Dillon HT; Baker Heart and Diabetes Institute, Melbourne, Australia & other centres
Saner NJ; Ilsley T; Kliman DS; Foulkes SJ; Brakenridge CJ;Spencer A; Avery S; Dunstan DW; Daly RM; Fraser SF; Owen N; Lynch BM; Kingwell BA; La Gerche A; Howden EJ;
Circulation [Circulation] 2024 Nov 04.
Date of Electronic Publication: 2024 Nov 04.
Background: Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematologic malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multicomponent activity intervention could attenuate reductions in cardiorespiratory fitness and exercise cardiac function (co-primary end points) in adults undergoing allo-SCT.
Methods: Sixty-two adults scheduled for allo-SCT were randomized to a 4-month activity program (n=30) or usual care (UC; n=32). Activity comprised multicomponent exercise training (3 days/week) and sedentary time reduction (≥30 min/day) program and was delivered throughout hospitalization (≈4 weeks) and for 12 weeks after discharge. Physiological assessments conducted before admission and at 12 weeks after discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake ([Formula: see text]), exercise cardiac magnetic resonance imaging for peak cardiac volume (CI peak ) and stroke volume (SVI peak ) index, echocardiography-derived left ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (cTn-I [troponin-I] and BNP [B-type natriuretic peptide]).
Results: Fifty-two participants (84%) completed follow-up (25 activity and 27 UC); median (interquartile range [IQR]) adherence to the activity program was 74% (41-96%). There was a marked decline in [Formula: see text] in the UC program (-3.4 mL‧kg -1 ‧min -1 [95% CI, -4.9 to -1.8]) that was attenuated with activity (-0.9 mL‧kg -1‧ min -1 [95% CI, -2.5 to 0.8]; interaction P =0.029). Activity preserved exercise cardiac function, with preservation of CI peak (0.30 L‧min -1 ‧m – 2 [95% CI, -0.34 to 0.41]) and SVI peak (0.6 mL/m 2 [95% CI, -1.3 to 2.5]), both of which declined with UC (CI peak , -0.68 L‧min -1 ‧m – 2 [95% CI, -1.3 to -0.32]; interaction P =0.008; SVI peak , -2.7 mL/m 2 [95% CI, -4.6 to -0.9]; interaction P= 0.014). There were no treatment effects of activity on cardiac biomarkers or echocardiographic indices.
Conclusions: Multicomponent activity intervention during and after allo-SCT is beneficial for preserving patient cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality after allo-SCT.