Wearable Monitors Facilitate Exercise in Adult and Pediatric Stem Cell Transplant

Ethan Pottebaum; Alexa Warmoth; Sabarish Ayyappan; David S. Dickens; Yogesh Jethava; Arunkumar Modi; Michael H. Tomasson; Lucas J. Carr; Melissa L. Bates

Disclosures

Exerc Sport Sci Rev. 2021;49(3):205-212. 

In This Article

Abstract and Introduction

Abstract

Hematopoietic stem cell transplant (HSCT) is a potentially curative treatment for hematopoietic malignancies, complicated by decreased performance status and quality of life. Exercise therapy improves outcomes in HSCT, but several barriers have prevented exercise from becoming routine clinical practice. Based on existing data that wearable technologies facilitate exercise participation in other sedentary and chronic illness populations, we propose the novel hypothesis that wearable technologies are a valuable tool in transcending barriers and developing exercise therapy programs for HSCT patients.

Introduction

Hematopoietic stem cell transplantation (HSCT) is the only potentially curative therapy for many adult and pediatric patients with hematological cancers. The clinical journey of the HSCT patient includes induction chemotherapy, the initial treatment of the blood cancer, lower-dose consolidation chemotherapy cycles, HSCT consisting of a conditioning regimen to further reduce tumor burden and prepare the bone marrow for engraftment, and transplantation with the patient's own (autologous) or a donor's (allogeneic) stem cells. Even patients that survive the procedure and are cured of their cancer face a highly variable survivorship period. Some patients receive more than one HSCT for the treatment of their disease. Each step of the HSCT process is associated with increased sedentary time and sequelae including depression and fatigue, muscle atrophy, decreased strength and flexibility, prolonged immune suppression, and anxiety. Long-term, posttreatment outcomes of HSCT include fatigue and depression, graft-versus-host disease, and cardiac toxicity. These can be debilitating and prevent patients from fully "returning to normal".[1] As we discuss here, evidence supports exercise as an effective therapy for ameliorating or lessening intra- and posttransplant sequelae. Yet, if exercise is an effective adjuvant treatment to HSCT, why is it not standard of care?

Addressing barriers to exercise in HSCT is central to answering this question. Wearable activity monitors have been used as an intervention tool to support individualized exercise interventions for patients with chronic diseases. However, to date, wearable activity monitors have not been used to support exercise therapy in HSCT. In this article, we assess the safety and feasibility of exercise in HSCT patients of all ages, the potential application of wearable activity monitors for supporting exercise in HSCT patients, the benefits and pitfalls of wearable activity monitors, and future directions needed to implement this model into clinical care. Based on existing data that wearable technologies facilitate exercise participation in other sedentary[2] and chronic illness populations,[3] we propose the novel hypothesis that wearable technologies are a valuable tool in transcending barriers and developing exercise therapy programs for HSCT patients (Figure 1).

Figure 1.

Hypothesized role for wearable technology in exercise prescription for HSCT patients. Hypothesized integration points for wearable technology are shown in red. In current practice, oncology providers develop exercise prescriptions for HSCT patients, whose implementation may be limited by barriers to exercise. Wearable technology may be useful in addressing these barriers and in providing feedback to providers. This may allow providers to better refine exercise prescriptions. Wearable technology may be useful at all stages of patient care, including cancer prevention, inpatient and outpatient treatment, and survivorship.

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