A Multifaceted Activity Program Preserves VO_2peak In Adults Undergoing Allogeneic Stem Cell Transplantation For Hematological Cancer

Allogeneic stem cell transplantation (SCT) is a potentially curative treatment for high-risk, recurrent, and refractory hematological cancers (HC). However, quality of life and longevity after SCT are hampered by significant treatment-induced exercise intolerance and associated cardiovascular mortality. PURPOSE: In a randomized controlled trial with HC patients scheduled for SCT, we evaluated the efficacy of a 4-mo multifaceted activity program to preserve peak oxygen uptake (V̇O2peak) and its determinants. METHODS: Sixty-two HC patients scheduled for SCT were randomized to usual care (UC; n = 32, 55 ± 15 y, 63% male) or the exercise, and sedentary behavior reduction program (Ex+SED; n = 30, 50 ± 16 y, 60% male). Patients assigned to Ex+SED completed 3 d/wk of aerobic and resistance exercise for 4-mo and concurrently aimed to reduce sedentary time by 30-min/d via replacement with short (3-min), frequent (hourly), light-intensity activity. Cardiopulmonary exercise testing (CPET) was conducted prior to SCT admission, and 12-wks following discharge to assess V̇O2peak, as well as peak O2 pulse, power output (PPO), respiratory exchange ratio (RER), and heart rate (HR). Peak lactate and blood pressure (BP) were also assessed. RESULTS: Fifty patients completed follow-up (23 Ex+SED; 27 UC), 96% of whom satisfied peak CPET criteria (22 Ex+SED; 26 UC). Compared to UC, there was a significant treatment benefit for Ex+SED on V̇O2peak (net difference: 2.5 ml/kg/min [95% CI 0.3, 4.8], p = 0.03) due to a 15% reduction in UC (-3.4 ml/kg/min [95% CI -4.9, -1.8], p < 0.001) and no significant change in Ex+SED (-0.9 ml/kg/min [95% CI -2.5, 0.8], p = 0.31). A treatment benefit for Ex+SED was also observed for O2 pulse (interaction, p < 0.01), driven by a 19% reduction in UC (p < 0.001). PPO declined less in EX+SED than UC (-11% vs. -24%; interaction, p = 0.03), while peak HR and lactate reduced similarly in Ex+SED and UC (-9 vs. -7 beats/min, p = 0.75; -1.3 vs -2.2 mmol/L; p = 0.22). There were no changes in peak RER or BP in either group. CONCLUSION: Intervening early in the SCT process with a multifaceted activity program is effective in preserving V̇O2peak and O2 pulse. Whether these benefits translate to reduced cardiovascular morbidity and greater longevity warrants investigation. FUNDING: World Cancer Research Fund International grant programme.