Strength Training Following Hematopoietic Stem Cell Transplantation: Designing Interventions for Eventual Translation into Clinical Practice

PURPOSE: Intensive cancer therapy followed by hematopoietic stem cell transplantation (HCT) results in highly distressing symptoms, impaired functional ability and diminished quality of life. These problems are amendable to exercise interventions but dependent upon participant uptake for eventual translation into clinical practice. This study reports subject attrition, compliance, adherence, and progression from the strength training arm (n = 37) of our intervention study, Strength Training to Enhance Early Recovery (STEER) after HCT. METHODS: This single-blind controlled study randomized subjects to STEER versus usual care plus attention control with health education. STEER consisted of a progressive resistance program using elastic resistance bands tailored to the individual’s capabilities and integrated seamlessly into existing clinical practice, Subjects received instruction and began active range of motion two times per week while hospitalized for HCT followed by a six-week moderate intensity program (three sessions per week/18 sessions total) post hospital discharge. STEER employed a combined supervised/unsupervised approach. RESULTS: Four subjects died during the course of the study, unrelated to the STEER intervention (attrition rate 10%). Post-hospitalization, subject compliance with STEER was high (83%, SD = 22) as well as adherence to the exercise prescription (89%, SD = 25). Most subjects (90%) were able to progressively increase their prescription by adding repetitions, sets, number of exercises or band resistance. CONCLUSIONS: STEER was tested in a challenging group of patients during a period of complex, frequently changing needs. Our study took advantage of common clinical situations following HCT, such as frequent clinic visits during the first six weeks following hospital discharge and downtime in clinic when subjects wait to see their healthcare provider. Using downtime in clinic to exercise is an efficient use of subjects’ time. The intervention was specifically designed to minimize subject burden and maximize benefits. Subjects had high compliance and adherence to the STEER intervention which (1) reflects a patient-centered approach; (2) demonstrates effective tailoring to HCT subject’s capability; and, (3) facilitates eventual translation into practice.