Effects of multimodal exercise on clinical status and patient-reported outcomes in children undergoing hematopoietic stem cell transplantation

Vesile Yildiz Kabak,Duygu Uckan Cetinkaya,Baris Kuskonmaz,Nevin Cetin,Tulin Duger

doi:10.1080/08880018.2019.1648619

Vesile Yildiz Kabak, Duygu Uckan Cetinkaya + Show 3 more

Open Access

https://doi.org/10.1080/08880018.2019.1648619

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Abstract

There are limited data available regarding effectiveness of exercise training in children undergoing hematopoietic stem cell transplantation (HSCT). We aimed to investigate effects of multimodal exercise program on clinical status and patient-reported outcomes including pain, fatigue, depression, and quality of life (QOL) level of children and their parents’ QOL level. Twenty-six children undergoing HSCT participated in this study. Clinical status, pain, fatigue, depression, and QOL level of children were assessed three times: before HSCT, at discharge, and one month later. For intervention group (IG, n = 15), multimodal exercise program was performed five days a week, throughout hospitalization and children were advised to continue exercise program at home. For control group (CG, n = 11), being active as much as possible was advised. The number of painful day and pain intensity was significantly lower in IG than in CG during hospitalization (p < .05). Depression level decreased in IG at the time points (p ˂ .05); however, there was no significantly difference between groups. The QOL level was higher in IG than CG only at control measurements (p ˂ .05). In addition, QOL level of the parents decreased in both groups (p ˂ .05). There was no statistically difference between groups in terms of other clinical variables. The multimodal supervised exercise program has positive effects on children’s pain and QOL level. Exercise program was also well tolerated by children during hospitalization. In addition, QOL levels of the parents were also negatively affected during hospitalization, and interventions aiming to increase QOL level of the parents should be considered.

Highlights

Hematopoietic stem cell transplantation (HSCT) has been frequently performed for the treatment of hematopoietic and immune system disorders and some kinds of cancers.[1]
Children were diagnosed with thalassemia major (n 1⁄4 5), leukemia (n 1⁄4 4), aplastic anemia (n 1⁄4 2), immune deficiency (n 1⁄4 2), and other (n 1⁄4 2) in IG; and leukemia (n 1⁄4 4), aplastic anemia (n 1⁄4 3), and other (n 1⁄4 4) in CG
After HSCT, graft-versus-host disease was occurred in one child in IG and in two children in CG

Summary

Introduction

Hematopoietic stem cell transplantation (HSCT) has been frequently performed for the treatment of hematopoietic and immune system disorders and some kinds of cancers.[1]. In spite of the improvement in treatment approaches, HSCT is still considered as an aggressive therapy which results with functional, psychological, and social impairments.[3,4,5,6] During the inpatient period, patients suffer from several side effects including pain, fatigue, fever, vomiting, diarrhea, and constipation Besides these common symptoms, graft-versus-host disease, long hospitalization period, and organ toxicities led to reduce in physical function and increase in fatigue complaint, and as a result decrease in patients’ QOL level.[7,8] In addition, there are various studies reported reduction in psychological status and QOL level when compared with the pretransplantation level in adult and pediatric HSCT patients.[9,10]

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