Effects of Maintenance of Motor and Respiratory Performance With a Training Program in Inpatients Undergoing Bone Marrow Transplant

Effects of Maintenance of Motor and Respiratory Performance With a Training Program in Inpatients Undergoing Bone Marrow Transplant | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of Maintenance of Motor and Respiratory Performance With a Training Program in Inpatients Undergoing Bone Marrow Transplant Chiara Bottani, Chiara Piazza This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3873032/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background. Substantial physical and functional deconditioning are all potential adverse effects of bone marrow transplantation. Objective. To observe how physiotherapy treatment during the hospitalization period can impact the maintenance of motor and respiratory performance in patients undergoing bone marrow transplantation. Furthermore, it is interesting to evaluate how the patient is able to independently manage the proposed activity and consider it important for their health in the long term. Methods. Patients underwent strength and endurance tests at the start, at the end of hospitalization, and two months after discharge. The patients were given a rehabilitation protocol to follow during the entire hospitalization. During this period, lasting approximately 21 days, the physiotherapist supervises the carrying out of the exercises twice a week. From discharge and for the two months of follow-up the patient carries out the proposed protocol independently. Results. Forty-four patients were tested upon admission, discharge, and two months after admission. The distance covered in the walking test remains constant. The strength of the upper limbs shows a slight flexion at discharge and recovery of the initial values after eight weeks. The power of the lower limbs remains constant during hospitalization and increases with remote control. Conclusion. The results show that the proposal of moderate intensity physical activity can help maintaining motor and respiratory performance, in patients undergoing bone marrow trasplantation. bone marrow transplantation exercise physiotherapy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 CONTRIBUTION OF PAPER This study adds data to the small and not recent literary landscape on the subject, by using validated tests. Confirms the benefits of exercise for transplant patients, administered by the therapist or self-managed. Confirms the psycho-emotional benefit of physical exercise. INTRODUCTION The patients (pts) arriving at the transplant stage are already functionally compromised due to them disease, previous anticancer treatments and other possible co-morbidities. Additional factors related to the transplant, which can compromise the functional status of the patient, are the preparatory regimen with high-dose chemotherapy, side effects related to steroids and hospitalization. Potential graft complications such as systemic or pulmonary infections, acute and chronic graft versus host disease (GVHD), pain, decreased nutritional intake, and other sequelae are added. ( 1 ) Hematological patients undergoing bone marrow transplantation are candidates for prolonged hospitalizations (on average between 3 and 5 weeks), during which they are forced to bed rest and have minimal mobility, resulting in a progressive reduction in motor performance. Physical activity and rehabilitation programs are helpful in addressing fatigue, muscle weakness and weakness, psychological symptoms (anxiety and depression), and improving quality of life. Reviewing the scientific literature, there is evidence of the benefits of physiotherapy in adult hematological cancer patients undergoing bone marrow transplantation ( 2 ) The rehabilitation intervention is confirmed to be safe for the patients and well tolerated. It produces benefits on functional residual capacity (CRF), muscle strength and power, mobility and functional status. In addition, physical activity increases the production of endorphins, which can help relieve pain and generate an improvement in pain and perception of well-being. Physical training programs can have a cardiological and muscular protective effect, as well as a salutary effect on the prevention and control of transplant complications. ( 3 ) Maintaining physical activity during the transplant period can improve hospitalization, reduce the risk of complications, and accelerate physical recovery after discharge. ( 4 ) The study's primary objective is to observe how physical activity, carried out during the recovery, allows maintenance or improvement of motor and respiratory performances observed at the entrance also at discharge and after two months. The secondary goal is to make the pts independent in the long term and aware of the effectiveness of physical exercise even after discharge. METHODS The study considered all pts undergoing physiotherapy during hospitalization for bone marrow transplantation from November 2017 to February 2019. The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Fondazione IRCCS Istituto Nazionale dei Tumori of Milan, Italy (Ethics Committee number: 13/22). Informed consent was obtained from all subjects involved. It was a retrospective data collection relating to physiotherapy of 44 consecutive pts suffering from hematological diseases, recovered at the Hematology Division of the National Cancer Institute of Milan (INT). Inclusion criteria : Patients > 18 years Suffering from haematological pathology Admitted to undergo bone marrow trasplant Able to carry out the proposed assessment tests Able to follow the rehabilitation protocol independently Exclusion criteria : Patients with cognitive deficits that limit the understanding of the rehabilitation protocol Patients with motor deficits that prevent the execution of the exercises Patients with a contraindication to perform motor exercises due to the pathology they are suffering from Clinical data relating to the pathology, the type of transplant, and any complications that occurred during the transplant period were collected. The physiotherapist trained each patient using an informative and descriptive manual, proposing modest physical training. Each patient was given a brochure with the exercises to be performed independently. The supervision of a physiotherapist was guaranteed for the entire duration of the hospitalization. The patient met the physiotherapist twice a week and verified with him the correct execution of the proposed exercises. These are total body muscle