1.0 g/kg/d) or to a physical exercise group (n = 22) additionally performing WB-EMS training twice weekly for 12 weeks. Bodyweight and body composition assessed by bioelectrical impedance analysis were measured every 4 weeks. Physical function, blood parameters, quality of life and fatigue were assessed at baseline and after 12 weeks. No WB-EMS-related adverse effects occurred. Patients attending the exercise program presented a higher skeletal muscle mass than controls after 12-weeks (1.51 kg [0.41, 2.60]; p = 0.008). In contrast, patients of the control group showed a higher fat mass percentage than patients of the WB-EMS group (-4.46% [-7.15, -1.77]; p = 0.001) that was accompanied by an increase in serum triglycerides in contrast to a decrease in the WB-EMS group (change ± SD, control 36.3 ± 50.6 mg/dl; WB-EMS -31.8 ± 68.7 mg/dl; p = 0.064). No significant group differences for lower limb strength, quality of life, and fatigue were detected. However, compared to controls the WB-EMS group significantly improved in physical functioning indicated by a higher increase in the 6-min-walking distance (p = 0.046). A combined therapeutic intervention of WB-EMS and protein-rich nutritional support seems to be safe and effective in improving skeletal muscle mass and body composition in hematological cancer patients during active oncological treatment.
... Randomized trials have demonstrated that the addition of a resistance training program to ADT therapy had many beneficial effects for PC patients and resulted in the mitigation of selected adverse effects. Studies comparing the impact of routine treatment on oncological patients with a specialized exercise program have shown a significant protective effect on the volume of muscle mass with the inclusion of a specialized exercise program (Battaglini et al. 2007, Coleman et al. 2003. ...
... Previously it has been shown, that a regular exercise program was effective in preventing muscle mass loss (Segal et al. 2009). Studies comparing the impact of routine treatment on oncological patients with a specialized exercise program have resulted in a significant protective effect on the volume of muscle mass with the inclusion of a specialized exercise program (Battaglini et al. 2007, Coleman et al. 2003, Collins et al. 2012. ...
Article
The randomized trials showed that the addition of training resistance program to androgen-deprivation therapy (ADT) had many beneficial effects for prostate cancer (PC) patients (significant protective effect on the volume of muscle mass) and the studies have revealed a panel of miRNAs, which are deregulate in PC and may serve as promising biomarkers of PC risk. The primary aim of our present study was to investigate the effect of exercise training to changes in body composition (muscle strength) and the secondary endpoint was to investigate the impact of an exercise training program on plasma levels of selected myogenic microRNAs (miRNAs) (miRNA-1, miRNA-29b, and miRNA-133) in PC patients undergoing the ADT. Effect of ADT and exercise intervention showed significant increase (experimental group vs. control group) the changes in body composition, free testosterone levels, IL-6 and plasma levels of myogenic miRNAs and significant reduced insulin serum levels. In conclusion, resistance training with ADT in the treatment of PC significantly changed the physical and metabolic function and the plasma levels of specific myogenic miRNAs. Our data support with the other publicized results.
... Due to bone manifestation of multiple myeloma and special clinical features (especially hypercalcemia and monoclonal gammopathy), a multiprofessional and interdisciplinary approach is required for planning and prescribing regular physical activity and exercise [2,[8][9][10][11][12]. Hereby, physical performance seems to be an important factor to identify which patients should receive an individual therapy or a therapy in an exercise group [11,[16][17][18][19]. Physical performance depends on endurance capacity, muscle strength and sensorimotor function. ...
... Patients with impaired subjective and objective walking performance should therefore be encouraged to at least maintain physical activity levels for as long as possible and perform suitable and supervised individual exercise to improve sensorimotor function, mobility, muscle strength, endurance capacity and independence from others' help. In comparison, exercise studies with multiple myeloma patients usually exclude patients with pathological fractures or increased risk of fractures [11,16,17]. Therefore, a multidisciplinary and interdisciplinary approach as described is necessary to manage the actual condition and to evaluate bone load-bearing capacity of this patient group [11,18,19]. ...
Article
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Purpose This pilot study aimed to describe physical performance, self-reported physical activity, health-related quality of life, anxiety and depression in patients who were assigned from Austrian self-help groups for multiple myeloma patients. These parameters were then discussed in the context of clinical decision-making concerning the recommended type of regular physical activity and exercise. Methods Members of the self-help groups were invited to participate. Physical performance and physical activity were assessed with the 6 min walk test (6MWT), handgrip strength test, timed up and go test (TUG), Tinetti performance oriented mobility assessment (POMA), falls efficacy scale (FES), international physical activity questionnaire (IPAQ), health-related quality of life (EORTC QLQ-C30) and the hospital anxiety and depression scale (HADS). Results A total of 40 patients (female:male = 15:25, mean age: 63.8 ± 9.0 years, range 41–80 years) were identified. In total 20 (50%) reached the performance of healthy peers in the tests 6MWT, handgrip strength, TUG and POMA, while 50% showed at least 1 result below the reference value or cut-off-point for each test. Self-reported activity levels were high. Patients showed a tendency to overestimate the risk of falling but a case by case analysis revealed a tendency for underestimating the actual performance in the respective tests (TUG, POMA). Conclusion The performance of healthy peers was reached by a substantial number of the participants in tests of physical performance and they reported high levels of physical activity. Nevertheless, they tended to overestimate the specific risk of falling. Patients with notably impaired physical performance might be suitable to perform regular physical activity and exercise in an individual therapy, whereas those with good physical performance are suited for training in exercise groups; however, individual contraindications and clinical considerations should be noted in a multiprofessional and interdisciplinary setting.
... The association found between regular PA and lower levels of fatigue is partially in line with previous data. 26 Coleman and colleagues observed a decrease in fatigue severity (although not statistically significant) in MM patients who practiced regular PA. 26 Interestingly, a recent RCT has shown that 3 months of regular PA was able to reduce fatigue in a population of MM survivors, even though further improvements were not found at 6 and 12 months. 44 Therefore, further prospective studies are needed to clarify the causal relationship between fatigue and PA in MM patients. ...
... The association found between regular PA and lower levels of fatigue is partially in line with previous data. 26 Coleman and colleagues observed a decrease in fatigue severity (although not statistically significant) in MM patients who practiced regular PA. 26 Interestingly, a recent RCT has shown that 3 months of regular PA was able to reduce fatigue in a population of MM survivors, even though further improvements were not found at 6 and 12 months. 44 Therefore, further prospective studies are needed to clarify the causal relationship between fatigue and PA in MM patients. ...
Article
Objectives To investigate whether physical activity (PA) is associated with health-related quality of life (HRQOL) outcomes in multiple myeloma (MM) survivors up to 11 years after diagnosis. Methods We used data from the Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship registry. We included 175 MM survivors diagnosed between 1999 and 2009 as registered by the Netherlands Cancer Registry. Sixty-four per cent (n=112/175) of patients who received the questionnaires, completed the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-MY20. Patients were classified into two groups: physically active and not physically active patients. Univariable and multivariable linear regression models were used to evaluate associations between PA and HRQOL outcomes. Results Physically active patients reported a statistically significant higher global health status/HRQOL (p=0.001), lower fatigue (p=0.002) and fewer side effects of treatments (p=0.001), than not physically active patients. PA was not associated with psychological symptoms (ie, anxiety and depressive symptoms) (anxiety: p=0.139; depressive symptoms: p=0.073). Exploratory analyses performed on the other scales of the EORTC QLQ-C30 indicated statistically significant better outcomes in several functional and symptom subscales for physically active patients. Conclusions These findings might contribute to a better understanding of the relationship between PA and disease specific HRQOL aspects in MM survivors. Prospective studies are warranted to further elucidate on the beneficial effects of PA on HRQOL outcomes of MM survivors.
... En particulier chez des patients traités par autogreffe de moelle osseuse, un programme de type aérobie a montré des bénéfices sur la fatigue et la détresse psychologique (Dimeo et al. 1999). Alors que la fatigue perçue par les patients atteints d'un cancer est assez peu corrélée au niveau de performances physiques, elle dépend essentiellement d'une détresse psychologique avec des niveaux élevés de dépression, d'anxiété et de somatisation (Dimeo et al. 1997 Cohen et al. 2004;Coleman et al. 2003;Courneya et al. 2009;Dimeo et al. 1996). Une revue systématique chez des patients greffés (autogreffe ou allogreffe) relève par ailleurs des effets positifs de l'AP selon les modalités d'exercice sur la qualité de vie, la fatigue et les capacités physiques des patients (Wiskemann 2013). ...
... Les programmes réalisés pendant l'hospitalisation montrent une stabilisation de la performance physique chez les sujets participant au programme par rapport aux sujets contrôles ; et pour les programmes qui se poursuivent après l'hospitalisation, les résultats montrent une amélioration des capacités physiques et notamment de la capacité aérobie. Les effets de l'AP sur la composition corporelle sont variables selon les études (Coleman et al. 2003;Courneya et al. 2009;Hayes et al. 2003) et certains résultats révèlent des effets possibles sur l'amélioration de la fonction immunitaire avec une diminution de la période de neutropénie et une augmentation du nombre de lymphocytes (Cunningham et al. 1986;Kim and Kim 2005 l'apex du coeur par le faisceau de His puis à l'ensemble des ventricules par les fibres de Purkinje, provoquant la contraction des deux ventricules (complexe QRS) puis leur repolarisation (onde T). Le tissu nodal, par la production et la conduction de l'influx nerveux, est ainsi responsable de la coordination de la contraction des différentes cavités du coeur. ...
