Feasibility and suitability of a graded exercise test in patients with aggressive hemato-oncological disease

Anja Großek,Thomas Elter,Philipp Hartig,Philipp Zimmer,Florian Wolf,Niklas Joisten,Max Oberste,Patrick Wahl,Friederike Rosenberger,David Kiesl,Wilhelm Bloch,David Walzik

doi:10.1007/s00520-021-06035-w

Abstract

PurposePhysical activity promises to reduce disease-related symptoms and therapy-related side effects in patients suffering from aggressive lymphoma (L) or acute leukemia (AL). For an efficient training program, determination of patients’ physical capacity with a purposive exercise test is crucial. Here, we evaluated the feasibility and suitability of a graded exercise test (GXT) frequently applied in patients suffering from solid tumors by assessing whether patients achieved criteria for maximal exercise testing according to the American College of Sports Medicine (ACSM).MethodsThe GXT was performed by 51 patients with an aggressive L or AL prior to the start or in the earliest possible phase of high-dose chemotherapy, following a recommended protocol for cancer patients, starting at 20 Watts (W), with an increase of 10 W/min until volitional exhaustion. Subsequently, we investigated whether the following ACSM criteria were fulfilled: (1) failure of heart rate to increase despite increasing workload, (2) post-exercise capillary lactate concentration ≥ 8.0 mmol L−1, (3) rating of perceived exertion at exercise cessation > 17 on the 6–20 Borg Scale.ResultsOut of 51 patients, two, six, and 35 participants met the first, second, and third criterion, respectively. No relevant relationships between the completion of the criteria and patients’ characteristics (e.g., gender, age) were found.ConclusionAlthough results of this study suggest a general feasibility of the applied GXT, the ACSM criteria were not met by the majority of the participants. Therefore, this study raises doubts about the suitability of the GXT protocol and the ACSM criteria for this group of patients.

Highlights

We investigated whether the following American College of Sports Medicine (ACSM) criteria were fulfilled: (1) failure of heart rate to increase despite increasing workload, (2) post-exercise capillary lactate concentration ≥ 8.0 mmol L−1, (3) rating of perceived exertion at exercise cessation > 17 on the 6–20 Borg Scale
Conclusion results of this study suggest a general feasibility of the applied graded exercise test (GXT), the ACSM criteria were not met by the majority of the participants
It can be stated that a GXT with the recommended protocol is safe and feasible for patients suffering from an aggressive form of leukemia or lymphoma

Summary

Introduction

Department I of Internal Medicine, Center for Integrated Oncology. Division for Performance and Health (Sport Medicine), Department of Sport and Sport Science, Technical University Dortmund, Otto-Hahn-Str. 3, 44227 Dortmund, Germany. The combination of disease, hospitalization, and therapy side effects leads to a decrease in physical activity, an increase of psychological stress, and an overall reduction in healthrelated quality of life [3,4,5]. Research data suggests that physical activity is the most promising counter to alleviate these side effects and it has already been nominated as medicine to prevent cancer and support cancer therapy [6]. The “dose” of physical activity has to be set individually in dependence of the patients’ type of disease, therapy, needs, and physical capacity [7, 8].

Methods

Results

Discussion

Conclusion