strengthening exercises, using both elastic and weight resistance, in addition to aerobic training with a cycle ergometer. The patient also performed breathing exercises using a volumetric incentive (COACH). In addition to discussing with the therapist, the patient recorded the exercises performed in a daily diary present in the last pages of the manual. In the follow-up period he continued the proposed protocol independently, adding activities of daily living and walking, gradually increasing the intensity of physical activity. A data collection form was compiled for each patient, from the recovery to the end of the follow-up, which included: history of hematological disease and history of other pathologies, physical parameters with calculation of the Body Mass Index (BMI), lifestyle. Ain the same form was recorded the results of the physical performance assessment tests in the three times corresponding to hospitalization (T0), discharge (T1) and two months after the latter (T2). The tests carried out were the following: Six-minute walking test, an exam which, in a simple and reliable way, measures the distance a person covers in 6 minutes walking as fast as possible on a flat surface. Before, during and after the effort, the parameters of SaO2, HR, possible dyspnea are recorded using the Borg scale. ( 5 ) Strength Test, an exam that measures the maximum isometric force exerted by the muscles. The patient is asked to grip a dynamometer that records changes in strength. The test is performed with each of the two upper limbs and the best result of three consecutive tests is recorded. ( 6 ) Sit to Stand Test, an exam that measures the time taken by the patient to get up and sit down from a chair, without the aid of armrests, for five consecutive times. ( 7 ) Estimated time for carrying out the above tests was 20–30 minutes. Execution was done on admission (T0), on discharge (T1), 30 days after discharge (T2). STATISTICAL ANALYSIS The tests included in the study are the walking test, arm-strength tests, and sit-to-stand test, plus the recording of the subjectively perceived effort. Such activities are measured with the Borg scale ranging between 0 and 10, with zero standing for no action and ten for maximum effort. To find out whether there is a variation throughout the process or not for all these values, it is proper to conduct a specific hypothesis testing, where the null hypothesis is that there is no difference among the average values over time. The test statistics are the actual variations observed. Because our aim is to find out whether or not the rehabilitation improved patients’ ability, it is proper to set a null hypothesis suggesting that there is no difference at all between the ability level measured before the transplant, after the transplant, and after two months of physiotherapy: this way, small p-values are going to prove evidence against the null hypothesis, indicating a positive impact by the rehabilitation. To compute such value or all the tests performed, we adopted a bootstrap simulation: bootstrapping consists of generating random samples from the original population (44 pts) and then computing a highly reliable approximation of the measurements required. Usually, such assessment is carried out via the construction of a confidence interval, in which the actual value is going to lay with a given probability; alternatively, since the approximations of the valid values are normally distributed, it is also possible to establish the probability for one of the bootstrapped approximations to be greater than the value observed, namely our test statistic: this probability is the p-value. Considering a 0.05 threshold, if such a p-value is below 5%, it means that, in theory, there are very small probabilities of observing a value greater than the one we already observed, suggesting that such a value is already extreme and leading us to reject the null hypothesis in favour of a new alternative hypothesis; otherwise we conclude our testing accepting the null hypothesis initially established. RESULTS Forty-six pts were recruited, 2 died due to complications that occurred during hospitalization. Forty-four pts were included in the study, and their characteristics are described in Table 1. Table 2 shows the tests administered to pts upon admission, discharge, and two months after admission. The distance covered in the 6-minute walking test remains constant, as described in Fig. 1 during the performance are registered subjective values of fatigue by Borg scale. The strength of the upper limbs, measured with a dynamometer in the strength test, shows a slight flexion at discharge and recovery of the initial values in the follow-up (Fig. 2 and Fig. 3 ). The strength of the lower limbs, measured in the last test (sit to stand), remains constant during hospitalization and increases with the remote control (Fig. 4 ). For most of the tests, there is not even a natural variation (arm-strength test and sit-to-stand test). In contrast, for the walking test, the average distance covered slightly increases from the post-transplant poll to the next check. Still, a p-value of 0.2 indicates that such a difference is not much statistically significant. Yet, it is interesting to notice that the analysis of the effort perception leads to a different conclusion: the data from the study of the Borg values declared by the patients are rearranged in the graph. On the x-axis, there are the three distinct moments in time, whereas the y-axis displays the possible Borg values. The figures are three different box plots, one per moment, which condensate 50% of the observations within the rectangles; the other data points lie on the vertical lines (inter-quartile range), and the only outlier is represented by a unique patient who claimed a 10 in the pre-transplant poll. The black lines in the center of the rectangles represent the median value (3, 5, 2.5), the red dots display the mean values (3.23, 5.02, 3.07), and the long blue line stands for the total average value (3.77). Even from the picture, there seems to be some change, but it is better to conduct proper hypothesis testing. The null hypothesis is that there is no difference between the three mean values, whereas the test statistics are the actual variations among the moments: 1.79 for the pre-post, -1.95 for the post-follow up, and 0.16 for the pre-follow up. It turns out that the corresponding p-values for these one-sided tests are respectively 1.7e-4, 4.9e-5, and 0.62, leading to reject the hypothesis in the first two