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Introduction : Les cancers hématologiques sont de survenues brutales et nécessitent des traitements agressifs, notamment de la chimiothérapie intensive et parfois des greffes de cellules souches hématopoïétiques. Les répercussions induites par le cancer et ses traitements sont responsables d’une altération majeure de la qualité de vie, autant qu’une fatigue chronique et des difficultés de réadaptation sociales et professionnelles. Les programmes d’Activité Physique Adaptée (APA) en hématologie ont montré leur efficacité sur l’état physique et la fatigue principalement mais restent peu concluants sur les dimensions psycho-émotionnelles de la qualité de vie. Des recherches récentes en neuro-cardiologie ont par ailleurs montré les bénéfices d’un entraînement à la Cohérence Cardiaque (CC) sur l’équilibre du Système Nerveux Autonome (SNA) et sur l’état psycho-émotionnel. Méthode : Les travaux de recherche entrepris dans cette thèse ont pour objectifs d’évaluer les effets d’une intervention non-médicamenteuse sur la qualité de vie de patients adultes en post-traitement d’une hémopathie maligne. La récupération d’un équilibre physiologique est indexée par la Variabilité de la Fréquence Cardiaque (VFC), reconnue comme une fenêtre d’observation du SNA. Nous présentons quatre études : une étude expérimentale auprès de sujets sains pour mieux comprendre les mécanismes de la VFC lors d’une respiration lente et profonde ; une étude de faisabilité portant sur la mise en œuvre d’un programme APA en hématologie ; puis les résultats préliminaires d’un essai contrôlé randomisé évaluant les effets d’un programme combinant APA et CC sur la VFC, la qualité de vie, la fatigue et l’état anxiodépressif ; et enfin une étude qualitative évaluant le déroulement du programme et les effets des deux interventions. Résultats : Nos résultats montrent d’abord la faisabilité de l’APA et de la CC chez ces patients. Même si les résultats portant sur l’analyse de la VFC sont difficiles à interpréter avec précision, ils tendent à confirmer qu’une intervention en CC entraîne une stimulation du tonus vagal. L’évaluation qualitative nous apporte de nombreux éléments déterminants dans l’adéquation entre les interventions et les besoins singuliers des patients et dans leur efficacité sur l’optimisation d’un retour à une vie active et autonome. Discussion : Ces travaux de recherche apportent par de nouveaux faits expérimentaux, des éléments supplémentaires dans la compréhension des mécanismes de la CC et de ses applications en milieu clinique. D’autres expérimentations sont encore nécessaires pour approfondir nos connaissances dans le cadre d’une approche psychophysiologique en APA et cancer.
... Our data and findings of Pagnotti and co-workers using low intensity vibration in a murine model of myeloma confirm the rationale for using physical stimuli as a countermeasure for osteolytic bone disease in MM [21,22]. In clinical settings, exercise training has already been proven to be feasible in patients suffering from MM [32,33]. We recently showed that whole-body vibration exercise benefits physical fitness and bone turnover in patients with monoclonal gammopathy of undetermined significance, a precursor condition of MMBD [29]. ...
... To reduce the effects of polychromatic X-ray absorption, a polynomial beam hardening correction is routinely applied in the reconstruction algorithm of the Scanco vivaCT 40. Using Otsu's method [32], a global threshold of 688 mg hydroxyapatite (HA)/cm 3 (cortical) or 467 mg HA/cm 3 (trabecular) was used for separation of cortical and trabecular bone from background. As suggested [33], we measured the following cortical bone parameters: principal moments of inertia (I max , I min ); cortical bone area = cortical volume/(number of slices·slice thickness) (Ct.Ar); total cross-sectional area inside the periosteal envelope (Tt.Ar); cortical area fraction (Ct.Ar/Tt.Ar); cortical thickness (Ct.Th); cortical volumetric tissue mineral density (Ct.vTMD); pore volume (Po.V); cortical porosity area, determined as the difference of the total cross-sectional area and the cortical bone area minus the medullary area (Ct.Po); and cortical porosity fraction (Ct.Po%). ...
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Limiting bone resorption and regenerating bone tissue are treatment goals in myeloma bone disease (MMBD). Physical stimuli such as mechanical loading prevent bone destruction and enhance bone mass in the MOPC315.BM.Luc model of MMBD. It is unknown whether treatment with the Bruton’s tyrosine kinase inhibitor CC-292 (Spebrutinib), which regulates osteoclast differentiation and function, augments the anabolic effect of mechanical loading. CC-292 was administered alone and in combination with axial compressive tibial loading in the MOPC315.BM.Luc model for three weeks. However, neither CC-292 alone nor its use in combination with mechanical loading was more effective in reducing osteolytic bone disease or rescuing bone mass than mechanical stimuli alone, as evidenced by microCT and histomorphometric analysis. Further studies are needed to investigate novel anti-myeloma and anti-resorptive strategies in combination with physical stimuli to improve treatment of MMBD.
... Until now, only a few exercise studies analyzed skeletal muscle mass as a primary outcome in cancer patients and hardly any data are available for patients with advanced disease [46], who often show severe muscle wasting and malnutrition [4,47], and thus physical weakness as a result of multiple catabolic processes and oncological therapy [3,4,48,49]. In a systemic review by Stene et al., summarizing the effects of physical exercise on muscle status in cancer patients under treatment, 6 trials reported changes in muscle mass, but included only early-stage breast, prostate or hematological cancer [13,[50][51][52][53][54]. Two trials demonstrated an increase in the lean body mass in patients performing a combined aerobic/resistance training, and a decline in the usual care groups [52,53]. ...
... In a systemic review by Stene et al., summarizing the effects of physical exercise on muscle status in cancer patients under treatment, 6 trials reported changes in muscle mass, but included only early-stage breast, prostate or hematological cancer [13,[50][51][52][53][54]. Two trials demonstrated an increase in the lean body mass in patients performing a combined aerobic/resistance training, and a decline in the usual care groups [52,53]. Another trial reported a superior role of resistance training on lean body mass compared to aerobic exercise after a median of 17 weeks [54], while 3 trials did not reveal a significant effect [50]. ...
Article
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Background: Physical exercise and nutritional treatment are promising measures to prevent muscle wasting that is frequently observed in advanced-stage cancer patients. However, conventional exercise is not always suitable for these patients due to physical weakness and therapeutic side effects. In this pilot study, we examined the effect of a combined approach of the novel training method whole-body electromyostimulation (WB-EMS) and individualized nutritional support on body composition with primary focus on skeletal muscle mass in advanced cancer patients under oncological treatment. Methods: In a non-randomized controlled trial design patients (56.5% male; 59.9 ± 12.7 years) with advanced solid tumors (UICC III/IV, N = 131) undergoing anti-cancer therapy were allocated to a usual care control group (n = 35) receiving individualized nutritional support or to an intervention group (n = 96) that additionally performed a supervised physical exercise program in form of 20 min WB-EMS sessions (bipolar, 85 Hz) 2×/week for 12 weeks. The primary outcome of skeletal muscle mass and secondary outcomes of body composition, body weight and hand grip strength were measured at baseline, in weeks 4, 8 and 12 by bioelectrical impedance analysis and hand dynamometer. Effects of WB-EMS were estimated by linear mixed models. Secondary outcomes of physical function, hematological and blood chemistry parameters, quality of life and fatigue were assessed at baseline and week 12. Changes were analyzed by t-tests, Wilcoxon signed-rank or Mann-Whitney-U-tests. Results: Twenty-four patients of the control and 58 of the WB-EMS group completed the 12-week trial. Patients of the WB-EMS group had a significantly higher skeletal muscle mass (0.53 kg [0.08, 0.98]; p = 0.022) and body weight (1.02 kg [0.05, 1.98]; p = 0.039) compared to controls at the end of intervention. WB-EMS also significantly improved physical function and performance status (p < 0.05). No significant differences of changes in quality of life, fatigue and blood parameters were detected between the study groups after 12 weeks. Conclusions: Supervised WB-EMS training is a safe strength training method and combined with nutritional support it shows promising effects against muscle wasting and on physical function in advanced-stage cancer patients undergoing treatment. Trial registration: ClinicalTrials.gov NCT02293239 (Date: November 18, 2014).
... A review of the effects of exercise therapy alone in cancer patients found that the combination of aerobic exercise and resistance training 6,7 ) affected physical function and skeletal muscle mass. Still, the improvement in grip strength was slight (improvement rate 4%) 19 ) , and the improvement in skeletal muscle mass was less consistent, ranging from 0.4 to 3.1% 20,21) . Also, consistent efficacy of nutrition therapy as a single intervention in cancer patients 5) has not been demonstrated. ...
... The effect was to improve the nutritional status of the patient, such as BMI and SMI, and their physical functions during hospitalization. In particular, the improvement rate of SMI and grip strength exceeded the results of previous studies [19][20][21] , which was considered the effect of multidisciplinary treatment by the rehabilitation nutrition care process. ...
Article
Objectives: Patients with cancer cachexia have poor adherence to treatment, which affects their prognosis. Currently, there are many studies on the effects of rehabilitation on cancer cachexia, but there is a lack of evidence on the effects of nutrition therapy alone or in combination with rehabilitation and nutrition therapy. This article describes a case in which rehabilitation nutrition care process was effective in a patient with lung cancer who developed cancer cachexia. Methods: A 68-year-old woman was hospitalized for treatment of lung adenocarcinoma. The patient had moderate malnutrition, sarcopenia, and cachexia at the time of admission, so the authors intervened according to rehabilitation nutrition care process. The physiotherapist mainly prescribed resistance training and aerobic exercise, 40-60 minutes a day, 5-6 days a week. And the dietitian provided oral nutritional supplements (100 kcal, branched-chain amino acid: 3.0 g) in addition to hospital food and adjusted the patient's energy intake to 26.96-33.05 kcal/kg/day and protein intake to 1.07-1.14 g/kg/day. Outcomes: Comparing the initial evaluation with the discharge, nutritional status, such as body mass index and skeletal muscle mass, and physical functions, such as maximum grip strength, gait speed, and functional independence measure (motor items), were improved. Conclusions: Rehabilitation nutrition care process-based interventions may improve nutritional status and physical functions more than exercise therapy alone in patients with lung cancer cachexia.
... Only two small trials have explored the use of a pretransplant exercise in a myeloma only population undergoing ASCT, with mixed results. [20][21][22] In the first study, a feasibility study of 24 participants showed a significant increase in lean muscle mass in the exercise group. 20 The second study of 166 patients reported a decline in aerobic capacity and increased fatigue in both the experimental and control group, with no difference between groups after SCT. ...
... [20][21][22] In the first study, a feasibility study of 24 participants showed a significant increase in lean muscle mass in the exercise group. 20 The second study of 166 patients reported a decline in aerobic capacity and increased fatigue in both the experimental and control group, with no difference between groups after SCT. This study, reported in two papers, was also testing the effect of prophylactic epotin alfa therapy, a medical product that raises haemoglobin levels, alongside exercise and was therefore not solely assessing the efficacy of the prescribed exercise. ...
