Effect Of Frailty And Exercise On Fatigue, Physical Activity, Functional Ability And Muscle Strength In Adult Hematopoietic Cell Transplantation Recipients

Abstract

PURPOSE: Intensive cancer treatment followed by hematopoietic cell transplantation results in moderate to severe fatigue, physical inactivity, diminished functional ability, and reduced muscle strength. These alterations may be magnified by frailty status. This study compared the effects of frailty (not frail, pre-frail, and frail) and exercise (strength training, n = 33, compared to attentional control with health education, n = 34) in adult hematopoietic cell transplantation recipients. Dependent variables included fatigue, physical activity, functional ability and muscle strength. METHODS: Subjects were randomly stratified by type of transplant (allogeneic or autologous) and age (≤ 60 years of age or > 60 years of age) in this single-blind randomized clinical trial. The strength training intervention consisted of a comprehensive program of progressive resistance introduced during hospitalization and continued for six weeks following hospital discharge. Subjects assigned to attention control with health education subjects received weekly health education post hospitalization. A composite frailty score was based on unexplained weight loss, poor hand-grip strength, self-reported exhaustion, slow walking speed, and low physical activity. Variables were assessed six weeks following hospital discharge. MANOVA was used to analyze the data. RESULTS: A significant interaction effect (frailty x exercise) was noted for fatigue, p = .007. Frail subjects in the health education with attention control group reported more overall fatigue compared to the strength training group, p = .04. Frail subjects in the health education with attention group reported more mental fatigue compared to the strength training group, p = .008. Significant frailty main effects were revealed for physical activity (p = .001), functional ability (p = .025), and muscle strength (p = .002). No significant main effects for exercise were identified. CONCLUSIONS: Strength training compared to health education with attentional control improved overall and mental fatigue in those who were frail. As expected, differences in physical activity, functional ability, and muscle strength were noted between frail, pre-frail and not frail hematopoietic cell transplantation recipients.