Wiskemann, J., Dreger, P., Schwerdtfeger, R., Bondong, A., Huber, G., Kleindienst, N., . . . Bohus, M. (2011). Effects of a partly self-administered exercise program prior to, during, and after allogeneic stem cell transplantation. Blood, 117, 2604–2613.

The primary aim was to identify the benefits of exercise performed during the entire hematopoietic stem cell transplantation (HSCT) time period. The secondary aim was to explore endurance performance via six-minute walk test (6MWT), isometric muscle strength, functional performance status, physical activity levels via pedometer step count, health-related quality of life, and psychological well-being and distress.

A self-administered exercise intervention was compared to a social contact pedometer-wearing control group. Exercise began one to four weeks prior to hospital admission. Exercise included three endurance (outpatient:  walking; inpatient:  bicycling and treadmill) and two resistance (color-coded bands with different levels of resistance focused on extremities, entire body, and bed exercises) training sessions per week (up to five sessions during hospitalization). Exercise continued six to eight weeks after discharge. The control group reported that moderate physical activity was helpful without instruction, wore step counters, and received thirty minutes of physiotherapy and access to bicycles and treadmills during hospitalization. Both groups received the same number of visits by study personnel.

• One hundred five patients were enrolled, and 80 (40 in each group) were included in the final analysis.
• Mean age was 48.8 years. 
• Thirty-four females and 71 males were included. 
• Patients had acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), myelodysplastic syndrome (MDS), chronic lymphocytic leukemia (CLL), multiple myeloma (MM), lymphoma, and aplastic anemia.

• Multisite
• University Clinic, Heidelberg, Germany and the German Diagnostic Clinic, Wiesbaden, Germany

This was a prospective, multicenter, randomized, controlled trial.

• Borg Scale – perceived exertion scale
• Multidimensional Fatigue Inventory (MFI)
• Profile of Mood States (POMS)
• European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
• Daily log
• 6MWT protocol by the American Thoracic Society estimated aerobic capacity
• Hand-held dynamometer measured maximal isometric voluntary strength
• National Comprehensive Cancer Network (NCCN) Distress Thermometer
• Hospital Anxiety and Depression Scale (HADS)

All assessments were measured at four time points:  baseline, admission, discharge, and six to eight weeks after discharge.

Significant group differences at the end of the intervention were:  general fatigue (p = 0.009); physical fatigue (p = 0.01); and POMS fatigue scale (p = 0.004). The exercise group was superior to the control group in all subscales. Physical capacity increased in the exercise group (p = 0.02) and was inversely correlated with general fatigue (p ≤ 0.01). The Intervention significantly improved the strength of the lower extremities (p = 0.03) (maybe due to walking and biking). The exercise group was significantly more anxious than the control group (p = 0.007). All benefits were observed most predominantly during hospitalization.

This partly supervised exercise intervention was beneficial for patients undergoing allogeneic (allo)-HSCT.

• The study had a small sample size, with less than 100 patients. 
• The 6MWT was not a standard procedure for assessing endurance capacity.
• Interrater reliability was unknown for the hand-held dynamometer.
• Exercise logs were missing (most before and during hospitalization).
• There was no documentation about social support for the control group.

The allo-HSCT patient population should be encouraged to exercise. An exercise intervention is feasible and can alter cancer-related fatigue in the allo-HSCT patient population. Use of preadmission exercise in concert with findings of differences in fatigue between individuals who have higher baseline activity levels suggests that further research in improving capacity and activity levels prior to treatment in various patients is worth investigating.