cases. In other words, there is no significant difference between the pre-transplant and the follow-up scenario, but there is a meaningful variation caused by the transplant. Therefore, it is reasonable to conclude that the recovery reduces the patient's physical capacity. Specifically, even though the average values for the pre-transplant and the follow-up polls are similar, we shall consider the median values since the median is more robust and not affected by the outlier registered only at the beginning. Once we do this slight correction, the p-value for the difference is still not below 0.05 but lower than before. DISCUSSION In this study of 44 pts undergoing bone marrow transplants with hematological diseases, we proposed a modest physical training to be performed during hospitalization. A comparison was made with other studies in which pts from the same population were subjected to different rehabilitation programs and administered further assessment tests ( 8 ). The acceptance, recruitment, and adherence to follow-up by all patients show that all well-accepted the proposed method. We decided to administer three tests together and three times instead of individually to get a complete picture of the individual patient's performance. These tests measure cardio-respiratory capacity, endurance, and strength of individual body districts; they are validated and used in clinical practice and reported in the literature. We are discussing the 6' walking, strength, and Sit-to-stand tests. The first one has been tested and validated on different patient populations and in a standardized way ( 9 ). It was used, in the beginning, to assess the functional status of patients with severe cardiopulmonary disease. Grip strength is used in the assessment of hand and upper limb function; it's a straightforward test to perform in a few seconds. The dynamometer used for the test is an inexpensive and readily available instrument. The Sit to Stand (STS) muscle power test proved to be a useful and, in general, more clinically relevant tool to assess the functional trend in older people. The low time, space, and material requirements of the STS muscle power test make this test an excellent choice for its application in extensive cohort studies and the clinical setting ( 10 ). Given the tests’ feasibility characteristics, we decided to use them simultaneously by administering them to this population of transplant patients who undergo a prolonged period of inactivity. Only a few studies report precedents following hospitalization and remote assessments ( 11 ). To our knowledge, there are no studies in which a respiratory simulator is used in the rehabilitation protocol of this type of patient. We decided to use it to measure and motivate patients' daily respiratory performance and avoid and reduce lung complications. To ensure patient involvement and awareness of intervention protocol, we compiled a descriptive manual of some respiratory, motor, and aerobic exercises to be given to pts. These exercises are explained in a simple and illustrated manner, allowing the patient a reasonable degree of self-management. Multiple interventions from the nurses and doctors supported the participants during the hospitalization. However, the ease of self-management of the rehabilitation program has the limitation that physiotherapy cannot be customized to the individual patient. The data collected show that physical and respiratory performance does not significantly reduce in terms of strength and endurance. In addition, pts report a reduction in the feeling of tiredness, measured by the Borg scale ( 12 ), through the maintenance of muscle tone and tropism. The limitation of this study is that it is not randomized moreover can be overcome by future and more complete resources. Furthermore, the activity level was not monitored during the entire intervention but only during the hospitalization. This model could be applied to a more heterogeneous population of cancer patients, even if not of hematological origin. The total participation from start to finish in the study and the compliance of all patients involved suggests that the recruitment method and the interventions tested are acceptable and repeatable in other cancer patient populations. The participants' adherence in the 3-phase assessment was always adequate, which provides input for future use on a larger scale. CONCLUSION This study observes the possible benefits that physiotherapy intervention has in patients undergoing bone marrow transplantation, to minimize the loss of physical and respiratory performance. Modest physical training during hospitalization could be useful to maintain the same motor and respiratory performance observed at admission or even improve them. Furthermore, it could improve patients' awareness and confidence in their treatment journey. Assuming that scientific evidence demonstrates that physiotherapeutic interventions are clinically relevant and should be implemented in these patients( 13 , 14 ) and considering our findings, we are encouraged to plan a further study to expand the case series and highlight the benefits on the risk of complications and quality of life. Declarations Ethical Approval : Study approved by INT’ ethic committee on 26 of January 2022, INT 13/22 Funding : This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector Conflict of Interest : None to declare. Authorship: Conception and design of the study: CB, CP Drafting the manuscript: CB, CP Final approval of the version: CB, CP Acknowledgments : The authors thank all the patients who participated in this study and all the nurses and physicians of the Hematology Department, INT. We would also like to thank Anna Guidetti, MD, and Alessandra Pigni, MD, for their support in the manuscript drafting. References Allart-Vorelli P, Porro B, Baguet F, Michel A, Cousson-Gelie F. Haematological cancer and quality of life: a systematic literature review. Blood Cancer J 2015 April 24;5(4):e305. Morales-Rodriguez E, Perez-Bilbao T, San Juan AF, Calvo JL. Effects of Exercise Programs on Physical Factors and Safety in Adult Patients with Cancer and Haematopoietic Stem Cell Transplantation: A Systematic Review. Int J Environ Res Public Health 2022;19(3):1288. doi: 10.3390/ijerph19031288 . Ishikawa A, Otaka Y, Kamisako M, Suzuki T, Miyata C, Tsuji T, et al. Factors affecting lower limb muscle strength and cardiopulmonary fitness after allogeneic hematopoietic stem cell transplantation. Support Care Cancer 2019;27(5):1793–1800. Abo S, Denehy L, Ritchie D, Lin