Gait Analysis of Patients After Allogeneic Hematopoietic Cell Transplantation Reveals Impairments of Functional Performance.

Background: After allogeneic hematopoietic cell transplantation (alloHCT), patients often report functional impairments like reduced gait speed and muscle weakness. These impairments can increase the risk of adverse health events similar to elderly populations. However, they have not been quantified in patients after alloHCT (PATs). Methods: We compared fear of falling (Falls Efficacy Scale-International) and temporal gait parameters recorded on a 10-m walkway at preferred and maximum gait speed and under dual-task walking of 16 PATs (aged 31-73 years) with 15 age-matched control participants (CONs) and 17 seniors (SENs, aged >73 years). Results: Groups' gait parameters especially differed during the maximum speed condition: PATs walked slower and required more steps/10 m than CONs. PATs exhibited greater stride, stance, and swing times than CONs. PATs' swing time was even longer than SENs'. The PATs' ability to accelerate their gait speed from preferred to fast was smaller compared with CONs'. PATs reported a greater fear of falling than CONs and SENs. Conclusion: Gait analysis of alloHCT patients has revealed impairments of functional performance. Patients presented a diminished ability to accelerate gait and extending steps possibly related to a notable strength deficit that impairs power-generation abilities from lower extremities. Furthermore, patients reported a greater fear of falling than control participants and even seniors. Slowing locomotion could be a risk-preventive safety strategy. Since functional disadvantages may put alloHCT patients at a higher risk of frailty, reinforcing appropriate physical exercises already during and after alloHCT could prevent adverse health events and reduce the risk of premature functional aging.

Whole body vibration training during allogeneic hematopoietic cell transplantation-the effects on patients' physical capacity.

Patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) experience a considerable decline in physical and psycho-social capacity. Since whole body vibration (WBV) is known to efficiently stimulate the neuromuscular system and enhance cardiorespiratory fitness and muscle strength in frail individuals, we hypothesized that WBV would maintain various physical and psychological capacities in patients during alloHCT. Seventy-one patients were randomly allocated to either an intervention group (IG) doing WBV or an active control group (CG) doing mobilization exercises five times per week. We determined peak oxygen consumption (VO2peak) and maximum power, maximum strength, functional performance, body composition, quality of life (QoL), and fatigue. Tests were carried out before conditioning therapy, at hospital discharge and at day ± 180 (follow-up). As 18 patients did not participate in post-intervention assessment and follow-up data from 9 patients was not collectible, per-protocol (PP) analysis of 44 patients is presented. During hospitalization, WBV maintained maximum strength, height, and power output during jumping, as well as reported QoL, physical functioning, and fatigue level compared with mobilization. At follow-up, relative VO2peak (p = 0.035) and maximum power (p = 0.011), time and power performing chair-rising test (p = 0.022; p = 0.009), and reported physical functioning (p = 0.035) significantly increased in the IG, while fatigue decreased (p = 0.005). CG's body cell mass and phase angle had significantly decreased at follow-up (p = 0.002; p = 0.004). Thus, WBV might maintain maximum strength, functional performance, QoL, and fatigue during alloHCT, while cardiorespiratory fitness might benefit from accelerated recovery afterwards.

A new approach to characterize postural deficits in chemotherapy-induced peripheral neuropathy and to analyze postural adaptions after an exercise intervention.

BACKGROUND: Postural instability presents a common and disabling consequence of chemotherapy-induced peripheral neuropathy (CIPN). However, knowledge about postural behavior of CIPN patients is sparse. With this pilot study, we used a new approach to i) characterize postural impairments as compared to healthy subjects, ii) allocate possible abnormalities to a set of parameters describing sensorimotor function, and iii) evaluate the effects of a balance-based exercise intervention. METHODS: We analyzed spontaneous and externally perturbed postural control in eight CIPN patients before and after a balance-based exercise intervention by using a modification of an established postural control model. These findings were compared to 15 matched healthy subjects. RESULTS: Spontaneous sway amplitude and velocity were larger in CIPN patients compared to healthy subjects. CIPN patients' reactions to external perturbations were smaller compared to healthy subjects, indicating that patients favor vestibular over proprioceptive sensory information. The balance-based exercise intervention up-weighted proprioceptive information in patients. CONCLUSIONS: CIPN patients' major postural deficit may relate to underuse of proprioceptive information that results in a less accurate posture control as spontaneous sway results indicate. The balance-based exercise intervention is able to partially correct for this abnormality. Our study contributes to a better understanding of postural impairments in CIPN patients and suggests an effective treatment strategy. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00004340, retrospectively registered 04 January 2013.

Altered postural timing and abnormally low use of proprioception in lumbar spinal stenosis pre- and post- surgical decompression.

