Blood cancers account for more than 10 per cent of new cancer diagnoses each year. Stem cell transplantation (SCT) involves taking cells, often from bone marrow, and putting them into the blood of a patient. This turns them into blood cells, which replace ones that are killed during chemotherapy treatment. This can be a lifesaving procedure for people with blood cancers.
However, due to extended bed rest and therapies which are toxic to the heart and muscles, individuals undergoing SCT have a five-fold increase in their risk for diabetes and cardiovascular disease (such as heart attack and stroke). Measures are urgently required to ensure that those who survive blood cancers do not die prematurely from diabetes and cardiovascular disease.
We will test the effectiveness of a novel intervention to both reduce and break up sedentary (sitting) time and increase physical activity to prevent heart and muscle damage and improve quality of life (QoL) in people undergoing stem cell transplantation.
A particular novel aspect of the study is the measurement of heart function using state-of-the-art cardiac magnetic resonance imaging (MRI) during exercise; a technique which assesses aspects of heart function related closely to the ability to perform daily activities.
Aims and objectives
Our objective is to determine the effectiveness of an individualised, physical activity intervention in patients undergoing SCT, combining aerobic and resistance exercise with reducing and breaking up sedentary time to:
- improve heart and muscle function
- reduce the risk of diabetes and heart disease
- improve quality of life (QoL)
- The physical activity intervention will reduce SCT-induced decline in oxygen capacity (measured using peak oxygen uptake during exercise) and heart capacity (measured using MRI during exercise) as compared with usual care.
- In people undergoing SCT, the physical activity intervention will improve QoL, reduce symptoms of fatigue and improve functional independence compared with usual care.
How it will be done
The study will be carried out with participants randomised into two groups, physical activity and usual care. Main measurements include peak oxygen uptake, peak cardiac output, QoL, fatigue, and functional independence. Patients with blood cancer who are at least 18 years old and require an allogeneic (cells donated by other people as opposed to cells from the patient’s bone marrow) SCT will be recruited to participate from the Alfred Hospital Haematology Clinic.
There will be two major components to the physical activity intervention. Firstly, a programme to reduce daily sedentary time and secondly a structured exercise programme combining aerobic and resistance exercises. Intervention delivery will be supported by individualised exercise and sedentary time behaviour reduction prescription and monitoring, including provision of a smartphone-based self-monitoring and behavioural prompting tool (Rise and Recharge R & D app).
This study will provide an evidence-based strategy to combat the serious risk for diabetes, heart disease and stroke in the rapidly growing global population of SCT survivors. This will provide the motivation for immediate changes in the management of SCT whilst also providing a platform for investigations evaluating longer-term health effects.
The use of our purposefully developed Rise and Recharge R & D app will enhance our ability to translate our findings beyond patients treated with SCT, to other cancers. Comprehensive testing of patients using sensitive techniques will identify effects which are meaningful for patients and may detect individuals who are more vulnerable to diabetes, heart disease and stroke as a result of SCT.
This advance would permit earlier, targeted intervention to prevent these serious complications and to preserve long-term QoL.