Impact of the initial fitness level on the effects of a structured exercise therapy during pediatric stem cell transplantation

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Before and after hematopoietic stem cell transplantation (HSCT), most patients suffer from psychophysical limitations due to the treatment. Exercise interventions demonstrate beneficial effects on, for example, strength, endurance, or health-related quality of life during and after HSCT, but with a great variation among patients concerning the response to exercise. This study examines the influence of the initial fitness on the effects of an exercise therapy in pediatric HSCT.


Fifty-three children and adolescents (10.9 ± 3.5 years) scheduled for HSCT were randomized into an exercise intervention group (IG) or a control group (CG). During hospitalization, the IG performed endurance, strength, and flexibility training three times per week. The CG included a nonexercise program. A 6-min walk test was completed before and after the inpatient period. Baseline results (6-min walking distance [6MWD]) were used to split both groups into the following: IGUNFIT, n = 14; IGFIT, n = 12; CGUNFIT, n = 16; CGFIT, n = 11. Differences in outcome changes between groups were analyzed with H-test.


Intergroup comparison revealed significant differences between IGUNFIT and CGUNFIT (P < 0.05). The IGUNFIT increased their 6MWD by +8% (vs. IGFIT, +1%); both CGs presented a decline in 6MWD (CGUNFIT, –14%; CGFIT, –16%). At discharge, the IGFIT achieved 85.5 ± 10.3% of healthy reference values.


The current results indicate that exercise during pediatric HSCT is feasible and contributes to prevention of treatment-related loss of physical function. As seen in healthy persons, patients’ benefits might depend on their initial fitness level. As a diminished physical capability may result in higher training effects, impaired especially patients should engage in exercise.

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