K, Edbrooke L, McDonald C, et al. People With Hematological Malignancies Treated With Bone Marrow Transplantation Have Improved Function, Quality of Life, and Fatigue Following Exercise Intervention: A Systematic Review and Meta-Analysis. Phys Ther 2021;101(8):pzab130. Hamilton DM, Haennel RG. Validity and reliability of the 6-minute walk test in a cardiac rehabilitation population. Journal of Cardiopulmonary Rehabilitation and Prevention 2000;20(3):156–164. Coldham F, Lewis J, Lee H. The reliability of one vs. three grip trials in symptomatic and asymptomatic subjects. Journal of Hand Therapy 2006;19(3):318–327. Jones SE, Kon SS, Canavan JL, Patel MS, Clark AL, Nolan CM, et al. The five-repetition sit-to-stand test as a functional outcome measure in COPD. Thorax 2013;68(11):1015–1020. Mohammed J, Aljurf M, Althumayri A, Almansour M, Alghamdi A, Hamidieh AA, et al. Physical therapy pathway and protocol for patients undergoing hematopoietic stem cell transplantation: recommendations from the eastern Mediterranean blood and marrow transplantation (EMBMT) group. Hematology/oncology and stem cell therapy 2019;12(3):127–132. Konopka DN, Shook RP, Kohut ML, Tulp RV, Franke WD. Comparability of the 6-min walk test using different test configurations. J Aging Phys Act 2008;16(3):355–361. Alcazar J, Losa-Reyna J, Rodriguez-Lopez C, Alfaro-Acha A, Rodriguez-Mañas L, Ara I, et al. The sit-to-stand muscle power test: an easy, inexpensive and portable procedure to assess muscle power in older people. Exp Gerontol 2018;112:38–43. Wiskemann J, Kuehl R, Dreger P, Schwerdtfeger R, Huber G, Ulrich CM, et al. Efficacy of exercise training in SCT patients-who benefits most? Bone Marrow Transplant 2014;49(3):443–448. Borg GA. Psychophysical bases of perceived exertion. Medicine & science in sports & exercise 1982. van Haren IEPM, Timmerman H, Potting CM, Blijlevens NMA, Staal JB, Nijhuis-van der Sanden MWG. Physical exercise for patients undergoing hematopoietic stem cell transplantation: systematic review and meta-analyses of randomized controlled trials. Phys Ther 2013;93(4):514–528. Persoon S, Kersten MJ, van der Weiden K, Buffart LM, Nollet F, Brug J, et al. Effects of exercise in patients treated with stem cell transplantation for a hematologic malignancy: a systematic review and meta-analysis. Cancer Treat Rev 2013;39(6):682–690. Tables Table.1: Patients’ characteristics NUMBER M/F 27/17 age 54 Disease: H.L. M.M. N.H.L. L.L.A. SARCOMA MIELOIDE 12 17 11 3 1 transplantation: Autologous Allogenic 30 14 comorbidities: Pulmonary Cardiac other 4 15 9 Average days of hospitalization 21 smoker: yes ex No 5 13 26 lifestyle: Active Sedentary 35 9 Legenda: HL= Hodgking Ly; MM=multiple myeloma; NHL= non-Hodgkin Ly; LLA=acute lymphatic leukemia Tab.2 Assessment tests data Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3873032","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":269352244,"identity":"d35022a0-17aa-4ed8-a0ce-55ff15b6c8d2","order_by":0,"name":"Chiara Bottani","email":"","orcid":"","institution":"Fondazione IRCCS Istituto Nazionale dei Tumori","correspondingAuthor":false,"prefix":"","firstName":"Chiara","middleName":"","lastName":"Bottani","suffix":""},{"id":269352245,"identity":"7587a689-2f8e-41f4-ab70-739f6c3fb03d","order_by":1,"name":"Chiara 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exercise.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eThe patients (pts) arriving at the transplant stage are already functionally compromised due to them disease, previous anticancer treatments and other possible co-morbidities. Additional factors related to the transplant, which can compromise the functional status of the patient, are the preparatory regimen with high-dose chemotherapy, side effects related to steroids and hospitalization. Potential graft complications such as systemic or pulmonary infections, acute and chronic graft versus host disease (GVHD), pain, decreased nutritional intake, and other sequelae are added. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eHematological patients undergoing bone marrow transplantation are candidates for prolonged hospitalizations (on average between 3 and 5 weeks), during which they are forced to bed rest and have minimal mobility, resulting in a progressive reduction in motor performance. Physical activity and rehabilitation programs are helpful in addressing fatigue, muscle weakness and weakness, psychological symptoms (anxiety and depression), and improving quality of life. Reviewing the scientific literature, there is evidence of the benefits of physiotherapy in adult hematological cancer patients undergoing bone marrow transplantation (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe rehabilitation intervention is confirmed to be safe for the patients and well tolerated. It produces benefits on functional residual capacity (CRF), muscle strength and power, mobility and functional status. In addition, physical activity increases the production of endorphins, which can help relieve pain and generate an improvement in pain and perception of well-being. Physical training programs can have a cardiological and muscular protective effect, as well as a salutary effect on the prevention and control of transplant complications. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMaintaining physical activity during the transplant period can improve hospitalization, reduce the risk of complications, and accelerate physical recovery after discharge. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe study's primary objective is to observe how physical activity, carried out during the recovery, allows maintenance or improvement of motor and respiratory performances observed at the entrance also at discharge and after two months.\u003c/p\u003e \u003cp\u003eThe secondary goal is to make the pts independent in the long term and aware of the effectiveness of physical exercise even after discharge.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThe study considered all pts undergoing physiotherapy during hospitalization for bone marrow transplantation from November 2017 to February 2019. The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Fondazione IRCCS Istituto Nazionale dei Tumori of Milan, Italy (Ethics Committee number: 13/22). Informed consent was obtained from all subjects involved.\u003c/p\u003e\n\u003cp\u003eIt was a retrospective data collection relating to physiotherapy of 44 consecutive pts suffering from hematological diseases, recovered at the Hematology Division of the National Cancer Institute of Milan (INT).