Article
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Introduction Myeloma, a blood cancer originating from plasma cells, is the most common indication for autologous stem cell transplantation (SCT). Patients with myeloma undergoing autologous SCT (ASCT) experience treatment-related morbidity and reduction in function and well-being for many months post-treatment. Interventions targeting physical functioning delivered prior to and during SCT have shown promising results in mixed haematological populations and may offer a non-pharmacological solution to physically optimising and preparing patients for SCT. The aim of this study is to investigate the feasibility of a physiotherapist-led exercise intervention as an integral part of the myeloma ASCT pathway at a UK tertiary centre. Methods and analysis PERCEPT is a single-site, pilot randomised controlled trial of an exercise intervention embedded within the myeloma ASCT pathway, compared with usual care. The primary study end points will be feasibility measures of study and intervention delivery including recruitment rates, acceptability of intervention, study completion rate and any adverse events. Secondary end points will evaluate differences between the exercise intervention group and the usual care control group in cancer-related fatigue, quality of life, functional capacity (6 min walk test; handheld dynamometry; a timed sit-to-stand test) and objective and self-reported physical activity. Outcomes will be assessed at four time points, approximately 6–8 weeks prior to SCT, on/around day of SCT, on discharge from SCT hospital admission and 12 weeks post-discharge. The exercise intervention comprises of partly supervised physiotherapist-led aerobic and resistance exercise including behaviour change techniques to promote change in exercise behaviour. The primary outcomes from the trial will be summarised as percentages or mean values with 95% CIs. Group differences for secondary outcomes at each time point will be analysed using appropriate statistical models. Ethics and dissemination This study has NHS REC approval (Camden and Kings Cross, 19/LO/0204). Results will be disseminated through publication and presentations at haematology and rehabilitation-related meetings. Trial registration number ISRCTN15875290 .
... The effect of exercise in cancer patients is well documented [19], as well as in the elderly [20]. In patients with MM physical training has been shown to be safe and feasible [21,22]. Furthermore, knowledge about whether and how patients with MM differ from other cancer populations would be helpful for clinical practice in the planning of exercise interventions. ...
Article
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Background: Multiple myeloma is a cancer in the bone marrow causing bone destruction. Patients experience various symptoms related to the disease and/or treatment, such as pain and fatigue, leading to poorer quality of life. The symptom burden might affect physical function and physical activity levels, posing a risk of physical deterioration. The aim was to investigate whether physical function in newly diagnosed patients with multiple myeloma differs from the reference values of the normal population and other cancer patients. Methods: The study is a cross sectional descriptive analysis of a prospective cohort of 100 patients newly diagnosed with multiple myeloma. Four physical function tests were carried out; Six-Minute-Walk-Test, Sit-to-Stand-Test, grip strength and knee extension strength. Age and gender specific results of physical function from the multiple myeloma population were compared to normative data and to data from other cancer populations. Results: Of the 100 patients included, 73% had bone disease and 55% received pain relieving medicine. Mean age was 67.7 years (SD 10.3). Patients with multiple myeloma had significantly poorer physical function compared to normative data, both regarding aerobic capacity and muscle strength, although not grip strength. No differences in physical function were found between patients with multiple myeloma and other cancer populations. Conclusions: Physical function in newly diagnosed Danish patients with multiple myeloma is lower than in the normal population. Exercise intervention studies are warranted to explore the value of physical exercise on physical function. Trial registration: ClinicalTrials.gov, ID NCT02439112, registered 8 May 2015.
... In addition, characteristics of multiple myeloma patients may have contributed to results. Coleman et al. [22] revealed that a home-based exercise program was effective in multiple myeloma patients, for increasing lean body weight and may be associated with decreased fatigue and mood improvement. Craike et al. [23] revealed that multiple myeloma patients tended to be interested in an exercise program, despite their low levels of physical activity, and Shallwani et al. [24] observed their high compliance with exercise. ...
Article
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Objective To investigate the effect of a rehabilitation program in terms of De Morton Mobility Index (DEMMI) score, in hematologic cancer patients after chemotherapy. Methods Hematologic cancer patients admitted for chemotherapy were reviewed. They received a rehabilitation program during their hospital stay. DEMMI score measurement was performed, before and after rehabilitation. Demographics, diagnosis, chemotherapy information, rehabilitation program duration, mortality, body mass index (BMI), and laboratory test results were collected. For analysis, patients were classified according to diagnosis (multiple myeloma, leukemia, and others), mortality, and additional chemotherapy. Results There was statistically significant improvement in DEMMI score of 10.1 points (95% confidence interval, 5.9–14.3) after rehabilitation. It was more evident in the multiple myeloma group, and they revealed less mortality. When patients were divided according to mortality, survivors received the program earlier, and in a shorter period than in mortality cases. Although survivors revealed higher initial DEMMI score, improvement after rehabilitation did not differ significantly. Conclusion In hematologic cancer patients, rehabilitation program was effective for recovery from deconditioning, revealing significant increase in DEMMI score. Multiple myeloma patients may be good candidates for rehabilitation. Rehabilitation could be sustained during chemotherapy and for high-risk patients.
... Multiple myeloma (MM) is a malignancy of plasma cells that normally reside in bone marrow, producing immunoglobulins (antibodies). In MM, the uncontrolled growth of these cells result in increased osteoclastic activity with the destruction of bone matrix leading to hypercalcemia and an increased risk of fracture [1]. According to the 2017 Canadian Cancer Statistics report, MM accounts for 1.6% of all new cases of cancer in men and 1.2% of all new cases of cancer in women [2]. ...
Article
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Background: Patients with multiple myeloma (MM) are often treated with chemotherapy, radiation, and, if indicated, autologous stem cell transplant. In addition to side effects of the treatment, patients with MM often have bone pain, pathological fractures, spinal cord compressions, fatigue, and muscle weakness, which negatively impact functional performance and quality of life. Currently, there are no related guidelines for safe and effective physiotherapy (PT) management. Accordingly, the aim of the present study is to develop guidelines for effective physiotherapy management of patients with MM by systematically reviewing and evaluating the available evidence followed by a consensus process to specifically describe the research questions as detailed below. Methods/design: Physiotherapy management guidelines for patients with multiple myeloma will be developed based on the results of a systematic search of the following databases: US National Library of Medicine Database (PubMed), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Elton B. Stephens Co. (EBSCO), Web of Science, Database of Abstracts of Reviews of Effects (DARE), Cochrane Database of Systematic Review, and Physiotherapy Evidence Database (PEDro). All articles will be screened for inclusion and exclusion criteria. Relevant potential articles will be identified and systematically reviewed for final phase of inclusion. Two independent reviewers will systematically review and analyze the quality of identified articles using standardized assessment tools. Scientific conclusions will be drawn and recommendations will be made based on a critical appraisal process. The guideline development will also be based on the team's judgment about the overall quality of the studies and a consensus process. Discussion: Draft guidelines will be developed in the form of action statements based on the strength of evidence and grades of recommendations. The draft guidelines will be reviewed internally by two independent reviewers using AGREE II and externally by a methodological expert from Evidence-Based Care - Cancer Care Ontario and will be sent to the Canadian Physiotherapy Association (CPA) for feedback from physiotherapists. Systematic review registration: PROSPERO CRD42017064056.
... Also, a number of quasi-experimental and small RCTs have evaluated the effect of EX interventions on sleep in this population [34][35][36][37][38]. Two reviews summarizing this literature have been published [39,40]. ...
Article
Study objectives Thirty to 60% of cancer patients have insomnia symptoms, a condition which may lead to numerous negative consequences and for which an efficacious management is required. This randomized controlled trial aimed to assess the efficacy of a 6-week home-based aerobic exercise program (EX) compared to that of a 6-week self-administered cognitive-behavioral therapy for insomnia (CBT-I) to improve sleep in cancer patients. Method Forty-one patients (78.1% female, mean age 57 years) with various types of cancer and having insomnia symptoms (Insomnia Severity Index [ISI] score ≥ 8) were randomized to the EX (n=20) or the CBT-I (n=21) groups. Measures were completed at pre- and post-treatment, as well as at 3- and 6-month follow-ups. Results The EX intervention was statistically inferior to CBT-I in reducing ISI scores at post-treatment but was non-inferior at follow-up. However, no significant group-by-time interaction was found on any outcome and both interventions led to a significant improvement of subjectively-assessed sleep impairments on the ISI, the Pittsburgh Sleep Quality Index (PSQI) and most sleep parameters from a daily sleep diary at post-treatment corresponding to medium to large time effects (ds > 0.50 for ISI, PSQI, sleep onset latency, wake after sleep onset, total wake time and sleep efficiency). Conclusion Both interventions produced significant improvements of sleep. However, EX was found to be significantly inferior to CBT-I in reducing ISI scores at post-treatment, which contradicts the initial non-inferiority hypothesis. These findings suggest that CBT-I remains the treatment of choice for cancer-related insomnia, although EX can lead to some beneficial effects. ClinicalTrials.gov Identifier NCT02774369 https://clinicaltrials.gov/ct2/show/NCT02774369?term=NCT02774369&rank=1
... This is in agreement with a study which designed a home based mixed resistanceaerobic exercise program for patients with multiple myeloma and bone lesions who were receiving high dose chemotherapy and stem cell transplantation. They found that this type of exercise could efficiently improve their symptoms (19). Moreover, a study examining quality of life, psychological well-being, physical fitness and time of hospitalization found that exercise could significantly improve physical fitness and quality of life in those patients. ...
Article
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Objectives: Improvement in cancer care increases life expectancy of patients with cancer, most of whom have experienced prolonged episodes of fatigue during and after their treatment. This has been found to reduce the quality of life and increase morbidity and mortality of such patients. Therefore, additional interventions are beneficial to improve overall quality of life as well as longevity. There is growing evidence that exercise is beneficial for oncology patients though improvements in their physical, physiological abilities and functions. The purpose of the present article is to evaluate the current evidence to determine if exercise could be used as a safe and effective medicine to reduce fatigue and improve quality of life in these patients. Methods: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL search engines were electronically searched and 21 empirical studies, published between 1995 and 2009, were located. Results: There is accumulative data in the literature supporting the effectiveness of exercise interventions on the physical and psychological wellbeing of patients with cancer. Exercise can improve muscle mass and strength and whole body oxygen uptake which are reduced during bed rest, infection and cancer treatments. Discussion: Growing evidence is now supporting the effectiveness of exercise on specific populations such as women suffering from breast cancer. However, the effect of exercise on other populations such as children and patients suffering from other types of cancers is vague. Therefore, more research is needed to define scientific evidence based rehabilitation protocols for oncology patients with different types of cancer.
... These impairments thus restrict patients' autonomy, QoL, and ultimately, their overall survival [13,14]. To counteract such declines, several studies investigated the effects of exercises during therapy [15][16][17][18]. There is ample evidence that physical exercise in form of aerobic or multimodal exercise programs (including moderate resistance exercises) is feasible and can positively influence patients' functional performance even during alloHCT [19][20][21][22]. ...
