Physical Inactivity in Candidates of HSCT
Condition: Hematopoietic Stem Cell Transplantation
Study type: Observational

Summary: 
      Decreased number of steps and poorer quality of life are prevalently observed among
      candidates of hematopoietic stem cell transplantation (HSCT). However, impairments in other
      aspects of physical activity measurement including energy expenditure, physical activity
      duration, metabolic equivalents of daily task (METs) and lying down duration are still
      unknown in candidates based on comparison with healthy individuals, which was therefore aimed
      to investigate in current study.
    

Detailed description: 
      In recent years, hematopoietic stem cell transplantation (HSCT) has been largely used to cure
      not only many hematologic malignancies but also autoimmune diseases and even genetic
      diseases. Advances in the HSCT and other cancer treatment approaches including supportive
      care practices provide patients better survival time nowadays. However, as life expectancy
      for recipients is increasing up to 85% for being alive 10 years after HSCT, post-HSCT
      complications are concurrently increasing. After HSCT, recipients may suffer from many
      infectious complications, cytopenia, immunosuppression, graft versus host disease, a lot of
      organ involvements and even secondary malignancies. In addition, they are also exposed to
      immobility condition, physical inactivity, depressive symptoms, psychosocial distress,
      fatigue, and complications of musculoskeletal, respiratory and cardiovascular systems rely on
      mostly treatments and treatment related with complications all of which have a negative
      impact on the survival, physical functions and quality of life of recipients. Hence, the
      guidelines recommend to all recipients both routine evaluations of clinical and
      cardiovascular risk factors, and also complying with healthy life style including doing
      regular physical activity and exercises.

      On the other hand, chemotherapy, radiation therapy and further conditioning regimens are
      required to exterminate the abnormally proliferating cancer cells in patients with
      hematologic malignancies before HSCT, which also leads to pre-HSCT complications. These
      complications are observed as physical inactivity, abnormal pulmonary functions, muscle
      weakness, decreased exercise capacity, evident fatigue, psychological mood disorders and
      poorer quality of life in these patients until HSCT. Should immobility and physical
      inactivity extend, the patients may need to respiratory support including oxygen supply,
      noninvasive or invasive mechanic ventilation. As previously shown, these impairments
      especially physical inactivity have even existed in patients with hematologic malignancies at
      the period of pre-diagnosis and early diagnosis. While 33.8% of patients (n=438) could
      achieve the daily/weekly exercise criteria of guidelines during the time of pre-diagnosis,
      only 6.5% of patients could perform physical activity during anticancer treatments. In that
      study, physical activity level was evaluated using a questionnaire, and the patients meeting
      public health exercise guidelines have reported higher quality of life level. According to
      results of another study with higher sample size (n=3060), 1392 (46%) of patients are
      physically active based on their responses to questions at the pre-diagnosis period. However,
      the most striking result to emerge from the data in 2018 is that these active patients have
      considerably higher survival rates rather than insufficiently active patients. As
      demonstrated in 2014 (n=29), 61% of patients with early diagnosis meet the physical activity
      guidelines, and patients walk about 6.149 steps/d before the start of chemotherapy which was
      evaluated via a tri-axial accelerometer. As known, although patients have survived after
      HSCT, these problems have not meliorated in survivors over a long time after HSCT. Therefore,
      guidelines recommend that the patients should be oriented for rehabilitation in order to
      maximize muscle strength, functional mobility and quality of life of patients before the
      patients are subject to the process of HSCT.

      Evaluation and counseling of physical activity have become one of the most challenging topics
      recently; however, there is confusion in the meaning and usage of this term. Original
      definition of physical activity is "Physical activity is defined as any bodily movement
      produced by skeletal muscles that results in energy expenditure. Physical activity in daily
      life can be categorized into occupational, sports, conditioning, household, or other
      activities. Exercise is a subset of physical activity that is planned, structured, and
      repetitive and has as a final or an intermediate objective the improvement or maintenance of
      physical fitness.". In the literature, researchers have mostly tend to only one aspect of
      physical activity measurement in candidates of HSCT which is either steps count or estimation
      of physical activity intensity as regard to metabolic equivalent of daily task (MET). In
      fact, reason of this situation was that less objective tools such as questionnaire,
      questions, and pedometers were used to evaluate physical activity level in candidates. There
      is just a few studies used an objective device like triaxial accelerometer in the literature.

      Physical inactivity as a cardiovascular risk factor is related with higher risks of
      cardiovascular diseases and complications after HSCT. Therefore, it is important to assess
      detailed physical activity along with its all aspects including energy expenditure, number of
      steps, activity types and durations in candidates of HSCT. However, impairments in energy
      expenditure, physical activity duration, metabolic equivalents of daily task (METs) and lying
      down duration are still unknown in candidates versus healthy individuals who are age and
      gender matched counterparts of candidates. Hence, it was aimed to compare physical activity
      parameters, pulmonary functions and quality of life scores of candidates with healthy
      individuals in the current study.
    

Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patients were previously diagnosed with a hematological malignancy and determined to be a
        candidate for allogeneic-HSCT who were orientated from Bone Marrow Transplantation Unit for
        rehabilitation program. Healthy individuals were recruited from staff in the university and
        their healthy relatives.
      
Keywords: Energy metabolism; Exercise; respiratory function test; quality of life; leisure activities; hematopoietic stem cell transplantation