Feasibility Study to Assess an Adapted Physical Activity Program in Children, Adolescents and Young Adults Requiring Hematopoietic Stem Cell Transplantation

Study Overview
=================
Brief Summary
-----------------
Allogeneic haematopoietic stem cell transplantation (aHSCT) is the only curative treatment for many paediatric and young adult haematological pathologies (acute leukaemia, myelodysplastic syndromes haemoglobinopathies, bone narrow aplasia, severe combined immunodeficiency). Despite the major therapeutic progress made over the last 50 years, particularly in terms of supportive care, post-transplant morbidity and mortality remain high. Infectious complications, whose incidence varies between 30 and 60%, are the first cause of mortality in the immediate post-transplant period. In order to protect the patient from the occurence of severe infectious episodes, aHSCT must be performed in a highly protected environment (positive pressure chambers). This has consequences for the experience and impact of hospitalization on the patient and family. This is particularly true in pediatrics, with children, adolescents or young adults, where it is not only the patient's quality of life that is at stake, but also his emotional and psychomotor development. In this specific population, prolonged hospitalization (at least 6 weeks) in a sterile room will be responsible for physical deconditioning accompanied by a decrease in muscle mass. Patients often experience an deteriorated quality of life. Today, the benefits of physical activity (PA) during and after cancer treatment have been widely demonstrated. The objective of the study is to assess the feasibility of an adapted physical activity program during the isolation phase for achieving aHSCT in children, adolescents and young adults. This is a prospective, interventional, monocentric cohort study conducted at the institute of Paediatric Haematology and Oncology in Lyon. The intervention will take place during the isolation phase and will be based on an adapted physical activity (APA) program defined at inclusion, integrating supervised sessions with an APA teacher, as well as autonomous sessions performed by means of a connected bike in the sterile room. The program will be individualized according to age, aerobic capacities, and PA preferences. Sessions will also be tailored to the biological, psychological, and social parameters of patients. The total duration of the intervention is 3 months. To date, no PA studies have been performed in patients under 21 years old requiring aHSCT during the sterile isolation phase. EVAADE will therefore be the first study in this population to offer an innovative procedure with a connected device.

Official Title
-----------------
A Feasibility Study Evaluating Connected Bikes as a Means of Adapted Physical Activity in Children, Adolescents and Young Adults Requiring Hematopoietic Stem Cell Transplantation

Conditions
-----------------
Haematological Malignancy, Acute Leukemia, Myelodysplastic Syndromes, Hemoglobinopathy in Children, Bone Marrow Aplasia, Severe Combined Immunodeficiency

Intervention / Treatment
-----------------
* Other: Physical activity program


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: 8 years ≤ Age ≤ 21 years Height ≥ 110 cm Histologically or cytologically confirmed malignant or non-malignant haemopathy Indication for hematopoietic stem cell transplantation Hospitalization in a sterile room in the investigating center Certificate of no contraindicatication to practice an APA, issued by the oncologist or the attending physician Having a smartphone available in the sterile room (iOS version 12 (iPhone/Apple) or 6 under Android at least) for playing connected games Signed and dated written consent (patient or parents of minor patients with obtaining the minor's acceptance) Exclusion Criteria: Severe heart disease and uncontrolled cardiovascular disease Temporary contraindications Severe anemia (hemoglobin ≤ 8 g/dl) will need to be treated (transfusion of red blood cells [RBCs]) before resuming the physical activity program. Severe infectious syndrome in progress and/or febrile feeling with accompanying signs (productive cough, muscle pain). Inclusion criteria for relatives : Person visiting the patient in a sterile room during the hospital stay At least 8 years old Height ≥ 110 cm Have a smartphone (iOS version 12 (iPhone/Apple) or 6 under Android at least) for the realization of the connected games. Not having any contraindication to physical activity. Signed and dated written consent (minor's relative or parents with the minor's acceptance).

Ages Eligible for Study
-----------------
Minimum Age: 8 Years
Maximum Age: 21 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Physical activity intervention<br>The intervention will take place during the whole isolation phase and will consist of an APA program defined at inclusion, integrating supervised sessions with an APA teacher, as well as unsupervised sessions. The program will be individualized according to the patient's age, physical condition and PA preferences. The sessions will also be adapted to the biological, psychological and social parameters of the patients. The intervention will be carried out during the entire hospitalization period and for a maximum of 3 months. An connected bike will be installed in the patient's room for the duration of the hospitalization. | Other: Physical activity program<br>* The supervised sessions will be offered 4 times a week in the participants' rooms by the APA teachers and will include moderate intensity aerobic activities (exercise bike), muscle strengthening (dumbbells, elastic bands, medicine balls) and playful situations (ball games, cooperative games, body expression games). Each patient will also be able to perform unsupervised sessions (on their own), following the advice given by the APA teacher. These unsupervised sessions can be done independently on the bike. In order to encourage patients to perform these unsupervised sessions, patients and their relatives will be given a connected device and will have access to a mobile application developed by the Kiplin company, which offers connected physical activity games to be performed in teams (from 2 to 4 participants). These games, lasting from 1 to 3 weeks, use the participants' daily PA level as a unit of animation and are punctuated by challenges.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| observance to the physical activity program | achieved/non achieved (achieved meaning the patient attended at least one session of 15 minutes weekly during the whole program, considering both supervised and unsupervised sessions) | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Impact of unsupervised sessions on patients' PA practice | Rate of unsupervised sessions/total of performed sessions | baseline, 3 months | 
| Impact of the physical activity program on weight | weight in kgs | baseline, 3 months | 
| Impact of the physical activity on waist circumference | waist circumference assessed in cm | baseline, 3 months | 
| Impact of the physical activity program on hip circumference | hip circumference assessed in cm | baseline, 3 months | 
| Impact of the physical activity program on body mass index | weight/(size)^2 | baseline, 3 months | 
| Impact of the physical activity program on endurance capacity | Harvard step test | baseline, 3 months | 
| Impact of the physical activity program on muscle strength | Dynanometer | baseline, 3 months | 
| Impact of the physical activity program on fatigue | Visual analogic scale from 0 to 10 | baseline, 3 months | 
| Self efficacy feeling | HAPA questionnaire | 3 months | 
| Motivation towards physical activity | BREQ-2 questionnaire | baseline, 3 months | 
| Impact of the PA program on metabolic syndrome | Lipid check-up | baseline, 3 months | 
| Impact of social environment of PA practice | PA practice of patient / PA practice of relatives | 3 months | 
| Overall satisfaction | Likert-scale questionnaire | 3 months | 
| Acceptability of the intervention | Number of enrolled patients/number of eligible patients | baseline |