Overview of Bone Marrow Transplant
A transplant of hematopoietic stem cells from bone marrow, peripheral blood, or umbilical cord blood into a client's bone marrow is a life-saving procedure. Clients typically have a type of cancer that requires chemotherapy or radiation that destroys the bone marrow in order to stop the progression of their disease. The bone marrow is repopulated with healthy stem cells that can differentiate into mature blood cells. The hematopoietic stem cells can be from an allogeneic donor, usually a close relative, or from the person's own (autologous) blood. Clients undergoing this procedure may have numerous complications that will require hospitalization and involvement of many health-care providers. This procedure places the client under a great amount of physical, emotional, and psychosocial stress.1 Clients are deconditioned due to significant declines in function and independence resulting from treatment of their disease process and the transplant procedure.2 Exercise interventions after hematopoietic stem cell transplantation have many potential benefits for the client.1
Potential Effects of an Exercise Program
|Improved endurance ||Improved strength |
|Decreased fatigue levels ||Improved quality of life |
|Improved body composition ||Improved mood states |
Comorbidities to Consider
Keys to Examination of Clients
Determine clients' readiness for activities by assessing the results of blood tests, especially platelet counts. Determine if clients need further assessments of their cardiac and pulmonary function.
Assess clients' vital signs and levels of fatigue to maintain a proper level of exercise intensity and endurance.
Look for early signs of transplant rejection, which include dyspnea, chest pain, irregular heart rate, and increasing fatigue, all of which may be exhibited during an exercise session.
Post-transplant pain syndromes with mouth sores, diarrhea, nausea, and fatigue can limit exercise adherence.
Opioid (narcotic) medications used to treat pain can also reduce the motivation to maintain an exercise program.3
Recommended Baseline Testing of Fitness Levels
Aerobic fitness can be assessed by walking or cycle ergometry testing.
Muscle strength is best assessed by isometric or isotonic movements with larger muscle groups in the upper and lower extremities, along with grip strength.4
Assess clients' overall mobility and muscle flexibility if clients have been hospitalized for an extended period.
Assess fatigue levels and physical function levels throughout the course of treatment.1
Type: Treadmill walking, cycle ergometry
Intensity: Start at 60%–70% of predicted maximum heart rate
Frequency: Five times per week
Exercise programs are typically staged into pre-transplant, post-transplant, and home exercise programs. ...