Strength Training to Enhance Early Recovery After Stem Cell Transplantation

Dates: 1/1/13 – 12/31/16

Co-Investigator: Chang Gi Park

Abstract: Background: High-dose chemotherapy (HDC) followed by hematopoietic stem cell transplantation (HSCT) is a curative treatment for hematologic malignancies, but it is associated with high 100-day treatment-related mortality and devastating complications. These complications result in highly  distressing symptoms, significantly impaired functional status, and diminished quality of life. Survivors report severe fatigue and experience decreased physical activity. Sustained physical inactivity after HSCT is sufficient to cause muscle mass loss with resulting decreases in strength. Muscle strength is required for physical activity and functional ability. Without intervention, frailty and long-term disability ensue even though the HSCT survivors are cancer-free. Strength training, in comparison to all other exercise modalities, most effectively builds muscle mass; however, few studies have evaluated strength training in the HSCT population. Our pilot studies demonstrate that  (1) strength training using elastic resistance bands has potential positive effects on physical activity, fatigue and quality of life; and, (2) strength training is feasible during the early recovery period if the intervention is tailored to the individual’s capabilities. Given the importance of maintaining muscle mass and reducing the debilitating effects of HDC and HSCT, there is a clear need for a larger study to evaluate a strength training intervention in the early recovery period following HSCT. 

Objective/hypotheses: The purpose of this study is to determine the efficacy of an exercise intervention, Strength Training to Enhance Early Recovery (STEER), on physical activity, fatigue, muscle strength, functional ability, and quality of life in people receiving HDC followed by HSCT.    Specific aims: The specific aims are to: (1) Compare the recovery patterns of the STEER intervention (experimental group) to usual care plus attention control (control group) on physical activity, fatigue, muscle strength, functional ability and quality of life; and (2) Determine if frailty at baseline and/or pre-engraftment predicts length of hospital stay and/or physical activity, fatigue,  muscle strength, functional ability, and quality of life six weeks following discharge from the hospital.

Study Design: This single-blind RCT will compare the efficacy of our STEER intervention to usual care plus attention control with health education following HDC and HSCT. A total of 74 subjects will be randomly assigned to one of two groups. The STEER intervention consists of a comprehensive strength training program using elastic resistance bands during the first 6 weeks following hospital discharge. Physical activity, fatigue, muscle strength, functional ability, quality of life and frailty will be measured three times: (T1) prior to HSCT - baseline; (T2) eight days following HSCT - after stem cell infusion but pre-engraftment; and (T3) six weeks following hospital discharge. While both groups are expected to recover, it is proposed that the STEER intervention  will enhance recovery from baseline and pre-engraftment to six weeks post hospital discharge.

Cancer Relevance: HDC followed by HSCT is a potentially curative treatment; however, it is associated with significant physical and psychological complications. The objective of our program of research is to facilitate early recovery following HSCT to attenuate symptoms, promote functional independence, and improve quality of life. Early intervention is critical to increase the likelihood of successful outcomes and prevent long-term functional consequences.

Funding Source: American Cancer Society
Dates: 1/1/13 – 12/31/16

Funding Source: Internal Research Support Program (IRSP)
Dates: 2/15/13 – 8/1/14

American Cancer Society