\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eInclusion criteria\u003c/span\u003e:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003ePatients\u0026thinsp;\u0026gt;\u0026thinsp;18 years\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSuffering from haematological pathology\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAdmitted to undergo bone marrow trasplant\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAble to carry out the proposed assessment tests\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAble to follow the rehabilitation protocol independently\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eExclusion criteria\u003c/span\u003e:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003ePatients with cognitive deficits that limit the understanding of the rehabilitation protocol\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePatients with motor deficits that prevent the execution of the exercises\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePatients with a contraindication to perform motor exercises due to the pathology they are suffering from\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eClinical data relating to the pathology, the type of transplant, and any complications that occurred during the transplant period were collected. The physiotherapist trained each patient using an informative and descriptive manual, proposing modest physical training. Each patient was given a brochure with the exercises to be performed independently. The supervision of a physiotherapist was guaranteed for the entire duration of the hospitalization. The patient met the physiotherapist twice a week and verified with him the correct execution of the proposed exercises.\u003c/p\u003e\n\u003cp\u003eThese are total body muscle strengthening exercises, using both elastic and weight resistance, in addition to aerobic training with a cycle ergometer. The patient also performed breathing exercises using a volumetric incentive (COACH).\u003c/p\u003e\n\u003cp\u003eIn addition to discussing with the therapist, the patient recorded the exercises performed in a daily diary present in the last pages of the manual.\u003c/p\u003e\n\u003cp\u003eIn the follow-up period he continued the proposed protocol independently, adding activities of daily living and walking, gradually increasing the intensity of physical activity.\u003c/p\u003e\n\u003cp\u003eA data collection form was compiled for each patient, from the recovery to the end of the follow-up, which included: history of hematological disease and history of other pathologies, physical parameters with calculation of the Body Mass Index (BMI), lifestyle.\u003c/p\u003e\n\u003cp\u003eAin the same form was recorded the results of the physical performance assessment tests in the three times corresponding to hospitalization (T0), discharge (T1) and two months after the latter (T2).\u003c/p\u003e\n\u003cp\u003eThe tests carried out were the following:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eSix-minute walking test, an exam which, in a simple and reliable way, measures the distance a person covers in 6 minutes walking as fast as possible on a flat surface. Before, during and after the effort, the parameters of SaO2, HR, possible dyspnea are recorded using the Borg scale. (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eStrength Test, an exam that measures the maximum isometric force exerted by the muscles. The patient is asked to grip a dynamometer that records changes in strength. The test is performed with each of the two upper limbs and the best result of three consecutive tests is recorded. (\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSit to Stand Test, an exam that measures the time taken by the patient to get up and sit down from a chair, without the aid of armrests, for five consecutive times. (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eEstimated time for carrying out the above tests was 20\u0026ndash;30 minutes. Execution was done on admission (T0), on discharge (T1), 30 days after discharge (T2).\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eSTATISTICAL ANALYSIS\u003c/h2\u003e\n \u003cp\u003eThe tests included in the study are the walking test, arm-strength tests, and sit-to-stand test, plus the recording of the subjectively perceived effort. Such activities are measured with the Borg scale ranging between 0 and 10, with zero standing for no action and ten for maximum effort.\u003c/p\u003e\n \u003cp\u003eTo find out whether there is a variation throughout the process or not for all these values, it is proper to conduct a specific hypothesis testing, where the null hypothesis is that there is no difference among the average values over time. The test statistics are the actual variations observed.\u003c/p\u003e\n \u003cp\u003eBecause our aim is to find out whether or not the rehabilitation improved patients\u0026rsquo; ability, it is proper to set a null hypothesis suggesting that there is no difference at all between the ability level measured before the transplant, after the transplant, and after two months of physiotherapy: this way, small p-values are going to prove evidence against the null hypothesis, indicating a positive impact by the rehabilitation.\u003c/p\u003e\n \u003cp\u003eTo compute such value or all the tests performed, we adopted a bootstrap simulation: bootstrapping consists of generating random samples from the original population (44 pts) and then computing a highly reliable approximation of the measurements required.\u003c/p\u003e\n \u003cp\u003eUsually, such assessment is carried out via the construction of a confidence interval, in which the actual value is going to lay with a given probability; alternatively, since the approximations of the valid values are normally distributed, it is also possible to establish the probability for one of the bootstrapped approximations to be greater than the value observed, namely our test statistic: this probability is the p-value.\u003c/p\u003e\n \u003cp\u003eConsidering a 0.05 threshold, if such a p-value is below 5%, it means that, in theory, there are very small probabilities of observing a value greater than the one we already observed, suggesting that such a value is already extreme and leading us to reject the null hypothesis in favour of a new alternative hypothesis; otherwise we conclude our testing accepting the null hypothesis initially established.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eForty-six pts were recruited, 2 died due to complications that occurred during hospitalization.