Abstract
PurposeExercise is emerging as a vital aspect of care to alleviate the physical and psychosocial symptom burden associated with allogeneic bone marrow transplantation (BMT). Understanding the patient perspective regarding exercise is important to move towards implementation. This study aimed to characterise experiences and views regarding participation in an exercise program in adults receiving treatment for haematological disease with allogeneic BMT.MethodsIndividual semi-structured interviews were conducted with 35 participants from either an early- or late-commencing supervised group-based exercise program. Using an inductive, conventional approach to qualitative content analysis data were independently analysed by two researchers.ResultsSix major themes and 33 sub-themes were identified: this encompassed motivation, physical opportunity and capability to exercise; psychosocial effects of group-based exercise; experienced impact of participation in an exercise program; and intervention design considerations. Key barriers to exercise included symptom severity and fluctuating health and distance or difficult access to an exercise facility or equipment, whilst facilitators included encouragement from staff; peer support in the group-based setting; flexibility; education; and ability to measure change.ConclusionThis study highlights the importance of a flexible approach to exercise with consideration of individual symptoms and preferences. The perceived psychological impact of exercise should not be underestimated; future exercise programs should be designed in partnership with patients, with consideration of group-based activities to reduce social isolation if this is feasible in the treatment context. Intervention design should also acknowledge the individual’s physical and psychological capability, opportunity and automatic and reflective motivation to direct and sustain exercise behaviours following BMT.
Highlights
Allogeneic bone marrow transplantation (BMT) for people with haematological disease is an intensive medical treatment which can result in significant symptom burden[1–4]
Regarding motivation to exercise in BMT, our study identified that support from staff, exercise tools and outcome measurement of physical change provided automatic incentive, whilst belief that exercise would provide a sense of control or benefit recovery provided reflective motivation
Further strengths include that data were collected in a pragmatic hospital setting which increases generalisability. This qualitative study highlights the importance of an individualised, flexible approach to exercise prescription in people treated for haematological disease with allogeneic BMT
Summary
Allogeneic bone marrow transplantation (BMT) for people with haematological disease is an intensive medical treatment which can result in significant symptom burden[1–4]. A recent meta-analysis of RCTs found that exercise can improve these symptoms, in allogeneic BMT[7–11]; structured exercise is not part of standard care in most centres worldwide. The reasons for this limited access to exercise in BMT are likely multifactorial, and may include historical caution regarding safety of exercise during cytopenia[12], that RCTs to date have been of poor-moderate methodological quality and/or have. In allogeneic BMT, patients perceive physical incapacity and/or reduced self-efficacy as key issues post-transplant increased access to specialised exercise support is required[18, 19]
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