Problems of physical activity dosage in pediatric patients receiving HSCT

Summary

With each passing year the problem of use of physical therapy methods in pediatric patients receiving hemopoietic stem cell transplantation (HSCT) for the correction of complications occurring in the process of treatment is becoming more and more pressing due to expansion of indications for HSCT and the increasing survival rates of such patients. Current publications dedicated to analysis of physical activity limitation in pediatric patients following HSCT within the framework of physical rehabilitation contain contradictory information and methodological variations that do not provide adequate insight into physical abilities of this category of children. We are aiming to critically review the matter of modern tendencies in physical activity tolerance assessment in children receiving HSCT, and are discussing the alternative approaches to this problem.

Our purposes are: 1. Comparative assessment of muscular strength and tolerance to physical activity decrease in patients hospitalized at the HSCT department at various stages of therapy. 2. Analysis of literature data concerning the assessment of muscular strength and tolerance to physical activity decrease in pediatric patients receiving HSCT.

Objects and methods

Prospective comparative non-randomized study was carried out. The object of assessment was the muscular strength and hemodynamic parameters during orthoclinostatic test in patients during various stages of therapy: prior to admission to HSCT department (day -5 of conditioning), after HSCT procedure (+5 days from HSCT), and upon discharge from HSCT department (+30 days from HSCT). For study of muscular strength and tolerance to physical activity in Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Healthcare of the Russian Federation (n=27) patients with median age of 9 years old were selected. No rehabilitation measures were taken prior to the admission to HSCT department.

Results

Average time from diagnosis determination in case of patients with acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML) prior to the inclusion to the study amounted to 3 months; in case of patients with other diagnoses including immune deficiency and aplastic anemia (AA) it amounted to 5 weeks. The analysis of publications is performed according to the following search terms: “physical therapy, hematopoietic stem cell transplantation, physical rehabilitation, physical activity” for the last 10 years is found in PubMed, Elsevier, and ClinicalKey.

Conclusions

Noticeable decrease of both hemodynamic and strength parameters in comparison with other patient groups preparing for HSCT was registered in the group of patients with ALL and AML. Complicated pretransplantation period in the form of prolonged highly toxic therapy was the reason of it. After HSCT was conducted, the patients from both group lost their muscular strength to a greater extent; their tolerance to physical activity also decreased. Physiotherapy allowed to improve controlled parameters of muscular strength and physical activity tolerance, but the optimal level was not achieved. According to evidence from actual publications, the approach of preventive physical therapy appointment for those patients who are preparing for HSCT procedure seems to be the most perspective one.

Keywords

Physical therapy, hematopoietic stem cell transplantation, physical exercise, dosage.