\u003c/p\u003e\n\u003cp\u003eForty-four pts were included in the study, and their characteristics are described in Table\u0026nbsp;1.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2 shows the tests administered to pts upon admission, discharge, and two months after admission.\u003c/p\u003e\n\u003cp\u003eThe distance covered in the 6-minute walking test remains constant, as described in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eduring the performance are registered subjective values of fatigue by Borg scale.\u003c/p\u003e\n\u003cp\u003eThe strength of the upper limbs, measured with a dynamometer in the strength test, shows a slight flexion at discharge and recovery of the initial values in the follow-up (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe strength of the lower limbs, measured in the last test (sit to stand), remains constant during hospitalization and increases with the remote control (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFor most of the tests, there is not even a natural variation (arm-strength test and sit-to-stand test). In contrast, for the walking test, the average distance covered slightly increases from the post-transplant poll to the next check. Still, a p-value of 0.2 indicates that such a difference is not much statistically significant.\u003c/p\u003e\n\u003cp\u003eYet, it is interesting to notice that the analysis of the effort perception leads to a different conclusion: the data from the study of the Borg values declared by the patients are rearranged in the graph.\u003c/p\u003e\n\u003cp\u003eOn the x-axis, there are the three distinct moments in time, whereas the y-axis displays the possible Borg values.\u003c/p\u003e\n\u003cp\u003eThe figures are three different box plots, one per moment, which condensate 50% of the observations within the rectangles; the other data points lie on the vertical lines (inter-quartile range), and the only outlier is represented by a unique patient who claimed a 10 in the pre-transplant poll.\u003c/p\u003e\n\u003cp\u003eThe black lines in the center of the rectangles represent the median value (3, 5, 2.5), the red dots display the mean values (3.23, 5.02, 3.07), and the long blue line stands for the total average value (3.77).\u003c/p\u003e\n\u003cp\u003eEven from the picture, there seems to be some change, but it is better to conduct proper hypothesis testing. The null hypothesis is that there is no difference between the three mean values, whereas the test statistics are the actual variations among the moments: 1.79 for the pre-post, -1.95 for the post-follow up, and 0.16 for the pre-follow up. It turns out that the corresponding p-values for these one-sided tests are respectively 1.7e-4, 4.9e-5, and 0.62, leading to reject the hypothesis in the first two cases. In other words, there is no significant difference between the pre-transplant and the follow-up scenario, but there is a meaningful variation caused by the transplant. Therefore, it is reasonable to conclude that the recovery reduces the patient's physical capacity.\u003c/p\u003e\n\u003cp\u003eSpecifically, even though the average values for the pre-transplant and the follow-up polls are similar, we shall consider the median values since the median is more robust and not affected by the outlier registered only at the beginning. Once we do this slight correction, the p-value for the difference is still not below 0.05 but lower than before.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study of 44 pts undergoing bone marrow transplants with hematological diseases, we proposed a modest physical training to be performed during hospitalization.\u003c/p\u003e \u003cp\u003eA comparison was made with other studies in which pts from the same population were subjected to different rehabilitation programs and administered further assessment tests (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe acceptance, recruitment, and adherence to follow-up by all patients show that all well-accepted the proposed method.\u003c/p\u003e \u003cp\u003eWe decided to administer three tests together and three times instead of individually to get a complete picture of the individual patient's performance.\u003c/p\u003e \u003cp\u003eThese tests measure cardio-respiratory capacity, endurance, and strength of individual body districts; they are validated and used in clinical practice and reported in the literature.\u003c/p\u003e \u003cp\u003eWe are discussing the 6' walking, strength, and Sit-to-stand tests.\u003c/p\u003e \u003cp\u003eThe first one has been tested and validated on different patient populations and in a standardized way (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). It was used, in the beginning, to assess the functional status of patients with severe cardiopulmonary disease.\u003c/p\u003e \u003cp\u003eGrip strength is used in the assessment of hand and upper limb function; it's a straightforward test to perform in a few seconds. The dynamometer used for the test is an inexpensive and readily available instrument.\u003c/p\u003e \u003cp\u003eThe Sit to Stand (STS) muscle power test proved to be a useful and, in general, more clinically relevant tool to assess the functional trend in older people. The low time, space, and material requirements of the STS muscle power test make this test an excellent choice for its application in extensive cohort studies and the clinical setting (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the tests\u0026rsquo; feasibility characteristics, we decided to use them simultaneously by administering them to this population of transplant patients who undergo a prolonged period of inactivity.\u003c/p\u003e \u003cp\u003eOnly a few studies report precedents following hospitalization and remote assessments (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo our knowledge, there are no studies in which a respiratory simulator is used in the rehabilitation protocol of this type of patient. We decided to use it to measure and motivate patients' daily respiratory performance and avoid and reduce lung complications.\u003c/p\u003e \u003cp\u003eTo ensure patient involvement and awareness of intervention protocol, we compiled a descriptive manual of some respiratory, motor, and aerobic exercises to be given to pts.\u003c/p\u003e \u003cp\u003eThese exercises are explained in a simple and illustrated manner, allowing the patient a reasonable degree of self-management. Multiple interventions from the nurses and doctors supported the participants during the hospitalization. However, the ease of self-management of the rehabilitation program has the limitation that physiotherapy cannot be customized to the individual patient.