Physical Functions in Allogeneic-HSCT Candidates
Physical Functions in Allogeneic-HSCT Candidates
Physical inactivity and impairments in physical functions have been observed in patients due
 to hematological malignancy itself and treatments of chemotherapy, radiotherapy,
 corticosteroids. However, no study investigated relationship of physical activity with
 pulmonary and physical functions in allogeneic hematopoietic stem cell transplantation (HSCT)
 candidates. Therefore, investigation of the relationship among outcomes in allogeneic HSCT
 candidates was aimed.
Hematological malignancies arise from deficiencies in blood cell lineage which represent a
 heterogeneous group including leukemias, lymphomas, myelomas, myeloproliferative diseases and
 myelodysplastic syndromes. In recent years, a great majority of patients with hematological
 malignancies often experience side effects of disease related treatments such as chemotherapy
 with multiple agents, radiotherapy, corticosteroids, combination of medical drugs, autologous
 and/or allogeneic hematopoietic stem cell transplantation (HSCT) throughout their remaining
 lives. Furthermore, there are substantial outcomes regarding the initial time of diagnosis
 that pulmonary function involvements, sedentary life style (39%), decreased exercise capacity
 and lower extremity muscle weakness have been present in patients with lymphoma even before
 first cycle of chemotherapy is administered to patients. During the period of or after
 chemotherapy, patients have suffered from decreased maximal oxygen uptake, advanced muscle
 weakness, decreased hemoglobin levels and evident fatigue, as well.

 As the treatment process continues for patients with hematological malignancies, HSCT is
 begun to schedule for almost all patients which has a significant potential for good clinical
 outcomes along with longer life expectancy. However, especially allogeneic-HSCT is a quite
 aggressive treatment option due to serious complications such as graft versus host disease,
 long term severe treatments of these complications and severe immune suppression related
 infections. Moreover, patients have already been exposed to immobility condition, low level
 of physical activity, pulmonary functions involvements, respiratory and peripheral muscle
 weakness as well as exercise intolerance before HSCT. In addition, the outcomes obtained from
 candidates just before HSCT have indicated that quadriceps femoris muscle strength, exercise
 capacity evaluated with 6-minute walk test, inspiratory and expiratory muscle strength are
 decreased respectively in 23%, 58%, 42% and 89% of candidates. Sarcopenia (50.6%), reduction
 in hip flexor, hip abductors and ankle flexors muscles strength and decreased diffusing
 capacity of the lung for carbon monoxide (78%) have also been mostly observed in HSCT
 candidates. In a study, candidates who were evaluated using a metabolic holter device are
 inactive (average 2180 steps/day) before HSCT. In another study, number of steps evaluated
 using a pedometer which provides only one output about step count are approximately 201.1
 steps per a day for HSCT candidates. Accuracy of pedometers can be reduced at slow walking
 speeds so that pedometers may not be suitable for cancer patients. On the other hand,
 metabolic holter devices use pattern recognition technology to evaluate physical activity
 level that may produce more accurate estimation of energy expenditure in cancer population.
 Besides, it has also been stated that quadriceps femoris muscle weakness is related to
 reduced daily number of steps, therefore if the muscles are strengthened, number of steps may
 be increased at the process of HSCT.

 Physical activity is any bodily movement which is produced by skeletal muscles concluded
 energy expenditure. While total daily energy expenditure demonstrates all types of energy
 costs including resting, diet-induced and activity-induced energy expenditures within 24
 hours, active energy expenditure related with physical activity is produced by daily living
 activities such as employment, sport and any other activities. Activity energy expenditure
 also decreases with excess body weight, older age, female gender, loss of muscle mass and
 diseases throughout life span . On the other hand, Canadian Academy of Sports and Exercise
 Medicine recommends that people prefer moderate-to-vigorous physical activity (>3.0 metabolic
 equivalents (METs)) including brisk walking, aerobic and resistance exercises, jogging,
 hiking, swimming and field games with ball or racquet for 150 min/week and a total
 sustainable activity duration from 30 min to 60 min per practice rather than sedentary
 behavior (<1.5 METs) in order to decrease risk of most major chronic disease by 25-50%.
 Moreover, a 15 min/d or 75 min/week of moderate-to-vigorous physical activity is also
 recommended as about 15% mortality risk reduces in diseases and benefits increase . Given the
 importance of physical activity assessment and counseling in people with/without chronic
 disease, according to literature, studies objectively investigating either detailed physical
 activity condition rather than number of steps or relations of physical activity with
 pulmonary and physical functions in allogeneic-HSCT candidates are scarce. Therefore, primary
 aim of the current study was to exhibit possible all detailed aspects of physical activity
 outcomes evaluated with a metabolic holter, an objective measurement device, secondary aim
 was to investigate relationship among physical activity parameters, pulmonary functions and
 physical functions in allogeneic-HSCT candidates and as finally, to identify independent
 predictors of physical inactivity in candidates was aimed.
Inclusion Criteria:

 -  being 18-65 years of age,

 -  having a diagnosis with hematologic malignancy

 -  being clinically stabile,

 -  being an allogeneic-HSCT candidate

 -  receiving optimal standard medical therapy including antibiotics, supplements and
 other drugs.

 Exclusion Criteria:

 -  having cooperation problems,

 -  having orthopedic or neurological disease with a potential to prevent assessment of
 exercise capacity,

 -  having comorbidities such as chronic obstructive pulmonary disease, cardiac diseases,

 -  acute infections and/or hemorrhage.