Article
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Patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) experience a considerable decline in physical and psycho-social capacity. Since whole body vibration (WBV) is known to efficiently stimulate the neuromuscular system and enhance cardiorespiratory fitness and muscle strength in frail individuals, we hypothesized that WBV would maintain various physical and psychological capacities in patients during alloHCT. Seventy-one patients were randomly allocated to either an intervention group (IG) doing WBV or an active control group (CG) doing mobilization exercises five times per week. We determined peak oxygen consumption (VO2peak) and maximum power, maximum strength, functional performance, body composition, quality of life (QoL), and fatigue. Tests were carried out before conditioning therapy, at hospital discharge and at day ± 180 (follow-up). As 18 patients did not participate in post-intervention assessment and follow-up data from 9 patients was not collectible, per-protocol (PP) analysis of 44 patients is presented. During hospitalization, WBV maintained maximum strength, height, and power output during jumping, as well as reported QoL, physical functioning, and fatigue level compared with mobilization. At follow-up, relative VO2peak (p = 0.035) and maximum power (p = 0.011), time and power performing chair-rising test (p = 0.022; p = 0.009), and reported physical functioning (p = 0.035) significantly increased in the IG, while fatigue decreased (p = 0.005). CG’s body cell mass and phase angle had significantly decreased at follow-up (p = 0.002; p = 0.004). Thus, WBV might maintain maximum strength, functional performance, QoL, and fatigue during alloHCT, while cardiorespiratory fitness might benefit from accelerated recovery afterwards.
... This feasibility study is unique in that a supervised physical fitness program was tested in the period prior to HSCT. Coleman et al. (2003), (2008) and Wiskemann et al. (2011) also started an exercise program before HSCT, but these programs were not supervised. The eligibility of 69% seems to be lower than the 79.5% in the RCT of Wiskemann et al. (2011), who studied the effects of an unsupervised exercise program also administered prior to HSCT. ...
Article
Purpose: This study explores the feasibility and preliminary effectiveness of an exercise program in people scheduled for hematopoietic stem cell transplantation (HSCT). Methods: In this controlled clinical trial, we compare pre-transplantation exercise to no exercise in the waiting period for an allogeneic of autologous HSCT. The supervised individually tailored exercise program (4-6 weeks) consisted of aerobic endurance, muscle strength, and relaxation exercises, administered twice a week in the period prior to HSCT. Feasibility was determined based on inclusion rate, attrition rate, adherence to intervention, safety, and satisfaction (0-10). Preliminary effectiveness was determined primarily by self-perceived physical functioning, quality of life (QOL), and fatigue. Secondary outcomes were global perceived effect (GPE), blood counts, hospital stay, and physical fitness. Results: Forty-six patients were eligible, of whom 29 (69%) participated: 14 in the intervention group and 15 in the control group. The adherence rate to training was 69%. No adverse events or injuries occurred. Satisfaction of training conditions was high (mean 9.2 ± 1.3). Positive (follow-up) trends in favor of the intervention group were found for self-perceived physical functioning, QOL, fatigue, GPE, blood counts, and hospital stay. Conclusion: Exercise prior to HSCT is safe and feasible, and positive trends suggest favorable preliminary effectiveness. Adherence to the exercise program needs to be optimized in a future trial.
... 38,39 Fati-gueUCope is a highly scalable, low cost, unsupervised exercise intervention for fatigue reduction that contrasts with other effective interventions that include supervised components, as noted in a recent meta-analysis. 40 Although other researchers have reported feasibility and the effect of aerobic exercise in patients with advanced cancer, 17,31,41,42 our study is notable for the large sample of patients with stage 4 cancers who completed our study. Those with metastatic disease participated in this study with no reported adverse effects. ...
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Aim Exercise can be an effective treatment for cancer-related fatigue, but exercise is not prescribed for many cancer patients. Our specific aim was to compare usual care and a tablet-based fatigue education and prescription program for effects on level of fatigue (primary outcome) and satisfaction with fatigue and amount of exercise (secondary outcomes). Methods In a four-week pretest/posttest randomized study, 279 patients with cancer completed a touch screen fatigue assessment and daily paper-based activity logs. The experimental group also had access to Fatigue UCope, a tablet-based multimedia education intervention focused on exercise as therapy for fatigue. Results In total, 94% of intervention group accessed Fatigue UCope. Controlling for baseline fatigue, compared to the usual-care group, the experimental group reported lower fatigue scores (P = .02). Neither satisfaction with fatigue nor exercise level was significantly different between groups, but not all activity logs were returned. None of the patients reported adverse effects. Conclusion Objective indicators of exercise are warranted in future studies to examine whether exercise is indeed the mechanism of the Fatigue UCope effect and determine the clinical utility of this intervention. This brief, engaging tablet-based multimedia education and prescription program has promise to help patients recognize the benefits of exercise to manage cancer-related fatigue.
... 지체장애인은 신체적 장애로 인해 움직임 이 제한적이고 낮은 신체활동량으로 인해 비만율이 높 게 나타났다 (Kim & Park, 2012). 따라서 지체장애인 을 대상으로 진행한 운동프로그램의 주요 목표는 체중, 체질량지수, 체지방 등 신체구성 및 총콜레스테롤, 중 성지방, 고밀도 지단백 콜레스테롤 등 혈액 지표 감소 가 대다수였으며, 이외 체력 및 정신건강 개선을 목표 로 진행되었다 (Kim & Min, 2018 (Zylowska, Ackerman, Yang, Futrell, Horton, Hale, & Smalley, 2008;Heywood, McCarthy, & Skinner, 2017;Coleman, Coon, Hall-Barrow, Richards, Gaylor, & Stewart, 2003). 또한 최소 6주 이상의 운동 에 참여해야 신체기능, 근력 증진 및 근비대를 기대할 ...
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The purpose of the study was to develop an individualized exercise program that consider the characteristics of individuals with physical disabilities and to verify the feasibility and safety of the exercise program. The exercise program was developed through literature review, twice experts panel discussions, preliminary interviews, assessments, and a six-week pilot study. The pilot study was a single group study of 12 persons with disabilities (mean age 51.77 years) for 60-minutes supervised exercise once a week and home-based exercise for 6 weeks. Height, weight, waist, thigh circumference, blood pressure, heart rate, muscle strength and range of motion were measured before and after the individualized exercise program. The results were as follows. There were no dropouts or injuries among the participants in the exercise program, and the exercise program conducted in the pilot study had a positive improvement in improving the body composition, strength, and range of motion. After 6 weeks of exercise program, muscle strength and range of motion improved significantly compared to preliminary measurement. Therefore, the individualized exercise program verified the feasibility, safety and effectiveness.
... Cancer-related fatigue, decreased physical functioning, and breathlessness are experienced with very high incidence and severity among people with MM, contributing to poor HRQoL [12]. Whilst aerobic exercise has been found to effectively reduce fatigue, enhance physical functioning, and increase cardiorespiratory fitness in other cancer populations [13], several randomized controlled trials [10,14,15] exploring its efficacy on these outcomes in patients with MM found no significant improvements. The aerobic exercise in these studies was prescribed at a moderate intensity. ...
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People with multiple myeloma (MM) are second only to people with lung cancer for the poorest reported health-related quality of life (HRQoL) of all cancer types. Whether exercise can improve HRQoL in MM, where bone pain and lesions are common, requires investigation. This trial aims to evaluate the efficacy of an exercise intervention compared with control on HRQoL in people with MM. Following baseline testing, people with MM (n = 60) will be randomized to an exercise (EX) or waitlist control (WT) group. EX will complete 12-weeks of supervised (24 sessions) and unsupervised (12 sessions) individualized, modular multimodal exercise training. From weeks 12–52, EX continue unsupervised training thrice weekly, with one optional supervised group-based session weekly from weeks 12–24. The WT will be asked to maintain their current activity levels for the first 12-weeks, before completing the same protocol as EX for the following 52 weeks. Primary (patient-reported HRQoL) and secondary (bone health and pain, fatigue, cardiorespiratory fitness, muscle strength, body composition, disease response, and blood biomarkers) outcomes will be assessed at baseline, 12-, 24- and 52-weeks. Adverse events, attendance, and adherence will be recorded and cost-effectiveness analysis performed. The findings will inform whether exercise should be included as part of standard myeloma care to improve the health of this unique population.
... The most common solid tumour groups investigated were cancers of colon or rectum (n = 15, 26%), lung (n = 12, 21%), and head and neck (n = 10, 17%). For studies in haematological cancers, 13 (52%) delivered exercise interventions during treatment [88][89][90][91][92][93][94][95][96][97][98][99][100], specifically stem-cell transplant or chemotherapy, four (16%) during and after treatment [25,[101][102][103] and eight (32%) after treatment [104][105][106][107][108][109][110][111]. In studies that enrolled adults with mixed cancer diagnoses, seven (29%) of these studies delivered interventions during cancer treatment [26, 38, 112-114, 131, 132], six (25%) during and after treatment [115][116][117][118][119]133], and 11 (46%) after treatment [120][121][122][123][124][125][126][127][128][129][130]. ...
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Background: The primary objective of this systematic review was to update our previous review on randomized controlled trials (RCTs) of exercise in cancers other than breast or prostate, evaluating: 1) the application of principles of exercise training within the exercise prescription; 2) reporting of the exercise prescription components (i.e., frequency, intensity, time, and type (FITT)); and 3) reporting of participant adherence to FITT. A secondary objective was to examine whether reporting of these interventions had improved over time. Methods: MEDLINE, EMBASE, CINAHL and SPORTDiscus databases were searched from 2012 to 2020. Eligible studies were RCTs of at least 4 weeks of aerobic and/or resistance exercise that reported on physiological outcomes relating to exercise (e.g., aerobic capacity, muscular strength) in people with cancer other than breast or prostate. Results: Eighty-six new studies were identified in the updated search, for a total of 107 studies included in this review. The principle of specificity was applied by 91%, progression by 32%, overload by 46%, initial values by 72%, reversibility by 7% and diminishing returns by 5%. A significant increase in the percentage of studies that appropriately reported initial values (46 to 80%, p < 0.001) and progression (15 to 37%, p = 0.039) was found for studies published after 2011 compared to older studies. All four FITT prescription components were fully reported in the methods in 58% of all studies, which was higher than the proportion that fully reported adherence to the FITT prescription components in the results (7% of studies). Reporting of the FITT exercise prescription components and FITT adherence did not improve in studies published after 2011 compared to older studies. Conclusion: Full reporting of exercise prescription and adherence still needs improvement within exercise oncology RCTs. Some aspects of exercise intervention reporting have improved since 2011, including the reporting of the principles of progression and initial values. Enhancing the reporting of exercise prescriptions, particularly FITT adherence, may provide better context for interpreting study results and improve research to practice translation.
