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Feasibility and safety of exercise training and nutritional support prior to haematopoietic stem cell transplantation in patients with haematologic malignancies
BMC Cancer ( IF 3.4 ) Pub Date : 2020-11-24 , DOI: 10.1186/s12885-020-07637-z
Erik Rupnik , Matevz Skerget , Matjaz Sever , Irena Preloznik Zupan , Maja Ogrinec , Barbara Ursic , Natasa Kos , Peter Cernelc , Samo Zver

Prehabilitation with regular exercise and nutritional care for patients undergoing surgeries for malignant disease was recently introduced to increase physiologic reserve prior to the procedure, accelerate recovery and improve outcomes. This study aimed to investigate the feasibility and safety of combined exercise training and nutritional support in patients with haematologic malignancies prior to haematopoietic stem cell transplantation (HSCT). In this single-arm pilot study, 34 HSCT candidates were enrolled at least two weeks before admission for the procedure. Patients performed aerobic exercises at least 4 days per week for 20–30 min and strength exercises 3 days per week for 10–20 min. They received daily supplements of whey protein (0.3–0.4 g/kg body weight) and oral nutritional supplements if needed. The primary endpoints were feasibility (acceptability > 75%, attrition < 20%, adherence > 66%) and safety. The secondary endpoints were fat-free mass (FFM), muscle strength, physical performance and health-related quality of life (HRQoL) at HSCT. The rate of acceptability, attrition and adherence to aerobic exercise, strength exercise and protein supplement consumption was 82.4, 17.8, 71, 78 and 80%, respectively. No severe adverse events were reported. Twenty-eight patients participated in the study for a median of 6.0 weeks (range, 2–14). They performed aerobic exercises 4.5 days per week for 132 min per week and strength exercises 3.0 times per week. Patients consumed 20.7 g of extra protein daily. At the end of the programme, we recorded increases of 1.1 kg in FFM (p = 0.011), 50 m in walking distance in the 6-min walking test (6MWT) (p < 0.001), 3.3 repetitions in the 30-s chair-stand test (30sCST) score (p < 0.001) and 2.6 kg in handgrip strength (p = 0.006). The EORTC QLQ-C30 scores improved by 8.6 (p < 0.006) for global health status, 8.3 (p = 0.009) for emotional functioning, and 12.1 (p = 0.014) for social functioning. There was less fatigue, nausea and insomnia (p < 0.05). Our study shows that a multimodal intervention programme with partially supervised exercise training combined with nutritional support prior to HSCT is feasible and safe. Patients showed improvements in FFM, physical performance and HRQoL. Additional research is needed to assess the possible positive effects of such interventions.

中文翻译:

血液系统恶性肿瘤患者进行造血干细胞移植之前进行运动训练和营养支持的可行性和安全性

最近引入了针对恶性肿瘤手术患者进行定期运动和营养护理的康复训练,以增加手术前的生理储备,加速康复并改善结局。这项研究旨在探讨在造血干细胞移植(HSCT)之前对血液系统恶性肿瘤患者进行联合运动训练和营养支持的可行性和安全性。在这项单臂先导研究中,入院至少两周前招募了34名HSCT候选人。患者每周至少4天进行有氧运动20-30分钟,每周进行3天力量运动10-20分钟。他们每天补充乳清蛋白(0.3-0.4 g / kg体重)和口服营养补充剂(如果需要)。主要终点是可行性(可接受性> 75%,损耗<20%,坚持性> 66%)和安全性。次要终点是HSCT的无脂肪质量(FFM),肌肉力量,身体表现和健康相关的生活质量(HRQoL)。对有氧运动,力量运动和补充蛋白质的摄入的接受率,损耗和坚持率分别为82.4%,17.8%,71%,78%和80%。没有严重不良事件的报道。28名患者参加了研究,中位时间为6.0周(范围2-14)。他们每周进行4.5天有氧运动,每周132分钟,每周进行3.0次力量运动。患者每天消耗20.7克额外蛋白质。在计划结束时,我们记录了FFM增加了1.1公斤(p = 0.011),在6分钟步行测试(6MWT)中步行距离为50 m(p <0.001),在30 s椅子站立测试(30sCST)得分中重复3.3次(p <0.001),握力2.6 kg(p = 0.006)。EORTC QLQ-C30的整体健康状况得分提高了8.6(p <0.006),情感功能得到了8.3(p = 0.009),社交功能得到了12.1(p = 0.014)。疲劳,恶心和失眠较少(p <0.05)。我们的研究表明,在HSCT之前采用部分监督的运动训练与营养支持相结合的多模式干预计划是可行且安全的。患者表现出FFM,身体机能和HRQoL改善。需要进行其他研究以评估此类干预措施可能产生的积极影响。握力6公斤(p = 0.006)。EORTC QLQ-C30的整体健康状况得分提高了8.6(p <0.006),情感功能得到了8.3(p = 0.009),社交功能得到了12.1(p = 0.014)。疲劳,恶心和失眠较少(p <0.05)。我们的研究表明,在HSCT之前采用部分监督的运动训练与营养支持相结合的多模式干预计划是可行且安全的。患者表现出FFM,身体机能和HRQoL改善。需要进行其他研究以评估此类干预措施可能产生的积极影响。握力6公斤(p = 0.006)。EORTC QLQ-C30的整体健康状况得分提高了8.6(p <0.006),情感功能得到了8.3(p = 0.009),社交功能得到了12.1(p = 0.014)。疲劳,恶心和失眠较少(p <0.05)。我们的研究表明,在HSCT之前采用部分监督的运动训练与营养支持相结合的多模式干预计划是可行且安全的。患者表现出FFM,身体机能和HRQoL改善。需要进行其他研究以评估此类干预措施可能产生的积极影响。我们的研究表明,在HSCT之前采用部分监督的运动训练与营养支持相结合的多模式干预计划是可行且安全的。患者表现出FFM,身体机能和HRQoL改善。需要进行其他研究以评估此类干预措施可能产生的积极影响。我们的研究表明,在HSCT之前采用部分监督的运动训练与营养支持相结合的多模式干预计划是可行且安全的。患者表现出FFM,身体机能和HRQoL改善。需要进行其他研究以评估此类干预措施可能产生的积极影响。
更新日期:2020-11-25
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