\u003c/p\u003e \u003cp\u003eThe data collected show that physical and respiratory performance does not significantly reduce in terms of strength and endurance. In addition, pts report a reduction in the feeling of tiredness, measured by the Borg scale (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), through the maintenance of muscle tone and tropism.\u003c/p\u003e \u003cp\u003eThe limitation of this study is that it is not randomized moreover can be overcome by future and more complete resources. Furthermore, the activity level was not monitored during the entire intervention but only during the hospitalization.\u003c/p\u003e \u003cp\u003eThis model could be applied to a more heterogeneous population of cancer patients, even if not of hematological origin.\u003c/p\u003e \u003cp\u003eThe total participation from start to finish in the study and the compliance of all patients involved suggests that the recruitment method and the interventions tested are acceptable and repeatable in other cancer patient populations.\u003c/p\u003e \u003cp\u003e The participants' adherence in the 3-phase assessment was always adequate, which provides input for future use on a larger scale.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study observes the possible benefits that physiotherapy intervention has in patients undergoing bone marrow transplantation, to minimize the loss of physical and respiratory performance.\u003c/p\u003e \u003cp\u003eModest physical training during hospitalization could be useful to maintain the same motor and respiratory performance observed at admission or even improve them.\u003c/p\u003e \u003cp\u003eFurthermore, it could improve patients' awareness and confidence in their treatment journey. Assuming that scientific evidence demonstrates that physiotherapeutic interventions are clinically relevant and should be implemented in these patients(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and considering our findings, we are encouraged to plan a further study to expand the case series and highlight the benefits on the risk of complications and quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthical Approval\u003c/u\u003e: Study approved by INT\u0026rsquo; ethic committee on 26 of January 2022, INT 13/22\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u003c/u\u003e: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConflict of Interest\u003c/u\u003e: None to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthorship:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eConception and design of the study: CB, CP\u003c/p\u003e\n\u003cp\u003eDrafting the manuscript: CB, CP\u003c/p\u003e\n\u003cp\u003eFinal approval of the version: CB, CP\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgments\u003c/u\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors thank all the patients who participated in this study and all the nurses and physicians of the Hematology Department, INT. We would also like to thank Anna Guidetti, MD, and Alessandra Pigni, MD, for their support in the manuscript drafting.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAllart-Vorelli P, Porro B, Baguet F, Michel A, Cousson-Gelie F. Haematological cancer and quality of life: a systematic literature review. Blood Cancer J 2015 April 24;5(4):e305.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorales-Rodriguez E, Perez-Bilbao T, San Juan AF, Calvo JL. Effects of Exercise Programs on Physical Factors and Safety in Adult Patients with Cancer and Haematopoietic Stem Cell Transplantation: A Systematic Review. Int J Environ Res Public Health 2022;19(3):1288. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph19031288\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19031288\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIshikawa A, Otaka Y, Kamisako M, Suzuki T, Miyata C, Tsuji T, et al. Factors affecting lower limb muscle strength and cardiopulmonary fitness after allogeneic hematopoietic stem cell transplantation. Support Care Cancer 2019;27(5):1793\u0026ndash;1800.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbo S, Denehy L, Ritchie D, Lin K, Edbrooke L, McDonald C, et al. People With Hematological Malignancies Treated With Bone Marrow Transplantation Have Improved Function, Quality of Life, and Fatigue Following Exercise Intervention: A Systematic Review and Meta-Analysis. Phys Ther 2021;101(8):pzab130.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamilton DM, Haennel RG. Validity and reliability of the 6-minute walk test in a cardiac rehabilitation population. Journal of Cardiopulmonary Rehabilitation and Prevention 2000;20(3):156\u0026ndash;164.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColdham F, Lewis J, Lee H. The reliability of one vs. three grip trials in symptomatic and asymptomatic subjects. Journal of Hand Therapy 2006;19(3):318\u0026ndash;327.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones SE, Kon SS, Canavan JL, Patel MS, Clark AL, Nolan CM, et al. The five-repetition sit-to-stand test as a functional outcome measure in COPD. Thorax 2013;68(11):1015\u0026ndash;1020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohammed J, Aljurf M, Althumayri A, Almansour M, Alghamdi A, Hamidieh AA, et al. Physical therapy pathway and protocol for patients undergoing hematopoietic stem cell transplantation: recommendations from the eastern Mediterranean blood and marrow transplantation (EMBMT) group. Hematology/oncology and stem cell therapy 2019;12(3):127\u0026ndash;132.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKonopka DN, Shook RP, Kohut ML, Tulp RV, Franke WD. Comparability of the 6-min walk test using different test configurations. J Aging Phys Act 2008;16(3):355\u0026ndash;361.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlcazar J, Losa-Reyna J, Rodriguez-Lopez C, Alfaro-Acha A, Rodriguez-Ma\u0026ntilde;as L, Ara I, et al. The sit-to-stand muscle power test: an easy, inexpensive and portable procedure to assess muscle power in older people. Exp Gerontol 2018;112:38\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiskemann J, Kuehl R, Dreger P, Schwerdtfeger R, Huber G, Ulrich CM, et al. Efficacy of exercise training in SCT patients-who benefits most? Bone Marrow Transplant 2014;49(3):443\u0026ndash;448.