... Several studies have focused on the physiological benefits of exercise, such as change in body composition, reduced fatigue, and improved blood cell counts, among individuals living with and undergoing treatment for MM (Table 1a). Overall, the available data demonstrates that exercise is feasible, safe, and may improve physical function, fatigue, mood, and sleep [26][27][28]. Further, it was found that exercise has profound physiologic benefits for patients such as reducing the discomfort and time burden of treatments such as transfusions [29]. ...
Article
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As the prognosis for multiple myeloma (MM) has significantly improved and patients remain on therapy longer, there is a need for supportive care interventions to optimize patient quality of life (QOL) and functional status over the course of cancer treatment. MM is characterized by a significant symptom burden and a relatively lower QOL compared to other cancers. This review evaluates the role of healthy lifestyle behaviors in improving both the physical functioning and psychological well-being of the MM population. We (1) describe the current literature on physical activity, weight management, diet, sleep, and substance use in the context of MM, (2) present important considerations for incorporating lifestyle factors into clinical practice, and (3) identify directions for future research. Developing MM-specific guidelines for modifiable lifestyle changes that take into account both the length of treatment and the unique disease features (i.e. osteolytic lesions and anemia) may provide a promising path for improved patient QOL and functioning.
... In the 'intensive' pathway for younger myeloma patients, a window of opportunity exists to offer prehabilitation between diagnosis and the commencement of ASCT -usually a period of 4-6 weeks but this can be longer -during which time stem cell harvesting takes place prior to admission for high dose conditioning chemotherapy. Coleman et al. [13] studied 24 myeloma patients undergoing a home based exercise programme during chemotherapy and stem cell transplantation and identified that no patient injured themselves and that the intervention had positive effects on lean body weight, fatigue and sleep disturbance. They experienced high attrition rates, with 42% of patients leaving the study before completion. ...
Article
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Evidence supports the benefits of exercise-based rehabilitation in promoting recovery in myeloma patients following autologous stem-cell transplantation (ASCT). However, ‘prehabilitation’ has never been evaluated prior to ASCT, despite evidence of effectiveness in other cancers. Utilising a mixed method approach the authors investigated the feasibility of a mixed strength and cardiovascular exercise intervention pre-ASCT. Quantitative data were collected to determine feasibility targets; rates of recruitment, adherence and adverse events, including 6 minute walking distance (6MWD) test and patient reported outcome measures (PROMs). Qualitative interviews were undertaken with a purposive sample of patients to capture their experiences of the study and the intervention. The authors recruited 23 patients who attended a mean percentage of 75% scheduled exercise sessions. However, retention rates were limited, with only 14/23 (62%) completing the programme. In these patients, the 6MWD increased from a mean of 346 to 451 m (i.e. by 105 m, 95% CI 62 to 148 m) with no serious adverse events. Whist participants found the exercise programme acceptable and reported improvement in their physical fitness and overall mental health and wellbeing prior to ASCT, the study identified challenges in hospital attendance for the prehabilitation schedule whilst receiving induction or re-induction chemotherapy. Evaluation of digitally-enhanced directed but remote prehabilitation models for this patient group is warranted. Trial registration number NCT03135925
... . 실제로 암, 장애 등 질환이 있는 경우 운동을 포함한 프로그램의 실현가능성과 안전성을 검증하는 연구를 먼저 진행하기도 한다 (Zylowska, Ackerman, Yang, Futrell, Horton, Hale, & Smalley, 2008;Heywood, McCarthy, & Skinner, 2017;Coleman, Coon, Hall-Barrow, Richards, Gaylor, & Stewart, 2003 (Humphries, Triplett-McBride, Newton, Marshall, Bronks, McBride, & Kraemer, 1999). 또한 하지 기능은 노인에게 치명적인 부상을 야기하는 낙상 (Society, Society, Of, & On Falls Prevention, 2001;Zheng, Pan, Hua, Shen, Wang, Zhang, & Yu, 2013)과도 밀접한 연관성이 있는데, 적절한 하지근력과 정적, 동적 민첩성은 노인들 의 낙상 위험을 최대 50%까지 줄일 수 있는 것으로 조사되었다 (Gillespie, Robertson, Gillespie, Sherrington, Gates, Clemson, & Lamb, 2012 (Rikli & Johns, 2013;Tozim, Furlanetto, Lorenzo França, Morcelli, & Navega, 2014 ...
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The purpose of the study was to determine the feasibility and safety of the a chair-based ballet(CBB) program consisting of a seat based on a seat and recommend availabilities in field. Total 29 elderly people participated for 1 time per weeks for 20 weeks at the A Dementia Center in Seoul from March to December 2019 and measured the lower strength, dynamic agility and flexibility required by the elderly in their independent lives. The results were as follows. First, the dropout rate of the program was 13.8%, and there were no injuries or side effects. Therefore, the feasibility and safety of the CBB program were verified. Second, the lower leg muscle strength and dynamic agility were significantly improved after 20 weeks of CBB program. Third, although the flexibility was improved, there was no statistically significant difference after 20 weeks of CBB program. In conclusion, the CBB program is an effective program for lower extremity-related physical functions of the elderly and is highly utilized on the site.
... 21,29 Also, the experimental exercise interventions reported in the literature generally lasts a minimum of 3 weeks and up to 36 weeks, and most interventions consists of a combination of aerobic, strengthening/resistance and flexibility exercises. 21,22,24,[27][28][29][30][31][32][33][34] These interventions are tailored to the patient's capacity and are administered under the supervision or with the counseling of a trained professional, usually a physical therapist. Depending on the cancer stage, interventions take place in the inpatient, outpatient or homebased setting. ...
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Introduction: Hematologic malignancies account for nearly 8% of new cancer diagnosis in Italy. Cancer-related fatigue (CRF) is one of the most distressing symptoms reported by patients with cancer. As CRF has a multifactorial etiology, physical activity and therapeutic education may be beneficial for managing CRF, both during and after cancer treatment. However, there is a lack of evidence specific to hematologic malignancies. This paper describes the protocol of a feasibility study on Therapeutic Education and Physical Activity (TEPA) intervention to support self-management of CRF in patients with hematologic malignancies. Methods: TEPA was addressed to newly diagnosed adult individuals with hematologic malignancy able to take part in a rehabilitation programme at the AUSL-IRCCS of Reggio Emilia. The protocol was developed in 2 phases. Phase I was an observational cohort study involving a convenience sample of 10 participants with the aim to evaluate the feasibility of the assessment schedule and to register longitudinal clinical data regarding CRF (FACIT-F), psychologic distress (NCCN Distress Thermometer), QoL (EORTC QLQ-C30), physical performance (TUG and 6MWT) and habitual level of physical activity during first months after diagnosis. Phase II (underway) is a feasibility randomized controlled trial (TEPA) involving a convenience sample of 40 participants and comparing 2 parallel active interventions (Therapeutic Education versus Therapeutic Education and Physical Activity) on top of usual care. The primary aim is to estimate the feasibility of TEPA, measured by the adherence rate to the intervention. Secondary aims are: to estimate the effect size of TEPA in terms of changes in CRF, psychological distress, QoL, physical performance and habitual level of physical activity (measured as in Phase I); to collect patient satisfaction, perception of usefulness of the TEPA intervention and data on long-term adherence to an active lifestyle. Data are collected in both phases at the time of diagnosis and then at 1-, 3- (completion of intervention) and 7-month follow-up. Discussion: Data on feasibility and effect size of TEPA will be analyzed upon completion of Phase II, allowing us to design a large, adequately powered RCT to verify the effectiveness of this intervention on CRF management in patients with hematologic cancer. Trial registration: clinicaltrials.gov; Trial registration number: NCT03403075.
... Thus, a second American College of Sports Medicine Roundtable was convened in 2018 to advance exercise recommendations and to develop more granular exercise prescriptions for distinct cancer-related health outcome [22]. Previous studies [23][24][25][26][27] have shown that ET programs can improve several clinical outcomes among haematological cancer patients. Some studies examined aerobic physical activity [28], other investigate the effects of a combined exercise (aerobic þ strength training) [29,30]. ...
Article
Lymphoma treatments can produce adverse effects leading to a reduced quality-of-life (QoL). Besides, in patients ≥65years, it can promote an accelerated geriatric decay. We conducted a prospective study on supervised Exercise-Training (ET), in consecutive, patients aged 18–80years, during anti-lymphoma treatments.16/30 (53%), median-age = 65.5y, participated to the ET sessions, this was the Interventional Group (IG); 14/30 (47%), median-age = 63y, were the Reference Group (RG). Both groups participated to the fitness and the QoL assessments, at baseline (T0), 3-months (T1) and 6-months (T2) after the start of chemotherapy. The adherence to the ET program was 50% (95% CI:36–64%). The IG showed substantial improvements compared to the CG in cardiorespiratory fitness (Cooper test) at both T1 and T2 and in all the functional domain of the QoL questionnaire (QLQ-C30) at T2. This study showed ET, during chemotherapy, is feasible and safe, even in patients ≥65 years. Furthermore, it may improve the provision of care.
