Alibhai, S.M., Durbano, S., Breunis, H., Brandwein, J.M., Timilshina, N., Tomlinson, G.A., . . . Culos-Reed, S.N. (2015). A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy. Leukemia Research, 39, 1178–1186. 

To determine if a multimodal exercise program for patients during induction chemotherapy is feasible, safe, and beneficial for fatigue, quality of life, and fitness

Patients were randomized to the exercise or usual care groups. Usual care generally included suggestions to walk on a regular basis, without further instruction. Those in the exercise group were approached 4–5 days per week during hospital admission to participate in light-to-moderate–intensity exercise for 30–60 minutes. Exercise sessions included combined aerobic, resistance, and flexibility training. Aerobic intensity was encouraged at an exertion equivalent to 50%–75% of heart-rate reserve. The resistance exercises targeted large muscle groups using resistance bands and free weights. Flexibility was incorporated into each session via static stretching. Exercise sessions were directly supervised by a certified exercise physiologist. Study assessments were completed at baseline, post induction, and within two weeks of discharge, post cycle 2 (4–6 weeks post discharge).

• N = 70 post induction; 63 completed post-consolidation measures.
• MEAN AGE = 57 years (SD = 14.7)
• MALES: 54.3%, FEMALES: 45.7%
• KEY DISEASE CHARACTERISTICS: Patients with acute myeloid leukemia (AML) or relapsed AML receiving induction chemotherapy who were medically cleared for participation
• OTHER KEY SAMPLE CHARACTERISTICS: Participants in the exercise group were slightly older.

• SITE: Single site  
• SETTING TYPE: Inpatient    
• LOCATION: Canada

• PHASE OF CARE: Active antitumor treatment

• Randomized, controlled trial

• European Organization of Research and Treatment of Cancer Core Quality of Life (EORTC QLC-C30)
• Functional Assessment of Cancer Therapy-Fatigue (FACT-F) subscale/BMI
• Maximal oxygen consumption test (VO₂ max test)
• Six-minute walk test (6MWT)
• Grip strength
• Daily exercise diary for control patients

Exercise group participants completed 514.2 minutes of exercise on average during an average admission of 36.5 days. The most common reported reason for not exercising was fatigue. Adherence to exercise sessions was 54%. Control group patients exercised an average of 510.4 minutes over 35.8 days. Participants in both groups demonstrated an improvement in global quality of life. Fatigue scores improved only in the exercise group, with a between group difference of 3.6 points, which was not statistically significant. The six-minute walk improved in both groups but improved significantly more in the exercise group (p = 0.005). No significant adverse event occurred. During over 1,000 patient days of observation, four musculoskeletal events were reported. No differences existed between groups in length of stay or other resource utilization.

This study demonstrated that the provision of an exercise program is feasible for patients during induction chemotherapy and may help manage fatigue in these patients. Patients who participated in the multimodal exercise program demonstrated improved physical fitness.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Given the comparison of mean hours of exercise between study groups, the total amount of physical activity did not appear substantially different between groups, which may have affected the lack of substantial differences in fatigue.

Participation in an exercise program of moderate intensity was shown to be feasible for patients who were hospitalized and receiving induction chemotherapy for AML.