Evaluating The Suitability Of A Graded Exercise Test In Patients With Acute Leukemia Or Lymphoma

Abstract

Several studies demonstrate the beneficial effect of exercise on side effects and well-being during high dose/induction chemotherapy in patients with acute leukemia. Nevertheless, not only the chosen intervention and the exercise intensity vary between these studies but also the operationalization of exercise intensities differ. Although advices to use a graded exercise test in cancer patients exist, the suitability of this exercise testing in this specific group of patients has not been examined yet as far as the author knows. PURPOSE: Investigate whether maximal effort of the participants has been generated during the graded exercise test. METHODS: As part of a bigger randomized controlled trial, 53 participants took part at the graded exercise test after being hospitalized to start high dose/induction chemotherapy treating acute leukemia or aggressive lymphoma. A graded exercise test starting at 20 watt increasing 10 watt per minute was performed. The ACSM criteria for a maximal exercise test were reviewed to determine whether the effort was maximal. These criteria are (1) a plateau in V˙O2 with increased workload, (2) failure of heart rate to increase with increases in workload (3), a post-exercise venous lactate concentration > 8.0 mmol/l, (4) a rating of perceived exertion at peak exercise > 17 on the 6-20 scale (Borg-Scale), and (5) a peak RER ≥ 1.10. RESULTS: Criteria one and five could not be tested, due to the study design. Only one participant fulfilled the first criteria. Lactate concentration was measured right after the test and three minutes later. 15.4% (6 participants) and 21.4% (9 participants) respectively, reached a lactate concentration > 8.0 mmol/l and thus fulfilled the third criteria. A higher value than 17 on the Borg-Scale was stated by 66.0% (35) of the participants fulfilling the fourth criteria. Five (16.7%) and seven (23.3%) participants respectively met both the third and fourth criteria simultaneously. CONCLUSION: Following the ACSM criteria, this investigation states that the majority of the participants did not reach the limit of exhaustion, suggesting that the graded exercise test might not be suitable for this group of patients.