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“ The lack of significant between-group differences ... may be related to suboptimal timing of intervention delivery [ and other factors ].”
— SASKIA PERSOON , PhD care ( control group ).
Patients engaged in the exercise intervention program twice a week during the first 12 weeks of follow-up then once a week from 13 to 18 weeks under the supervision of local physiotherapists . To improve compliance and motivate participants to pursue an active lifestyle outside of the study program , the intervention group also attended five short counseling sessions during weeks one , four , 10 , 12 , and 18 .
The control cohort was not specifically motivated to exercise , but they were also not restricted in physical activities or the use of health-care services .
Between baseline and follow-up physical tests , patients completed diaries that documented medication use and physiotherapy session attendance . Physiotherapists also reported on session attendance and adverse events ( AEs ) in a training log .
At last follow-up ( July 2014 ), 12 patients were lost to follow-up ( 4 in the intervention group and 8 in the control group ). An additional two patients in each group were excluded from the final analysis , including one patient in the control group who experienced
disease progression .
Eight serious AEs were reported ( 4 in each cohort ), none of which was considered related to study participation ; however , one patient in the intervention cohort strained a calf muscle during a training session .
The intervention cohort attended an average of 25.8 of the 30 prescribed exercise sessions , with most patients ( n = 36 ; 75 %) attending ≥80 percent of sessions . Reasons for missed sessions included illness or injury ( 34 %), holiday ( 27 %), and session taking place after final follow-up ( 19 %).
Both groups experienced cardiorespiratory and muscular fitness improvements , as well as decreased fatigue ( primary outcomes ), with no significant between-group differences ( TABLE 4 ). Median improvements in physical fitness ( both cardiorespiratory and muscular ) ranged from 16 percent to 25 percent in the intervention group and 12 percent to 19 percent in the control group ; general and physical fatigue declined a median of 25 percent to 32 percent in the intervention group and 12 percent to 25 percent in the control group ( p values not provided ).
Ultimately , the authors noted “ no significant favorable effects of a supervised high-intensity exercise program on physical fitness , fatigue , body composition , HRQoL , distress , or physical activity , compared [ with ] usual care .”
In a post-hoc analysis to assess potential favorable effects of attending 10 or more sessions of physiotherapy , the authors found that patients who participated in any exercise group ( regardless of their assigned treatment group ) had a larger increase in level of selfreported physical activity ( β = 35.0 ; 95 % CI 0.9-69.1 ), but a smaller reduction in anxiety ( β = 1.3 ; 95 % CI 0.2-2.3 ) and depression ( β = 1.5 ; 95 % CI 0.5-2.5 ) at follow-up ( p values not provided ).
“ We hypothesize that the lack of significant between-group differences in our study may be related to suboptimal timing of intervention delivery , contamination in the control group , and / or suboptimal compliance to the prescribed exercise intervention ,” the researchers noted . “ Therefore , further studies are needed to clarify the optimal timing of intervention delivery .”
The study is limited by its “ relatively high number of missing values ,” as well as potential contamination in the control group . ● The authors report no conflicts .
REFERENCE
Persoon S , ChinAPaw MJM , Buffart LM , et al . Randomized controlled trial on the effects of a supervised high intensity exercise program in patients with a hematologic malignancy treated with autologous stem cell transplantation : results from the EXIST study . PLoS One . 2017 ; 12 : e0181313 .
TABLE 4 . Effects on Primary Outcomes in Intervention and Control Cohorts *
Cardiorespiratory fitness
VO 2peak
W peak
Exercise Intervention Group ( n = 50 )
Usual-Care Control Group ( n = 47 ) ß
Baseline Follow-Up Baseline Follow-Up
21.7 mL / kg / min ( SD = 4.8 )
2.0 Watt / kg ( SD = 0.5 )
Muscular fitness
Chair stand test 15.5 ( SD = 4.6 )
Grip strength test
35.5 kg ( SD = 10.7 )
Fatigue †
Physical fatigue 13.2 ( SD = 4.2 )
General fatigue 12.7 ( SD = 3.8 )
Mental fatigue 10.0 ( SD = 4.3 )
26.0 mL / kg / min ( SD = 6.3 )
2.4 Watt / kg ( SD = 0.7 )
18.7 ( SD = 6.0 )
40.9 kg ( SD = 12.0 )
9.8 ( SD = 4.4 )
10.0 ( SD = 4.5 )
9.7 ( SD = 4.5 )
21.2 mL / kg / min ( SD = 5.4 )
2.0 Watt / kg ( SD = 0.6 )
14.5 ( SD = 4.6 )
36.9 kg ( SD = 10.1 )
14.4 ( SD = 4.8 )
13.5 ( SD = 4.3 )
10.3 ( SD = 4.8 )
* Physical fitness assessments were available for 48 patients in the exercise intervention group and 45 in the usual care control group . † Measured using the Multidimensional Fatigue Inventory .
VO2 peak
= highest 15-second interval values for oxygen uptake ; W peak = highest achieved workload ; SD = standard deviation
24.2 mL / kg / min ( SD = 6.6 )
2.4 Watt / kg ( SD = 0.8 )
17.1 ( SD = 4.3 )
41.3 kg ( SD = 11.7 )
11.1 ( SD = 5.0 )
11.8 ( SD = 4.8 )
9.7 ( SD = 4.2 )
1.2 ( 95 % CI 0.5-2.9 )
0.1 ( 95 % CI 0.1-0.2 )
0.7 ( 95 % CI -0.5-1.9)
1.3 ( 95 % CI -0.5-3.1)
-0.8 ( 95 % CI -2.2-0.7)
-1.4 ( 95 % CI -2.9-0.1)
0.1 ( 95 % CI -1.4-1.6)
46 ASH Clinical News October 2017