Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

A Combined Exercise and Sedentary Behaviour Intervention Preserves VO2peak in Adults Undergoing Allogeneic Stem Cell Transplantation for Haematological Cancer (#194)

Hayley T Dillon 1 2 , Nicholas J Saner 2 , Tegan Ilsley 2 3 , David Kliman 4 , Andrew Spencer 4 , Sharon Avery 4 , David W Dunstan 1 2 , Robin M Daly 1 , Steve F Fraser 1 , Neville Owen 2 5 , Brigid M Lynch 2 6 7 , Bronwyn A Kingwell 2 8 , André La Gerche 2
  1. Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, AU
  2. Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
  3. Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, AU
  4. Malignant Haematology and Stem Cell Transplantation Service, Alfred Hospital, Melbourne, VIC, Please Select, Australia
  5. Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
  6. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
  7. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  8. CSL, Melbourne, VIC, AU

Background. Allogeneic stem cell transplantation (allo-SCT) provides a potential cure for high-risk, recurrent, and refractory hematological cancers (HC). However, allo-SCT survivors experience significant treatment-induced exercise intolerance and associated cardiovascular mortality. Purpose. We conducted a randomized controlled trial in HC patients scheduled for allo-SCT to determine if a 4-mo multifaceted activity program could preserve peak oxygen uptake (V̇O2peak) and its determinants. Methods. Sixty-two HC patients scheduled for allo-SCT were randomized to usual care (UC; n=32, 55±15 y, 63% male) or the multifaceted activity program (Activity; n=30, 50±16 y, 60% male). Patients assigned to Activity completed thrice weekly aerobic and resistance exercise for 4-mo and concurrently aimed to reduce sedentary time by 30-min/d via replacement with short (3-min), frequent (hourly), light-intensity activity. Cardiopulmonary exercise testing (CPET) was conducted prior to allo-SCT admission, and 12-wks following discharge to assess V̇O2peak, as well as peak power output (PPO), respiratory exchange ratio (RER), and heart rate (HR). Peak lactate was also assessed via finger prick capillary sample. Results. Fifty patients completed follow-up (23 Activity; 27 UC), 96% of whom satisfied peak CPET criteria (22 Activity; 26 UC). Compared to UC, there was a significant treatment benefit for Activity on V̇O2peak (net difference: 2.5 ml/kg/min [95% CI 0.3, 4.8], p=0.03) due to a 15% reduction in UC (-3.4 ml/kg/min [95% CI -4.9, -1.8], p<0.001) and no significant change in Activity (-0.9 ml/kg/min [95% CI -2.5, 0.8], p=0.31). Similarly, PPO declined less in Activity than UC (-11% vs. -24%; interaction, p=0.03), while peak HR and lactate reduced similarly in Activity and UC (-9 vs. -7 beats/min, p=0.75; -1.3 vs -2.2 mmol/L; p=0.22). Peak RER was unchanged in both groups. Conclusion. A multifaceted activity program targeting exercise and sedentary behaviour is effective in attenuating allo-SCT-induced declines in V̇O2peak. Whether these benefits on VO2peak translate to reduced cardiovascular morbidity and greater longevity warrants investigation.