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorg GA. Psychophysical bases of perceived exertion. Medicine \u0026amp; science in sports \u0026amp; exercise 1982.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Haren IEPM, Timmerman H, Potting CM, Blijlevens NMA, Staal JB, Nijhuis-van der Sanden MWG. Physical exercise for patients undergoing hematopoietic stem cell transplantation: systematic review and meta-analyses of randomized controlled trials. Phys Ther 2013;93(4):514\u0026ndash;528.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePersoon S, Kersten MJ, van der Weiden K, Buffart LM, Nollet F, Brug J, et al. Effects of exercise in patients treated with stem cell transplantation for a hematologic malignancy: a systematic review and meta-analysis. Cancer Treat Rev 2013;39(6):682\u0026ndash;690.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable.1: Patients\u0026rsquo; characteristics\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38317757009346%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.61682242990654%\" valign=\"top\"\u003e\n \u003cp\u003eNUMBER\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38317757009346%\" valign=\"top\"\u003e\n \u003cp\u003eM/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.61682242990654%\" valign=\"top\"\u003e\n \u003cp\u003e27/17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38317757009346%\" valign=\"top\"\u003e\n \u003cp\u003eage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.61682242990654%\" valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38317757009346%\" valign=\"top\"\u003e\n \u003cp\u003eDisease:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026nbsp;H.L.\u003c/li\u003e\n \u003cli\u003eM.M.\u003c/li\u003e\n \u003cli\u003eN.H.L.\u003c/li\u003e\n \u003cli\u003eL.L.A.\u003c/li\u003e\n \u003cli\u003eSARCOMA MIELOIDE\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.61682242990654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38317757009346%\" valign=\"top\"\u003e\n \u003cp\u003etransplantation:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eAutologous\u003c/li\u003e\n \u003cli\u003eAllogenic\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.61682242990654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38317757009346%\" valign=\"top\"\u003e\n \u003cp\u003ecomorbidities:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003ePulmonary\u003c/li\u003e\n \u003cli\u003eCardiac\u003c/li\u003e\n \u003cli\u003eother\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.61682242990654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;4\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 9\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38317757009346%\" valign=\"top\"\u003e\n \u003cp\u003eAverage days of hospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.61682242990654%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38317757009346%\" valign=\"top\"\u003e\n \u003cp\u003esmoker:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eyes\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;ex\u003c/li\u003e\n \u003cli\u003eNo\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.61682242990654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 5\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38317757009346%\" valign=\"top\"\u003e\n \u003cp\u003elifestyle:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eActive\u003c/li\u003e\n \u003cli\u003eSedentary\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.61682242990654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eLegenda: HL= Hodgking Ly; MM=multiple myeloma; NHL= non-Hodgkin Ly; LLA=acute lymphatic leukemia\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTab.2\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAssessment tests \u0026nbsp;data\u003c/p\u003e\n\u003cp\u003e\u003cimg 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physiotherapy","lastPublishedDoi":"10.21203/rs.3.rs-3873032/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3873032/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground.\u003c/strong\u003e Substantial physical and functional deconditioning are all potential adverse effects of bone marrow transplantation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective.\u003c/strong\u003e To observe how physiotherapy treatment during the hospitalization period can impact the maintenance of motor and respiratory performance in patients undergoing bone marrow transplantation.\u003c/p\u003e\n\u003cp\u003eFurthermore, it is interesting to evaluate how the patient is able to independently manage the proposed activity and consider it important for their health in the long term.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods.\u003c/strong\u003e Patients underwent strength and endurance tests at the start, at the end of hospitalization, and two months after discharge. The patients were given a rehabilitation protocol to follow during the entire hospitalization. During this period, lasting approximately 21 days, the physiotherapist supervises the carrying out of the exercises twice a week. From discharge and for the two months of follow-up the patient carries out the proposed protocol independently.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults.\u003c/strong\u003e Forty-four patients were tested upon admission, discharge, and two months after admission. The distance covered in the walking test remains constant.\u003c/p\u003e\n\u003cp\u003eThe strength of the upper limbs shows a slight flexion at discharge and recovery of the initial values after eight weeks. The power of the lower limbs remains constant during hospitalization and increases with remote control.\u003c/p\u003e\n\u003cp\u003eConclusion. The results show that the proposal of moderate intensity physical activity can help maintaining motor and respiratory performance, in patients undergoing bone marrow trasplantation.\u003c/p\u003e","manuscriptTitle":"Effects of Maintenance of Motor and Respiratory Performance With a Training Program in Inpatients Undergoing Bone Marrow Transplant","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-30 17:26:45","doi":"10.21203/rs.3.rs-3873032/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27913a2e-cf64-42db-91d6-d85b14b50d5c","owner":[],"postedDate":"January 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-28T11:21:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-30 17:26:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3873032","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3873032","identity":"rs-3873032","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}