Exercise and activity patterns in cancer patients after recent allogeneic bone marrow transplatation
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Exercise following autologous bone marrow/ peripheral blood stem cell transplants (BMT/PBSCT) may decrease fatigue and loss of physical function that usually occur post-transplant. However, there is little empirical data regarding the effect of exercise on activity levels and symptom severity following allogeneic BMT. The purposes of this dissertation was to perform an exploratory examination of the effectiveness of short-term clinician directed and self-directed exercise programs in recent allogeneic BMT/PBSCT patients using multi-dimensional outcomes; to examine activity and sleep patterns in post-BMT or peripheral stem cell transplant patients using actigraphy, and to describe through a series of case reports changes in physical performance, activity patterns and quality of life during participation in a supervised or a self-directed exercise program. Forty-four (44) patients with a primary cancer diagnosis of lymphoma or leukemia, within 6 months of an allogeneic BMT/PBSCT participated. They were randomly assigned to a self-directed exercise group, which received instruction on a home exercise program and walking regimen, or a clin ician-directed exercise group, which performed mixed aerobic-resistive exercises for 45-60 min., thrice a week for 4 weeks. Subjects were evaluated at baseline, 4 and 8 weeks using a physical performance battery, Brief Fatigue Inventory, M.D. Anderson Symptom Inventory, and Functional Assessment of Cancer Therapy- Bone Marrow Transplant (FACT-BMT). Objective sleep and wake activity data were obtained through continuous monitoring using an actigraph. Marginal power was observed for group differences, and selected data analyses were performed on a combined exercise group. Within the short time period measured, it appears that both clinician-directed and self-directed exercise regimens are beneficial and may result in improvements in physical performance and quality of life, and a reduction in fatigue severity. Significant relationships noted between self-reported measures point to the possible influence of fatigue and/or BMT-related symptomatology on physical and functional aspects of quality of life. Polyphasic activity patterns, with longer than normal sleep durations and shorter than normal sleep episode lengths were observed via actigraphy. Future studies with larger samples over a longer period of time are warranted for statistical relevance.