BACKGROUND: Lumbar spinal stenosis (LSS) is frequently associated with postural instability. Although several studies evaluated patients' functional impairments, underlying sensorimotor mechanisms are still poorly understood. We aimed to assess the specific set of postural control deficits associated with LSS during spontaneous and externally perturbed stance and evaluated post-surgical changes in postural behavior. METHODS: We analyzed postural control in eleven LSS patients (age 69 ± 8 years) pre- and post-laminectomy, correlated experimental data with functional tests and patient-reported outcomes, and compared findings to 15 matched, healthy control subjects (age 70 ± 6 years). Postural control was characterized by spontaneous sway measures and measures of perturbed stance. Perturbations were induced by anterior-posterior pseudorandom tilts of the body support surface. We used an established postural control model to extract specific postural control parameters. RESULTS: Spontaneous sway amplitude, velocity and frequency were abnormally large in LSS patients. Furthermore, patients' postural reactions to platform tilts, represented by GAIN and PHASE were significantly altered. Based on simple feedback model simulations, we found that patients rely less on proprioceptive cues for stance regulation than healthy subjects. Moreover, their postural reactions' timing is altered. After surgery, patients' spontaneous sway amplitude was significantly reduced and their postural timing approximated the behavior of healthy subjects. CONCLUSION: The reduction in proprioceptive input for stance control due to stenosis-caused afferent dysfunction is a functional disadvantage for LSS patients - and may be the basis of increased spontaneous sway. This disadvantage may cause the timing of postural reactions to alter, with the intent of preventing rapid changes in stance regulation for safety reasons. After surgery, patients' postural timing approximated those of healthy subjects, while the abnormally low use of proprioception remained unchanged. We suggest the post-surgery rehabilitation of proprioception, eg through balance exercises on unstable surfaces and reduced visual input.

Endurance and resistance training in patients with acute leukemia undergoing induction chemotherapy-a randomized pilot study.

PURPOSE: Acute leukemia (AL) and its initial treatment can impair physical functioning and capacity significantly. Exercise as a countermeasure has been investigated in few studies confirming its feasibility and safety during intensive induction chemotherapy, but the relative effects of diverse exercise programs have not been analyzed. Therefore, we aimed to investigate independent effects of endurance and resistance training on physical capacity and quality of life (QOL). METHODS: Twenty-nine adult AL patients were randomly allocated to an endurance (EG), resistance (RG), or control (CG) group. The intervention took place during induction chemotherapy with three exercise sessions per week for 30-45 min each. Endurance capacity at individual anaerobic threshold, maximum knee extension and flexion strength, standardized phase angle (SPA), and QOL were measured at baseline prior to induction chemotherapy and before discharge. RESULTS: Endurance capacity changed in neither the EG, RG, or CG (P = 0.104); descriptively, the EG (- 0.05 W/kg) and RG (- 0.04 W/kg) exhibited a smaller decrease than CG (- 0.22 W/kg). We noted a significant difference in knee extension strength (P = 0.002); RG improved their maximum strength (+ 0.14 Nm/kg), while the EG's (- 0.13 Nm/kg) and CG's (- 0.19 Nm/kg) was significantly reduced. QOL and SPA revealed no change after the intervention. CONCLUSIONS: We conclude that resistance training is a key component when exercising during induction chemotherapy: it improved maximum strength, but also influenced endurance capacity even during intensive treatment. Considering the prognostic value of physical function, we strongly propose integrating exercise, especially resistance-based training, already during induction chemotherapy to preserve AL patients' physical capacity and functional status.

Feasibility of whole body vibration during intensive chemotherapy in patients with hematological malignancies - a randomized controlled pilot study.

