The Role of Physiotherapy and Rehabilitation in Stem Cell Transplantation Patients

Patient with hematological malignancies maintain profound functional, physiologic and cognitive disability and often experience a pronounced increase in psychosocial stress. Supportive care measures have advanced to improve the quality of life and overall survival of HCT survivors. Important key component of improved supportive care is gaining increased attention, and that is physiotherapy and rehabilitation. New insight and research within the discipline have focused on fatigue, inflammation, exercise, and the development of structured rehabilitation programs to improve the musculoskeletal and cardiopulmonary disorders of HCT.
 
Related problems of hematopoietic stem cell transplantation
 
Before, during and after HCT, patients often experience enormous physical, psychological and psychosocial stress. Such stress tends to occur even if the treatment is successful, but nevertheless negatively influences the longterm success of these procedures. Reasons for cardiopulmonary rehabilitation include:
 

 
In addition, common side effects (GVHD, infections, diarrhea, pain and so on) likely exacerbated the physical and psychological problems. Moreover, hospitalization for long time, side effects of other medications, unsteady changes in clinical status and the real risk of dying further lead to treatment-related problems and stress. Thereby, physical and psychosocial stress, treatment-related side effects and the disease process itself influence the total success of the treatment and the well-being of the patient. In the long run, all these different physical and psychological stress factors and problems massively affect the individual quality of life of each patient.
 
Physical Exercise’s Benefits
 
Based on Cochrane Database Systematic Reviews, exercise has demonsrated physiological and psyhological improvement for HCT patients. Over the past few years, the number of studies declaring the promising role of physiotherapy programs performing as non-pharmacologic adjuvant therapy. Exercise interventions contribute to improvements in multiple areas related to quality of life in addition to fatigue, including body composition, functional capasity, bone health, sleep, mood and overall mortality. Moreover, exercise reduces visceral fat (which is associated with increased all-cause mortality and the development of diabetes, cardiovascular disease and demantia), helps to release anti-inflammatory cytokines, increases the secretion of adrenal hormones and may reduce inflamation via downregulation of toll-like receptors on monoctyes and macrophages. Exercise has also been shown to reduce fatigue and musculoskeletal symptoms in survivors.
 
Physical Exercise Intervention Period
 
The onset timing of physical exercise interventions varies and can occur in 3 phases:

 
Many patients have had a significant decline in physical activity even before the procedure due to prior medical interventions (chemotherapy, radiation therapy, surgery). Reduced exercise activity will exacerbate reduces functional performance. Pre-tranplant rehabilitation is important because improving strenght and cardiorespiratory reserves may benefit the patient after procedure. Post-transplant rehabilitaton involves reducing risk for pneumonia and atelectasis, maintaining functional activity and muscle mass, improving aerobic capasity and reducing symtom burden. Besides, one goal of the physiotherapy interventions is overcome barriers to discharging the patient home such as how to transfer, family training, educating on the use of equipment. Respiratory exercises, inspiratory muscle training, strenght training, aerobic exercises, balance and flexibility exercises are used to solve the problems that patients will encounter. Rehabilitation protocols are planned as patient-centered and interdisciplinary.

MSc. PT. Sena TEBER