Article
Older adults with Hematologic Malignancy (HM) are vulnerable to functional decline secondary to disease and treatment. Interventions for physical deconditioning, in concert with routine hematology care are limited. The feasibility of accrual, retention, and demand for an exercise intervention among a high-risk HM population was piloted. Methods Older adults with HM, on active treatment, with functional impairment were recruited prospectively to participate in a 6-month Otago Exercise Programme (OEP). Measures of motivation, self-efficacy, patient identified barriers to exercise, barriers to clinical trial enrollment, study satisfaction, and serious adverse events were captured. Results 63 patients were approached, 18 declined trial enrollment, 45 consented, 30 patients enrolled in the exercise program. The main barrier for trial enrollment was transportation/travel concerns (n = 15). Of the 45 consented participants, 8 (12.7%) dropped out due to clinical deterioration, 5 (7.9%) withdrew, and 2 (3.2%) were ineligible prior to exercise-intervention intiation. The median age was 75.5 years (range 62–83) with plasma cell dyscrasia (63%), non-Hodgkin lymphoma (20%) and leukemia (17%). Retention of the physical therapist (PT) led-OEP was 76.6% of patients (n = 23/30), and end-of-study retention was 66.7% (n = 20/30). Of the evaluable patients, 23/29 completed the PE-led OEP yielding a completion rate of 79%. Participants were extremely motivated (72.4%) and strongly intended (89.7%) to engage in regular physical activity. Exercising when tired increased from a median score of 50 at Visit 1 to 70 at Visit 2, but dropped significantly to 45 at Visit 3 (p < 0.001). Participants reported significantly lower self-efficacy to exercise over the next 6 months from Visit 1 to Visit 3 (p = 0.001). Conclusions Older patients with HM had higher completion of in-person, PT-led exercise compared to at-home, independent exercise. Older adults were motivated and found the program acceptable, yet the ability to sustain a structured exercise program was challenging due to changes in health status. ClinicalTrials.gov Identifier: NCT02791737
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Objective: Individuals with multiple myeloma (MM) often have reduced functional performance due to the cancer itself or as a direct side effect of cancer treatments. Physical therapy is a part of cancer rehabilitation; however, no guidelines are available to provide information and direction for physical therapists managing patients with MM. The goal of this guideline is to provide recommendations based on a systematic review and consensus process that physical therapists can use to manage patients with MM. Methods: A systematic review of the literature published until August 2018 was performed in eight databases with two independent reviewers assessing quality. Seventeen articles were identified as relevant and a draft guideline was developed in the form of action statements. A total of 10 physical therapists with hematology experience and 10 patients with MM were recruited for consensus process. A priori threshold of 80% agreement was used to establish a consensus for each statement. The draft guidelines were reviewed externally by four methodologists using the AGREE II tool and a stakeholder representing OH (Cancer Care Ontario) Program in Evidence Based Care (PEBC), McMaster University. The final guideline was reviewed and officially endorsed by the Canadian Physiotherapy Association. Results: A total of 30 action statements were developed that achieved consensus, indicating physical therapy recommendations based on physiological markers (ie, hemoglobin, platelet count), complete patient presentation, and the stage of medical treatment. Conclusion: These clinical practice guidelines were developed to aid physical therapists in implementing evidence-based and best-practice care for patients with MM in order to optimize rehabilitation outcomes.
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Introduction While myeloma is an incurable malignancy, developments in disease management have led to increased life expectancy in recent years. Treatment typically involves stem-cell transplantation. Increased survival rates equate to more patients living with the burden of both the disease and its treatment for increasing number of years, rendering myeloma a long-term condition. Evidence exists to demonstrate the benefits of exercise for patients recovering from stem-cell transplantation, and prehabilitation—exercise before treatment—has been shown to be effective in other disease areas. To date there has been no research into prehabilitation in patients with myeloma awaiting transplantation treatment. Our objective is to determine whether it is feasible to conduct a randomised controlled trial into pretransplant exercise for patients with multiple myeloma who are awaiting autologous stem-cell transplantation. Methods and analysis This mixed methods study identifies patients with diagnosis of multiple myeloma who have been assigned to the autologous transplantation list and invites them to participate in six weekly sessions of individualised, supervised exercise while awaiting transplantation. Quantitative data to determine feasibility targets include rates of recruitment, adherence and adverse events, and outcome measures including 6 min walking distance test and quality of life. Qualitative interviews are undertaken with a purposive sample of patients to capture their experiences of the study and the intervention. Ethics and dissemination Ethics committee approval has been obtained. Dissemination will be through open-access publications and presentations and will seek to reach multiprofessional bases as well as patients and carer groups, addressing the widespread interest in this area of research. Trial registration number NCT03135925; Pre-results.
Article
Recent advances in treatment have extended the survival of patients with multiple myeloma. This improvement in itself poses challenges because of the length of time that patients live with myeloma, its physical complications, and toxicities of treatment. Thus, improvements in maintaining quality of life are essential, and part of this challenge involves learning how to optimally use new therapeutic agents. Panobinostat is the first histone deacetylase inhibitor approved for the treatment of multiple myeloma. It is approved for use in combination with bortezomib and dexamethasone for the treatment of patients with relapsed or relapsed and refractory multiple myeloma who have received ≥ 2 previous regimens, including bortezomib and an immunomodulatory drug. In this review multiple myeloma-related symptoms and adverse events resulting from treatments for multiple myeloma are discussed, with a focus on adverse events related to histone deacetylase inhibitors and histone deacetylase inhibitor combinations. The contribution of myeloma to these adverse events is discussed as well as how these AEs can best be managed.
Article
Objectives Multiple myeloma (MM) is the second most common hematological malignancy. Progression free survival (PFS) and overall survival (OS) have substantially improved, nonetheless MM usually remains incurable. Patients with active disease may be affected by numerous comorbidities, including fatigue, depression and osteolytic lesions, which influence their quality of life (QoL). Albeit, it is known that exercising is beneficial for patients' QoL, few clinical trials are available in patients with MM. We therefore aimed to compare comorbidities and clinical outcome in physically active and inactive patients with MM. Material and Methods We defined physical activity according to WHO criteria (150 min of moderate activity and two sessions of resistance training/week). We matched 53 physically active patients with 53 controls (for age, gender, cytogenetics, disease stage, and therapy) and compared the cohorts for incidence of comorbidities/MM symptoms (osteolytic lesions, anemia, infections, fatigue, depression, Revised-Myeloma Comorbidity Index [R-MCI]) and clinical outcome (treatment tolerance, responses to therapy, PFS and OS) in a retrospective audit. All patients were newly diagnosed with MM and received autologous stem cell transplantations (ASCT) between 2001 and 2017. Results Physically active patients showed superior outcomes in R-MCI (p = 0.0005), fatigue (p = 0.0063), treatment tolerance (p = 0.0258) and hospital stays (p = 0.0072). Furthermore, they showed better treatment responses (p = 0.0366), especially complete remission (CR; p = 0.0018) as well as better OS and PFS. Conclusion Physical activity in patients with MM undergoing ASCT seemed associated with better overall clinical outcome. Randomized clinical trials are required to understand the benefits and devise strategies for improving exercising among patients with MM.
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Fizioterapija ima svoje mjesto u gotovo svim granama medicine, pa i kao dio liječenja bolesnika s malignim bolestima. U ovome se radu razmatra uloga fizioterapije u bolesnika s hematološkim malignim bolestima liječenih transplantacijom krvotvornih matičnih stanica. Prikazan je tijek liječenja transplantacijom krvotvornih matičnih stanica od pripreme za transplantaciju do razdoblja nakon transplantacije te problemi i komplikacije koje se pritom javljaju. Liječenje transplantacijom praćeno je nizom komplikacija kao što su promjene na muskoloskeletnom sustavu te na kardiovaskularnom i respiratornom sustavu. Posebno je izražen problem akutne i kronične reakcije transplantata protiv primatelja (graft versus host disease, GvHD). Način liječenja kojem je bolesnik podvrgnut i sve komplikacije rezultiraju raznolikim ozbiljnim tjelesnim promjenama koje utječu na fizičko stanje i kvalitetu života bolesnika, pa i na krajnji ishod liječenja. Fizioterapija tih bolesnika iznimno je važna u svakom trenutku liječenja, a njezini učinci na kvalitetu života bolesnika, smanjenje komplikacija i konačni ishod liječenja relativno su slabo istraženi. Zbog specifičnoga stanja i komplikacija nakon transplantacije hematološkim je bolesnicima potreban jedinstven i složen pristup u fizioterapijskim procedurama. Međutim, ne postoje jasna uputstva i protokoli koje bi fizioterapeuti nužno slijedili i provodili u bolesnika liječenih transplantacijom krvotvornih matičnih stanica. Opisana su dosadašnja iskustva i navedeni mogući pristupi fizioterapiji tih bolesnika.
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Background: Monoclonal antibodies (mAbs) that target the programmed cell death-1 (PD-1)/programmed death-ligand 1 (PD-L1) immune checkpoint have demonstrated substantial clinical benefit for a variety of solid tumors. However, their applications in patients with hepatocellular carcinoma (HCC) are reported with unclear molecular mechanisms. Here, we report a novel mouse anti-human PD-1 mAb that can reverse the immunosuppressive effect of HePG2 cells on Jurkat cells. Materials and methods: HepG2 liver cancer cells, which were induced to overexpress PD-L1 by IFN-γ, were co-cultured with PHA-activated Jurkat lymphocytic cells to investigate the immunostimulative effect and mechanisms of the 14 newly generated PD-1 mAbs. Multiple cellular and molecular biology experiments were performed in this study, such as CCK-8, ELISA, flow cytometry, immunofluorescence and Western blot. Results: We found that mAb B1C4 significantly enhanced the tumor-killing cytokine secretion level by Jurkat cells in the co-culture system and increased the killing ability of Jurkat cells on HepG2 cells. Co-culture with HePG2 cells led to Jurkat cell cycle delay in S phase, and B1C4 promoted cell cycle progression from S to G2/M. Co-culture with HePG2 cells also caused apoptosis in Jurkat cells, which was inhibited by B1C4. B1C4 reversed the immunosuppression of Jurkat cells resulted from co-cultured with HePG2 cells through inhibiting PTEN and activating PI3K/AKT/mTOR signaling pathways. Conclusion: Our study demonstrated that anti-PD-1 mAb B1C4 could inhibit the apoptosis of Jurkat cells induced by HePG2 hepatoma cells and reverse the immunosuppressive effect of HePG2 cells on Jurkat cells. The study provides a vital basis for applying PD-1 monoclonal antibodies in the treatment of HCC and provides antibody selection for the development of novel PD-1 mAb with blocking activity.
Preprint
Background: Frailty is a common but underdiagnosed syndrome among long-term survivors of allogeneic hematopoietic cell transplantation (HCT). Conditions such as malnutrition, fatigue, and weakness may suggest frailty despite patients not receiving a formal diagnosis. Furthermore, the optimal interventions to overcome frailty in long-term survivors of allogeneic HCT is not yet established. Patients and Methods: This study consists of a retrospective and prospective component. First, we completed a retrospective review using diagnosis data from the electronic medical record to estimate the prevalence of components of frailty in 1077 recipients of allogeneic HCT through 5 years post-transplant. Second, we developed a community-based pilot study of strength training for long-term survivors of allogeneic HCT that addressed several common barriers exercise engagement and adherence. Four allogeneic HCT recipients (2 males, 2 females) and 4 controls (2 males, 2 females) completed the strength training pilot study, consisting of a baseline assessment, 10 weeks of personalized and supervised strength programming at least once weekly as a group, and an end-of-study assessment to measure progress in strength, body composition, and a standardized measure of self-efficacy. Results: Despite a lack of a formal diagnosis, approximately 80% of HCT recipients in this series received a diagnosis of a component of frailty (weakness, fatigue, or malnutrition), and over 1/3 of HCT recipients had symptoms extending beyond 1 year. Over the course of the strength training pilot study, both pre-frail/frail allogeneic HCT recipients and healthy controls doubled their total strength, lost body fat, and gained muscle mass. Self-efficacy improved from baseline in allogeneic HCT recipients after the strength training pilot program. Discussion: Based upon the prevalence of frailty-related diagnoses among long-term survivors of HCT, a comprehensive mitigation strategy needs to be developed for this population. A community-based strength training program that includes a personalized component, a group setting, and caregiver/partner involvement appears feasible and overcomes several established barriers to exercise engagement and adherence.
