Abstract
PurposeHematologic patients have a poorer health-related quality of life due to the disease and its treatments. Non-pharmacological interventions represent an opportunity in tertiary cancer prevention to manage persistent symptoms and support patients in their return to active daily living. This interventional study aimed to evaluate the feasibility of a program combining physical exercise (PE) and heart rate variability biofeedback (HRVB) in hematologic patients.MethodHematologic patients in remission within 6 months participated in a 12-week rehabilitation program including 24 supervised sessions of PE associated with 10 supervised sessions of HRVB and daily home-based practice of paced breathing. We assessed patient adherence, fatigue, physical function, and heart rate variability.ResultsTwenty patients were included, 17 completed the protocol and 3 dropped out due to disease progression or time constraints; no adverse events or incidents were reported. Participation rates were 85% for PE and 98% for HRVB-supervised sessions. Significant improvements of physical capacity (6-min walk test, p < 0.001; 50-foot walk test, p < 0.001), muscle strength (grip force test, p < 0.01), and flexibility (toe-touch test, p < 0.001; back scratch test, p < 0.05) were measured. Coherence ratio (p < 0.001) and low-frequency spectral density of HRV signal (p < 0.003) increased significantly, suggesting improved autonomic function. Fatigue, static balance, and other time and frequency indicators of HRV were not improved (all p > 0.05).ConclusionA rehabilitation program combining PE and HRVB is feasible in hematologic patients and effective on physical function. Further research with a larger sample size is needed to investigate effectiveness on patients’ autonomic functions and their impacts on symptomatology.
Highlights
Hematologic malignancies and their treatment are responsible for serious impairments on overall quality of life [1, 2]
Heart rate variability biofeedback (HRVB) is a non-pharmacological intervention based on the regular practice of rhythmic breathing at a frequency of approximately 6 cycles/ min for which a resonance occurs between cardiac and respiratory rhythms, producing large amplitudes of heart rate variability (HRV) [10]
Results show a high participation rate for both physical exercise (PE) (85%) and HRVB (98%) intervention, and an average practice of 6 HRV sessions per week at home during the intervention. This rehabilitation program combining PE and HRVB was able to proceed according to the terms of the protocol without any difficulties related to its implementation
Summary
Hematologic malignancies and their treatment are responsible for serious impairments on overall quality of life [1, 2]. Physical exercise (PE) is recommended to improve physical function and quality of life during and after treatments in cancer patients [5]. PE is effective on cancer-related fatigue, physical function, and quality of life, depending on. Cancer patients have lower HRV than healthy people, and higher levels of HRV are positively correlated to a better prognosis [19] According to these authors, the main hypothesis for explaining the lower HRV values in cancer patients than in healthy people is that HRV level is associated with tumor growth through inflammation, oxidative stress, and sympathetic nerve activation, due to disease and aggressive treatments (radiotherapy and chemotherapy). Studies of patients with various chronic illnesses have reported effectiveness of HRVB on HRV increase and autonomic function [20], stress reduction [21], and clinical outcome improvements [22]. Results highlighted the feasibility of HRVB with high rates of participation adherence and satisfaction [21, 22]
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