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Abstract
Purpose
To summarize and review the methodological quality of the evidence from trials examining the effectiveness of physical exercise in patients undergoing allogeneic hematopoietic stem cell transplantation (Allo-HSCT).
Methods
Six randomized clinical trials (RCTs) were identified, reviewed for substantive results, and assessed for methodological quality.
Results
Six trials met all methodological criteria on the modified Jadad score above 3 out of 5 points. Failure to blind the outcome assessor, and failure to describe the method of blinding of outcome assessor appropriately were the most prevalent methodological shortcomings. Various exercise modalities have been applied, differing in content, frequency, intensity, and duration. Positive results have been observed in part for a diverse set of outcomes, including physical and psychological performance.
Conclusion
The trials reviewed in this study were of moderate methodological quality. They suggest that exercise in patients undergoing Allo-HSCT may be safe and feasible, and in part patients benefit from increased physical performance both during and after transplantation. Future RCTs should use larger samples, appropriate comparison groups, and a standard of outcome measures, and examine what kind of exercise intervention (aerobic vs. resistance vs. combined) is the most effective for Allo-HSCT patients. It would be necessary to define contraindication for exercise to guarantee its safety.
Figures and Tables
Fig. 1
Flow diagram for trial identification and selection HSCT.
HSCT=hematopoietic stem cell transplantation.
Table 1
Methodological Quality Assessment for Each Included Study: Modified Jadad Scale
1) Was the study described as randomized (1=yes; 0=no)?, 2) Was the outcome assessment described as blinded (1=yes; 0=no)?, 3) Was there a description of withdrawals and dropouts (1=yes; 0=no)?, 4) Was the method of randomization well-described and appropriate (1=yes; 0=no)?, 5) Was the method of blinding of the assessment of outcomes well-described and appropriate (1=yes; 0=no)?, 6) Deduct 1 point if methods for randomization OR blinding were inappropriate.
Table 2
Randomized Controlled Trials in Patients undergoing Allogeneic Hematopoietic Transplantation
I=intervention group; C=control group; EORTC-QLQ-C30=European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; FACT-An=Functional Assessment of Cancer therapy-Anemia scale; HADS=Hospital Anxiety and Depression Scale; 6MWT=6-minute walk test; MFI=Multidimensional Fatigue Index; POMS=Profile of Mood States; NCCN=National Comprehensive Cancer Network; TUDS=Timed Up and Down Stairs; TUG=Time Up and Go; 6 RM test=six repetition maximum; CHIP-CE/CRF=Child's Health and Illness Profile-Child Edition/Cancer Related Fatigue.
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