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Background: People undergoing multimodal cancer treatment are at an increased risk of adverse events. Physical fitness significantly reduces following cancer treatment, which is related to poor postoperative outcome. Exercise training can stimulate skeletal muscle adaptations, such as increased mitochondrial content and improved oxygen uptake capacity may contribute to improved physical fitness. Objectives: To determine the effects of exercise interventions for people undergoing multimodal treatment for cancer, including surgery, on physical fitness, safety, health-related quality of life (HRQoL), fatigue, and postoperative outcomes. Search methods: We searched electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, SPORTDiscus, and trial registries up to October 2018. Selection criteria: We included randomised controlled trials (RCTs) that compared the effects of exercise training with usual care, on physical fitness, safety, HRQoL, fatigue, and postoperative outcomes in people undergoing multimodal cancer treatment, including surgery. Data collection and analysis: Two review authors independently selected studies, performed the data extraction, assessed the risk of bias, and rated the quality of the studies using Grading of Recommendation Assessment, Development, and Evaluation (GRADE) criteria. We pooled data for meta-analyses, where possible, and reported these as mean differences using the random-effects model. Main results: Eleven RCTs were identified involving 1067 participants; 568 were randomly allocated to an exercise intervention and 499 to a usual care control group. The majority of participants received treatment for breast cancer (73%). Due to the nature of the intervention, it was not possible to blind the participants or personnel delivering the intervention. The risk of detection bias was either high or unclear in some cases, whilst most other domains were rated as low risk. The included studies were of moderate to very low-certainty evidence. Pooled data demonstrated that exercise training may have little or no difference on physical fitness (VO2 max) compared to usual care (mean difference (MD) 0.05 L/min-1, 95% confidence interval (CI) -0.03 to 0.13; I2 = 0%; 2 studies, 381 participants; low-certainty evidence). Included studies also showed in terms of adverse effects (safety), that it may be of benefit to exercise (8 studies, 507 participants; low-certainty evidence). Furthermore, exercise training probably made little or no difference on HRQoL (EORTC global health status subscale) compared to usual care (MD 2.29, 95% CI -1.06 to 5.65; I2 = 0%; 3 studies, 472 participants; moderate-certainty evidence). However, exercise training probably reduces fatigue (multidimensional fatigue inventory) compared to usual care (MD -1.05, 95% CI -1.83 to -0.28; I2 = 0%; 3 studies, 449 participants moderate-certainty evidence). No studies reported postoperative outcomes. Authors' conclusions: The findings should be interpreted with caution in view of the low number of studies, the overall low-certainty of the combined evidence, and the variation in included cancer types (mainly people with breast cancer), treatments, exercise interventions, and outcomes. Exercise training may, or may not, confer modest benefit on physical fitness and HRQoL. Limited evidence suggests that exercise training is probably not harmful and probably reduces fatigue. These findings highlight the need for more RCTs, particularly in the neoadjuvant setting.
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Hematopoietic stem cell transplantation (HSCT) is a standard treatment for several malignancies, and >50,000 HSCT are performed annually worldwide. As survival after HSCT improves, cardiovascular disease and associated risk factors have gained importance as a significant cause of morbidity and mortality in this cohort. In this article, we detail the risk factors for cardiovascular disease and their impact in patients undergoing HSCT. Additionally, we critically review the data on the impact of physical exercise in patients undergoing HSCT. Although limited by significant heterogeneity in methodologies, small sample sizes, attrition, and lack of long-term cardiovascular follow-up, most of these studies reinforce the beneficial effects of physical activity and exercise in this patient population. Cardiac rehabilitation (CR) is a structured exercise and lifestyle modification program that is typically instituted in patients who experience acute cardiovascular events. We review the data on CR in the oncologic and nononcologic populations with an aim of building a framework for use of CR in HSCT patients.
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Background: Although people with haematological malignancies have to endure long phases of therapy and immobility, which is known to diminish their physical performance level, the advice to rest and avoid intensive exercises is still common practice. This recommendation is partly due to the severe anaemia and thrombocytopenia from which many patients suffer. The inability to perform activities of daily living restricts them, diminishes their quality of life and can influence medical therapy. Objectives: In this update of the original review (published in 2014) our main objective was to re-evaluate the efficacy, safety and feasibility of aerobic physical exercise for adults suffering from haematological malignancies considering the current state of knowledge. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2018, Issue 7) and MEDLINE (1950 to July 2018) trials registries (ISRCTN, EU clinical trials register and clinicaltrials.gov) and conference proceedings. We did not apply any language restrictions. Two review authors independently screened search results, disagreements were solved by discussion. Selection criteria: We included randomised controlled trials (RCTs) comparing an aerobic physical exercise intervention, intending to improve the oxygen system, in addition to standard care with standard care only for adults suffering from haematological malignancies. We also included studies that evaluated aerobic exercise in addition to strength training. We excluded studies that investigated the effect of training programmes that were composed of yoga, tai chi chuan, qigong or similar types of exercise. We also excluded studies exploring the influence of strength training without additive aerobic exercise as well as studies assessing outcomes without any clinical impact. Data collection and analysis: Two review authors independently screened search results, extracted data and assessed the quality of trials. We used risk ratios (RRs) for adverse events, mortality and 100-day survival, standardised mean differences (SMD) for quality of life (QoL), fatigue, and physical performance, and mean differences (MD) for anthropometric measurements. Main results: In this update, nine trials could be added to the nine trials of the first version of the review, thus we included eighteen RCTs involving 1892 participants. Two of these studies (65 participants) did not provide data for our key outcomes (they analysed laboratory values only) and one study (40 patients) could not be included in the meta-analyses, as results were presented as changes scores only and not as endpoint scores. One trial (17 patients) did not report standard errors and could also not be included in meta-analyses. The overall potential risk of bias in the included trials is unclear, due to poor reporting.The majority of participants suffered from acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML), malignant lymphoma and multiple myeloma, and eight trials randomised people receiving stem cell transplantation. Mostly, the exercise intervention consisted of various walking intervention programmes with different duration and intensity levels.Our primary endpoint overall survival (OS) was only reported in one of these studies. The study authors found no evidence for a difference between both arms (RR = 0.67; P = 0.112). Six trials (one trial with four arms, analysed as two sub-studies) reported numbers of deceased participants during the course of the study or during the first 100 to 180 days. For the outcome mortality, there is no evidence for a difference between participants exercising and those in the control group (RR 1.10; 95% CI 0.79 to 1.52; P = 0.59; 1172 participants, low-certainty evidence).For the following outcomes, higher numbers indicate better outcomes, with 1 being the best result for the standardised mean differences. Eight studies analysed the influence of exercise intervention on QoL. It remains unclear, whether physical exercise improves QoL (SMD 0.11; 95% CI -0.03 to 0.24; 1259 participants, low-certainty evidence). There is also no evidence for a difference for the subscales physical functioning (SMD 0.15; 95% CI -0.01 to 0.32; 8 trials, 1329 participants, low-certainty evidence) and anxiety (SMD 0.03; 95% CI -0.30 to 0.36; 6 trials, 445 participants, very low-certainty evidence). Depression might slightly be improved by exercising (SMD 0.19; 95% CI 0.0 to 0.38; 6 trials, 445 participants, low-certainty evidence). There is moderate-certainty evidence that exercise probably improves fatigue (SMD 0.31; 95% CI 0.13 to 0.48; 9 trials, 826 patients).Six trials (435 participants) investigated serious adverse events. We are very uncertain, whether additional exercise leads to more serious adverse events (RR 1.39; 95% CI 0.94 to 2.06), based on very low-certainty evidence.In addition, we are aware of four ongoing trials. However, none of these trials stated, how many patients they will recruit and when the studies will be completed, thus, potential influence of these trials for the current analyses remains unclear. Authors' conclusions: Eighteen, mostly small RCTs did not identify evidence for a difference in terms of mortality. Physical exercise added to standard care might improve fatigue and depression. Currently, there is inconclusive evidence regarding QoL, physical functioning, anxiety and SAEs .We need further trials with more participants and longer follow-up periods to evaluate the effects of exercise intervention for people suffering from haematological malignancies. To enhance comparability of study data, development and implementation of core sets of measuring devices would be helpful.
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BACKGROUND Changes in N-linked glycosylation have been observed in the circulation of individuals with hepatocellular carcinoma. In particular, an elevation in the level of core fucosylation has been observed. However, the mechanisms through which core fucose is increased are not well understood. We hypothesized that a review of the literature and related bioinformatic review regarding six genes known to be involved in the attachment of core fucosylation, the synthesis of the fucosylation substrate guanosine diphosphate (GDP)-fucose, or the transport of the substrate into the Golgi might offer mechanistic insight into the regulation of core fucose levels. AIM To survey the literature to capture the involvement of genes regulating core Nlinked fucosylation in hepatocellular carcinoma METHODS The PubMed biomedical literature database was searched for the association of hepatocellular carcinoma and each of the core fucose-related genes and their protein products. We also queried The Cancer Genome Atlas Liver hepatocellular carcinoma (LIHC) dataset for genetic, epigenetic and gene expression changes for the set of six genes using the tools at cBioportal. RESULTS A total of 27 citations involving one or more of the core fucosylation-related genes (FPGT, FUK, FUT8, GMDS, SLC35C1, TSTA3) and hepatocellular carcinoma were identified. The same set of gene symbols was used to query the 371 patients with liver cancer in the LIHC dataset to identify the frequency of mRNA over or under expression, as well as non-synonymous mutations, copy number variation and methylation level. Although all six genes trended to more samples displaying over expression relative to under-expression, it was noted that a number of tumor samples had undergone amplification of the genes of the de novo synthesis pathway, GMDS (27 samples) and TSTA3 (78 samples). In contrast, the other four genes had undergone amplification in 2 or fewer samples. CONCLUSION Amplification of genes involved in the de novo pathway for generation of GDPfucose, GMDS and TSTA3, likely contributes to the elevated core fucose observed in hepatocellular carcinoma.