BACKGROUND: Hospitalized cancer patients undergoing intensive or high-dose chemotherapy often experience a considerable decline in functional performance associated with the increased risk of adverse health events. Exercises, particularly resistance-based exercises that may counteract this decline are restricted by therapy-related side effects. Since whole body vibration (WBV) is known to efficiently stimulate the neuromuscular system without significantly raising blood pressure, we hypothesize that especially WBV is particularly feasible even during intensive or high-dose chemotherapy (primary endpoint) and thus induces beneficial functional adaptations. METHODS: Twenty hospitalized patients with hematological malignancies scheduled for intensive or high-dose chemotherapy were randomly allocated to an intervention group (IG) undergoing WBV, or an active control group (CG) cycling. Feasibility was determined by comparing the IG's and CG's training compliance. Furthermore, to assess feasibility, WBV-induced changes in chemotherapy-related side effects, blood pressure, and heart rate immediately after exercising were documented. To assess patients' functional performance, we measured jump height (cm), the duration (sec) of performing the chair rising- (CRT) and timed-up-and-go test (TUG), maximum power output during jumping and CRT (watt/kg) as well as sway path (mm) during balance tasks. RESULTS: Training compliance was similar between groups (IG: median 62%, range 39-77; CG: 67%, 58-100; p = 0.315). Moreover, we observed neither the IG's reported side effects worsening, nor any increase in blood pressure after WBV. IG's jump height (+ 2.3 cm, 95%CI 0.1-4.4, p = 0.028) and TUG performance (- 1.3 s, 95%CI -2.53 - -0.65, p = 0.027) improved significantly, while sway paths in semi-tandem stance were augmented after the intervention (eyes open: + 60 mm, 95%CI 2-236, p = 0.046; eyes closed: + 88 mm, 95%CI 49-214, p = 0.028). The CG's performances did not change over time. Maximum power output during CMJ and CRT and time during CRT did not change. CONCLUSION: Our study is the first proving the feasibility of WBV during intensive/high-dose chemotherapy of hospitalized cancer patients. Additionally, WBV-induced neuromuscular adaptations resulted in functional benefits relevant to patients' autonomy. We believe that WBV can be implemented as an alternative training method during intensive chemotherapy, although the relative benefit compared to conventional resistance training requires more evaluation in future studies. TRIAL REGISTRATION: German Register of Clinical Trials No.: DRKS00004338 , prospectively registered on 11/30/2012.

Results From a Pilot Study of Handheld Vibration: Exercise Intervention Reduces Upper-Limb Dysfunction and Fatigue in Breast Cancer Patients Undergoing Radiotherapy: VibBRa Study.

PURPOSE: Although there is evidence that breast cancer patients benefit from exercising during treatment, exercising during radiotherapy and especially the effects on upper-limb dysfunctions have been infrequently assessed. Therefore, we primarily aimed to confirm our interventions' feasibility and secondarily aimed to affect upper-limb dysfunctions and fatigue. METHODS: Twenty-two breast cancer patients scheduled for radiotherapy were allocated to an intervention (IG) or a passive control group (CG) as they preferred. IG exercised 3×/week during 6 weeks of radiotherapy: cycling endurance, handheld vibration, and balance training. We documented adverse events and training compliance (feasibility) and assessed the range of shoulder motion (ROM), isometric hand grip strength, vibration sense on the first metacarpophalangeal joint of the affected upper limb, and fatigue. RESULTS: We observed no adverse events and a training compliance of 98 %. IG's ROM improved significantly (abduction: 11°; 95% confidence interval [CI] 5 to 20; external rotation: 5°, 95% CI 0 to 10), as did the hand grip strength (1.6 kg, 95% CI -0.6 to 3.1), while CG's ROM did not change. CG's vibration sense worsened (-1.0 points, 95% CI -1.5 to -0.5), while IG's remained stable. Changes in general fatigue levels between IG (-2.0 points, 95% CI -3.0 to -1.0) and CG (0.5 points, 95% CI -1.0 to 4.5) revealed significant differences ( P = .008) Conclusions: Our intervention proved to be feasible and provides novel findings: it reduced fatigue levels and interestingly, handheld vibration exercises improved upper-limb function due to shoulder ROM, hand grip strength, and vibration sense.

Balance impairments and neuromuscular changes in breast cancer patients with chemotherapy-induced peripheral neuropathy.

OBJECTIVE: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment. Resulting sensory and motor dysfunctions often lead to functional impairments like gait or balance disorders. As the underlying neuromuscular mechanisms are not fully understood, we compared balance performance of CIPN patients with healthy controls (CON) to specify differences responsible for postural instability. METHODS: 20 breast cancer patients with CIPN (PAT) and 16 matched CONs were monitored regarding centre of pressure displacement (COP) and electromyographic activity of M. soleus, gastrocnemius, tibialis anterior, rectus femoris and biceps femoris. We calculated antagonistic co-contraction indices (CCI) and elicited soleus H-reflexes to evaluate changes in the elicitability and sensitivity of spinal reflex circuitry. RESULTS: PAT's COP displacement was greater than CON's (p=.013) and correlated significantly with the level of CCIs and self-reported CIPN symptoms. PAT revealed prolonged H-wave latency (p=.021), decreased H-reflex elicitability (p=.001), and increased H-reflex sensitivity from bi- to monopedal stance (p=.004). CONCLUSIONS: We summarise that CIPN causes balance impairments and leads to changes in elicitability and sensitivity of spinal reflex circuitry associated with postural instability. We assume that increased simultaneous antagonistic muscle activation may be used as a safety strategy for joint stiffness to compensate for neuromuscular degradation. SIGNIFICANCE: Sensorimotor training has the potential to influence neuromuscular mechanisms in order to improve balance performance. Therefore, this training modality should be evaluated as a possible treatment strategy for CIPN.