A Randomized Control Trial of Benefits of Intrahopsital Exercise on Post-Transplantation Deconditioning in the Pediatric Hematopoietic Stem Cell Transplant Population

Abstract

Deconditioning is a common adverse effect of short and long-term immobilization. For months pediatric hematopoietic stem cell transplant patients can be quarantined while hospitalized, much of which time is spent immobilized putting these patients at a higher risk for loss of muscle strength, functionality, endurance, and quality of life. Studies have shown that exercise as an effective countermeasure to deconditioning in stem cell transplant patients. However, research is lacking in pediatric HSCT due to the complications associated with treatment. This study was conducted to determine if there is a correlation between intrahopsital exercise and improved functionality, endurance, strength, and quality of life. In addition, this randomized control study looked at the merit and feasibility of adding an exercise routine into treatment plans. We have currently recruited 23 of our target 40 patients, 12 in the control arm and 11 in the intervention arm, ages 8-17 at Phoenix Children’s Hospital. Each participant received baseline measured by an OT or a PT for functionality using (WeeFIM), muscle strength using manual muscle testing (MMT), endurance using the 6-minute walk test, and quality of life using the NIH PROMIS measures. Measurements were taken again at discharge and 6-weeks post-discharge. During hospital admittance the intervention group performed exercise routines 3-times weekly while the control group were encouraged to spend time out of bed. Patients recruited were receiving their first HSCT and did not have any post-HSCT complications such as severe infection or GVHD. Data and results are limited due to the timepoint of the study and the limited number of recruited patients affecting the power of the study. No statistically significant difference is noted between the two arms in functional status, muscle strength, or endurance. There appears to be an increase in quality of life patients in the interventional arm compared to the control arm. Simple analysis has shown that compliance with time out of bed decreases across both groups the further away from transplant. Currently the study is midway, and data is limited to make any conclusions but shows promise.