Physical activity for children undergoing Haematopoietic Stem Cell Transplantation (HSCT)

Purpose: Impairments in muscle strength, aerobic capacity and bone mineral density in children during and following HSCT have been observed and have a significant impact on function and Quality of Life (QoL). The aim of the studies contained in this thesis was to determine if a low-moderate intensity exercise program was feasible for children undergoing HSCT and to document the physical activity levels in HSCT survivors. Method: Sixteen children (6 to 18 years) who were undergoing HSCT were recruited from the Sydney Children's Hospital Network for the in-patient intervention. A baseline exercise assessment included 6-minute walk test (6MWT), hand-held dynamometry and single leg balance. Fatigue (Peds-Multidimensional Fatigue Scale) and QoL (PedsQL - Cancer Module) were also assessed pre-transplant, at Day 42 and 100. An individualised exercise program was provided by an Accredited Exercise Physiologist 5 days/week. Secondly, a questionnaire was administered to 40 children who were more than 1yr post-HSCT to examine physical activity levels, screen time and barriers and facilitators towards exercise.Results: The mean weekly minutes of exercise performed was 114±21, with an average session time of 37 minutes and 60% uptake rate of sessions offered. More than 50% of children were able to achieve the goal of 60 minutes/wk for 6 of 7 weeks. A median decline in 6MWT (-23%) and a stabilization effect was observed for upper (-5%) and lower body strength (-7%), with non-significant improvements in fatigue (3%) and QoL (8%).Early survivors (1-2 years) were less active and engaged in higher levels of screen time than late survivors (>2yrs), specifically adolescents. Irrespective of time post-transplant, survivors are insufficiently active (38% met WHO recommendations) and screen time was significantly greater than recommended (180-240min). Primary barriers to exercise were physical (52%) and motivational (23%). Key facilitators were parental support.Conclusions: A minimum of 60 minutes of low-moderate intensity exercise is safe and achievable for the majority of children throughout the in-patient HSCT period, and may contribute to physiological and psychological benefits.Children should be encouraged early after transplant to increase physical activity and decrease screen time. Individualised exercise therapy may be required to address barriers to exercise