A randomized control trial of a supervised versus a self-directed exercise program for allogeneic stem cell transplant patients

Objectives: To determine if therapist supervision of an exercise program produced better functional program outcomes in allogeneic stem cell transplant patients than a patient-directed exercise program. Methods: Sixty-one patients who were less than 6 months post allogeneic stem cell transplant were randomly assigned to either a therapist supervised training group (supervised) or a patient-directed training group (Self-directed). Training consisted of aerobic exercises (treadmill, bicycle ergometer versus walking) and resistance exercises (free weights, weight machines versus resistive band activities). Subjects completed physical performance tests (50-foot fast walk, 6-min walk, forward reach, repeated sit-to-stand, uniped stance) and the Brief Fatigue Inventory (BFI) before and after 4 weeks of training. Pre- and post-training outcomes and group differences were analyzed by a Student t-test. Results: Patients in both groups were similarly deconditioned at baseline. Training increased the 6-min walk distance and 50-foot walk in the supervised group by 12 and 14%, respectively, and increased the 6-min walk distance by 10% in the Self-directed group (P < 0.05). BFI score for worst level of fatigue declined in both groups but not significantly. Conclusions: These results demonstrate that allogeneic transplant patients derive functional benefits from short-term exercise training regardless of how the training program is supervised. Determining (1) the reasons for the low participation rate (28%), (2) the patient-preferred characteristics of each exercise supervision style and (3) how best to match patient preference to exercise supervision style remain significant issues in this area of patient delivery services. Copyright (C) 2008 John Wiley & Sons, Ltd.