Cancer, Leukemia—Acute Lymphoblastic

Overview of Acute Lymphoblastic Leukemia

This condition is a malignant disease of the bone marrow and blood cells. The condition results in immature blast cells in the marrow and lymphoid organs, which limits development of normal blood cells. Clients may develop a variety of manifestations that include bleeding, bone pain, fatigue, and neurologic problems. The disease is found primarily in older adults with previous exposure to environmental hazards and infections. The treatment of this condition usually involves chemotherapy followed by bone marrow transplant, which requires extended hospitalization in an isolated environment.¹ Clients undergoing a bone marrow transplant will be confined in a hospital setting to prevent infections.

Environmental Risk Factors for Developing Acute Leukemia

Comorbidities to Consider

• Neurologic problems of headaches, facial nerve palsy, blurred vision, and auditory abnormalities occur secondary to cerebral bleeding or leukemic infiltration of the brain.

• Clients develop limited endurance from anemia, loss of body mass, cancer-related fatigue, and depression.

Client Examination

Keys to Examination of Clients

• Exercise readiness can be determined by assessing the results of tests for blood counts, platelets, inflammatory markers, and hemoglobin levels. Low blood platelet levels (<50,000/mm³) or low hemoglobin levels may preclude a client from participating in an exercise program.²

• Examine clients for arthralgias that may develop from leukemic infiltrates into the joint synovium.

Recommended Baseline Testing of Fitness Levels

• Use a cycle ergometer or treadmill walking test with a slow progression of exercise intensity to assess clients' cardiorespiratory endurance.^1,3

• Clients' muscle strength and endurance can be tested by standard assessments or functional activities of squatting, stepping, or repetitive resisted movements.¹

Exercise Prescription

Type: Walking, cycling, weight training

Intensity: Start with moderate levels of exercise followed by rest periods

Duration: 15–30 minutes

Frequency: Every other day or coordinated with chemotherapy treatments.

Getting Started

Use a treadmill or portable cycle ergometer and resistance exercises using hand weights, elastic bands, and other portable exercise equipment for clients confined to a hospital setting. Exercise programs have included a daily intermittent walking program starting at 70% of maximum heart rate for 3 minutes, followed by 3 minutes at half this intensity, for a total of 30 minutes.^3,4 Another program used cycle ergometry at 40% to 50% of heart rate reserve for up to 15 minutes, followed by 5 to 15 minutes of resistive exercise using hand weights and exercise balls and trunk-strengthening exercises.^...