Oechsle, K., Aslan, Z., Suesse, Y., Jensen, W., Bokemeyer, C., & de Wit, M. (2014). Multimodal exercise training during myeloablative chemotherapy: A prospective randomized pilot trial. Supportive Care in Cancer, 22, 63–69. 

To evaluate the effects of combined aerobic and strength exercise on physical performance and symptoms in patients who are hospitalized while receiving myeloablative therapy

Patients were randomly assigned to the exercise intervention or usual care. Usual care patients were allowed to undergo physical therapy as medically indicated according to standard practice. The intervention group included ergometer endurance training for 10–20 minutes and resistance exercises for main muscle groups for 20 minutes. Exercises were done five days per week during the entire hospital stay, and training intensity was individually adjusted based on spiroergometry at study entry. Training was suspended if patients experienced fever, infection, thrombocytopenia (platelet < 20,000) cardiac arrhythmia, or life-threatening clinical complications. Neutropenic patients wore masks when they left their rooms. Follow-up assessment was done at 12 months.

• N = 48
• MEAN AGE = 52 years
• MALES: 70.8%, FEMALES: 29.2%
• KEY DISEASE CHARACTERISTICS: Most frequent diagnoses were acute myeloid leukemia (AML) and non-Hodgkin's lymphoma (NHL)

• SITE: Single-site  
• SETTING TYPE: Inpatient  
• LOCATION: Germany

• PHASE OF CARE: Active antitumor treatment

Randomized controlled trial

• Spiroergometry oxygen consumption measurement
• European Organization for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-C30) scale
• Modified Fatigue Impact Scale (MFIS)

The median duration of exercise training was 15 days with the median hospital stay being 21 days. The control group’s lung function as measured by oxygen consumption increased. Treatment group oxygen consumption and expiratory minute ventilation volume was significantly higher at the end of the study compared to controls (p < .05). EORTC physical functioning was significantly higher in the treatment group compared to controls (p = .04). There were no other differences in symptoms between groups. The treatment group complained of fatigue for fewer days than those in the control group (p = .04). Self-report of overall condition at 12 months indicated no significant difference between groups. There were no exercise-related adverse events.

This study demonstrated that exercise training during myeloablative chemotherapy is feasible, well-tolerated, and may improve physical performance during treatment.

• Small sample (< 100)
• Risk of bias (no blinding)
• Subject withdrawals ≥ 10% 
• Other limitations/explanation: High drop-out rate

Findings suggest that exercise training during hospitalization for myeloablative chemotherapy is generally well-tolerated. The study was underpowered to show any effect on symptoms of fatigue; however, exercise training was associated with improved physical performance measures. Nurses can advocate for exercise programs for this group of patients.