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This survey was designed to confirm the prevalence and duration of fatigue in the cancer population and to assess its physical, mental, social, and economic impacts on the lives of patients and caregivers. Patients and Methods. A 25-minute telephone interview was completed with 379 cancer patients having a prior history of chemotherapy. Patients were recruited from a sample of 6, 125 households in the United States identified as having a member with cancer. The median patient age was 62 years, and 79% of respondents were women. Patients reporting fatigue at least a few times a month were asked a series of questions to better describe their fatigue and its impact on quality of life. Seventy-six percent of patients experienced fatigue at least a few days each month during their most recent chemotherapy; 30% experienced fatigue on a daily basis. Ninety-one percent of those who experienced fatigue reported that it prevented a "normal" life, and 88% indicated that fatigue caused an alteration in their daily routine. Fatigue made it more difficult to participate in social activities and perform typical cognitive tasks. Of the 177 patients who were employed, 75% changed their employment status as a result of fatigue. Furthermore, 65% of patients indicated that their fatigue resulted in their caregivers taking at least one day (mean, 4.5 days) off work in a typical month. Physicians were the health care professionals most commonly consulted (79%) to discuss fatigue. Bed rest/ relaxation was the most common treatment recommendation (37%); 40% of patients were not offered any recommendations. Cancer-related fatigue is common among cancer patients who have received chemotherapy and results in substantial adverse physical, psychosocial, and economic consequences for both patients and caregivers. Given the impact of fatigue, treatment options should be routinely considered in the care of patients with cancer.
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Purpose: To describe the occurrence of fatigue in a large sample of breast cancer survivors relative to general population norms and to identify demographic, medical, and psychosocial characteristics of fatigued survivors. Patients and methods: Breast cancer survivors in two large metropolitan areas completed standardized questionnaires as part of a survey study, including the RAND 36-item Health Survey, Center for Epidemiological Studies-Depression Scale, Breast Cancer Prevention Trial Symptom Checklist, Medical Outcomes Study Sleep Scale, and demographic and treatment-related measures. Results: On average, the level of fatigue reported by the breast cancer survivors surveyed (N = 1,957) was comparable to that of age-matched women in the general population, although the breast cancer survivors were somewhat more fatigued than a more demographically similar reference group. Approximately one third of the breast cancer survivors assessed reported more severe fatigue, which was associated with significantly higher levels of depression, pain, and sleep disturbance. In addition, fatigued women were more bothered by menopausal symptoms and were somewhat more likely to have received chemotherapy (with or without radiation therapy) than nonfatigued women. In multivariate analyses, depression and pain emerged as the strongest predictors of fatigue. Conclusion: Although the majority of breast cancer survivors in this large and diverse sample did not experience heightened levels of fatigue relative to women in the general population, there was a subgroup of survivors who did report more severe and persistent fatigue. We identified characteristics of these women that may be helpful in elucidating the mechanisms underlying fatigue in this population, as well as directing intervention efforts.
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This study investigated the characteristics, course, and correlates of fatigue in women receiving adjuvant chemotherapy for breast cancer. Fifty-four patients were assessed before the start of chemotherapy and during the first three treatment cycles. An age-matched sample of women with no cancer history was assessed at similar time intervals for comparison purposes. Results indicated that breast cancer patients experienced worse fatigue than women with no cancer history. These differences were evident before and after patients started chemotherapy. In addition, fatigue worsened among patients after treatment started. More severe fatigue before treatment was associated with poorer performance status and the presence of fatigue-related symptoms (e.g., sleep problems and muscle weakness). Increases in fatigue after chemotherapy started were associated with continued fatigue-related symptoms and the development of chemotherapy side effects (e.g., nausea and mouth sores). These findings demonstrate the clinical significance of fatigue in breast cancer patients before and during adjuvant chemotherapy treatment. Results also suggest that aggressive management of common side effects, such as nausea and pain, may be useful in relieving chemotherapy-related fatigue.
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Data on the widely used Profile of Mood States (POMS) are presented for 923 recently diagnosed, previously untreated cancer patients. The patients' responses to the POMS were significantly different from those of other groups on which normative data are currently available. Therefore, the authors recommend that investigators who are conducting empirical studies of mood in patients with cancer use the tables in this article rather than previously published test norms on college students and psychotherapy patients.
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Skeletal muscle is a clinically important body composition component which at present is difficult to quantify in vivo. Previous studies suggest that measured appendicular resistance at 50 kHz can be used to predict extremity skeletal muscle mass, although accurate technician placement of multiple gel electrodes is required. In the present study we developed a new bioimpedance analysis (BIA) electrode stand designed for rapid whole-body and segmental resistance and reactance measurements. The new system incorporates stainless steel hand and foot contact electrodes in place of gel electrodes and employes a previously reported lead placement algorithm for deriving extremity resistances without the need for placing conventional proximal limb gel electrodes. This report describes the new electrode system's design and examines the relationships between contact and gel electrode-measured resistance and between appendicular resistance measured with the recently reported lead placement algorithm and conventionally placed segmental electrodes. Results in healthy adults demonstrate high correlations between contact and gel electrodes (e.g., hand-to-hand, N = 12, r = 0.994,P < 0.001) and between segmental resistance measured by the recently reported approach and conventionally-measured segmental resistance(e.g., right arm, N = 13, r = 0.997, P < 0.001). These results strongly support the validity of the new electrode system's resistance measurements and suggests the feasibility of developing a BIA system for rapidly measuring extremity skeletal muscle mass.
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Conventional single frequency bioimpedance analysis (BIA) systems require technician placement of arm and leg gel electrodes, a suitable location for recumbent measurements, and a separate measurement of body weight. The aim of this study was to evaluate a new single frequency 50 kHz leg-to-leg bioimpedance analysis (BIA) system combined with a digital scale that employs stainless steel pressure-contact foot pad electrodes for standing impedance and body weight measurements. Healthy adults were evaluated for 1) electrode validity and 2) potential for body component estimation. Pressure-contact foot-pad electrode measured impedance was highly correlated with (N= 9, r = 0.99, P < 0.001) impedance measured using conventional gel electrodes applied to the plantar surface of both lower extremities; mean(±SD) impedance was systematically higher by about 15 ohms for pressure contact electrodes (526 ± 56 ohms vs 511 ± 59 ohms; P< 0.001). Second, the relationship between stature-adjusted leg-to-leg impedance (H2/Z) measured by the new system and two body composition components (total body water by 3H2O dilution (N = 144); and fat-free body mass, by underwater weighing and dual x-ray absorptiometry (N = 231)) was modeled using multiple regression analysis. Correlation coefficients for H2/Z alone versus body composition components were lower for leg-to-leg BIA than for arm-to-leg BIA: correlation coefficients and SEEs became similar for the leg-to-leg and arm-to-leg BIA systems with addition of three covariates (age, gender, and waist/hip circumference ratio) to regression models. The leg-to-leg pressure contact electrode BIA system has overall performance characteristics for impedance measurement and body composition analysis similar to conventional arm-to-leg gel electrode BIA and offers the advantage of increased speed and ease of measurement.
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We examined sleeping problems in women with metastatic breast cancer in relation to depression, social support, and salivary cortisol. Ninety-seven women with metastatic breast cancer were drawn from a larger study on the effects of group therapy on quality of life and survival. This study is based on the baseline assessments conducted prior to randomization into treatment conditions. Sleep, depression symptoms, and social support were assessed by self-reporting. Cortisol was assessed from saliva samples taken over a 3-day period. Medical status and demographic characteristics were also examined in relation to each sleep variable in multiple regression analysis. Most women (63%) reported one or more types of sleep disturbance and 37% reported using sleeping pills in the previous 30 days. Problems with falling to sleep were significantly related to greater pain and depressive symptoms. Problems of waking during the night were significantly associated with greater depression and less education. Problems in waking/getting up were significantly associated with greater depressive symptoms and less social support. Sleepiness during the day was not significantly related to the variables in the regression model. Fewer hours of sleep were significantly associated with metastases to the bone, higher depressive symptoms, and more social support. Women who reported sleeping 9 or more hours per night, compared to those who reported a moderate amount of sleep (6.5–8.5 hours), had significantly lower 9 p.m. cortisol levels. Use of sleeping pills was more frequent among women reporting greater pain and depressive symptoms. These results suggest that women with metastatic breast cancer who are at higher risk for having sleeping problems are those who are less educated, in pain, depressed, have bony metastases, or lack social support.
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The effect of a 10-week aerobic interval-training cycle ergometer protocol on the functional capacity (VO2Lmax) of 45 women receiving chemotherapy for treatment of Stage II breast cancer was studied. Subjects were stratified by baseline functional capacity (+/- 1 MET) and randomized to experimental (EX), placebo (PL), and control (CO) groups. EX subjects completed a 10-week, 3 times/week exercise training program; PL subjects participated in 10 weeks of nonaerobic stretching and flexibility exercises; the CO group maintained normal activities. The EX group showed significant, p less than .05, improvement on pre- to posttest VO2Lmax as well as workload and test time compared to the PL and CO groups. The interval-training exercise intervention was effective in improving the functional capacity of Stage II breast cancer patients on adjuvant chemotherapy.
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In order to determine which strategies are most effective in relieving fatigue of women undergoing treatment for cancer, women receiving either chemotherapy (n = 45) or radiation therapy (n = 54) were interviewed twice to determine their level of fatigue and the effectiveness of the strategies they used to relieve their fatigue. The subjects were interviewed either at the start and mid-point of any cycle of chemotherapy, or at the beginning and end of a 5- or 6-week course of radiation therapy. At each interview, the subjects completed the Pearson Byars Fatigue Feeling Checklist and the Fatigue Relief Scale. At the second interview, the patients were significantly more fatigued than they had been at the first interview (p < 0.0001). The more effective the fatigue-relieving strategies at the second interview, the less fatigue experienced by the women (p < 0.0001). At both interviews, subjects used similar strategies to relieve their fatigue. Sleep and exercise were among the most effective strategies. However, there was a wide range of scores for each strategy used, indicating variability among subjects as to the effectiveness of the strategy. The results of the study provide nurses with some guidance as to strategies they might suggest to patients who experience fatigue.