PMID 38086868

Research
All papers

Prehabilitative high-intensity interval training and resistance exercise in patients prior allogeneic stem cell transplantation

Kuehl R, Feyer J, Limbach M, Pahl A, Stoelzel F, Beck H, Wegner A, Rosenberger F, Dreger P, Luft T, Wiskemann J

Question

Is a supervised moderate-to-high intensity HIIT plus resistance exercise prehabilitation program safe, feasible, acceptable, and preliminarily effective for improving cardiorespiratory fitness, muscle strength, quality of life, and fatigue in patients before allogeneic stem cell transplantation?

Summary

This multicenter single-arm pilot study tested supervised prehabilitation with HIIT plus moderate-to-high intensity resistance exercise in patients with hematological cancer scheduled for allogeneic stem cell transplantation. The intervention was difficult to recruit for because transplant scheduling left little time before admission, but enrolled participants showed high exercise adherence, no reported adverse events, high enjoyment, and significant improvements in VO2peak, peak power output, 6-minute walk distance, some strength measures, physical functioning, fatigue, and dyspnea.

Methodology

  • Sixteen adults with hematological cancer scheduled for allogeneic stem cell transplantation.
  • 16 participants.
  • Bicycle ergometer HIIT followed by resistance machines/free weights.
  • Work intervals: 1 minute.
  • Recovery: 1 minute at 50% PPO.
  • Intensity: HIIT 90-100% PPO after two 70% PPO familiarization sessions; resistance exercise 60-80% 1RM.
  • HIIT approximately 26-31 minutes plus 30 minutes resistance exercise.
  • 2 sessions per week.
  • 4-12 weeks planned before allo-HCT.
  • Multicenter prospective single-arm pilot study.
  • Recruitment and feasibility, VO2peak, Peak power output, and 6-minute walk distance were tracked.

Outcomes

Recruitment

The study intended to include 30 patients but included 16 and stopped early because of low recruitment.

Safety concern

HIIT adherence

HIIT adherence was high, with 92% adherence and mean 7.4 of 8 intervals completed per exercise session.

Improved

VO2peak

VO2peak increased from 20.4 to 23.4 ml/kg/min.

Median improvement 2.15 ml/kg/min; z=-2.34, p=0.019, 95% CI 0.67 to 5.35, d=1.6

Improved

Peak power output

Peak power output increased from 117 to 131.2 W.

Median improvement 15 W; z=-2.56, p=0.010, 95% CI 5.04 to 23.53

Improved

6-minute walk distance

6-minute walk distance increased from 558.8 to 608.6 m.

Median improvement 30.5 m; z=-2.03, p=0.043

Improved

Patient-reported outcomes

Physical functioning, role functioning, emotional functioning, fatigue, dyspnea, physical fatigue, and reduced activity improved significantly; several other QOL/fatigue domains did not.

Physical functioning p=0.01; role functioning p=0.041; emotional functioning p=0.004; fatigue p=0.007; dyspnea p=0.024; MFI physical fatigue p=0.03; MFI reduced activity p=0.013

Mixed

Safety

No adverse events were reported, but some sessions ended prematurely or required modification and 8 sessions were rated overstraining.

112/128 feedback sessions, or 87.5%, were without complaints.

Mixed

Insights

  • A short, supervised 1:1 cycling HIIT format with resistance training can be tolerated by selected allo-HCT candidates under close medical and exercise-specialist monitoring.
  • Recruitment and timing are major barriers when exercise starts only after allo-HCT is scheduled.
  • Familiarization at lower intensity and symptom-based intensity reduction are important in medically complex populations.
  • This study informs clinical safety boundaries more than general consumer HIIT programming.

Limitations

  • Low recruitment and early study stop
  • Small sample
  • Single-arm design
  • No control group
  • Variable intervention duration
  • Combined HIIT and resistance exercise prevents attribution to HIIT alone
  • Findings limited to selected patients able to attend supervised sessions

Safety

  • No adverse events were reported.
  • Four sessions had premature endings: two during HIIT because of exhaustion and palpitations, and two during resistance exercise because of shoulder pain and lack of energy/weakness.
  • Five sessions required reduced intensity or termination of specific exercises.
  • Seven sessions involved discomfort such as vertigo directly after strain or exhaustion.
  • Pain associated with the last training session was reported at the beginning of eight sessions.
  • Exercise was contraindicated during fever, acute infections, thrombocytes below 15000/uL, or hemoglobin below 8 g/dl.