AUTONOMIC DYSFUNCTION IS AUGMENTED DURING THERAPY, BUT CAN BE IMPROVED BY PHYSICAL EXERCISE IN PATIENTS WITH HEMATOLOGICAL MALIGNANCY. RESULTS OF A PILOT TRIAL.

ABSSUB-5681

Background: Autonomic dysfunction is common in patients with cancer and may have considerable negative effects on quality of life and mortality. Vagal nerve activity, indexed by heart rate variability (HRV), could have a role of prognosticator in cancer. Exercise enhances cardiac autonomic regulation of cancer patients. Because of the association of higher HRV-parameters and prolonged survival in cancer patients, improvement in autonomic control may be important goal of exercise.

Aims: Therefore, the aim of this prospective longitudinal study was to assess parameters of physical fitness and HRV in patients with hematological malignancy before, during chemotherapy and after supervised physical training.

Methods: Patients with hematological malignancies treated with systemic anticancer therapy were enrolled. HRV, physical fitness and muscle strength were measured in three time-points: before start o systemic therapy (15pts), after end of treatment (56pts with response) and after 12-week exercise program (30pts). HRV was tested by vagal activity (VA), sympatovagal balance (SVB) and global score (GS), physical fitness was measured with cycle ergometer (pVO₂max), muscle strength with hand grip test. Exercise training consisted of spinning (about 45-60%), resistance exercise (15-25%), remaining activities included balance exercise and stretching. Lesson duration was 50-90 minutes with intensity between 60-75% HRmax with frequency of three times per week.

Results: Totally 64 patients were included in this prospective study (43 NonHodgkin´s lymphoma, 14 Hodgkin lymphomas and 7 leukemias). Median age was 54 (19-77) years, and 36/64 pts were women. At baseline (before chemotherapy), physical fitness (pVO₂ max) was normal and HRV was only mildly reduced compared to common population. After treatment significant decrease in pVO₂max (p0.065) and in HRV were observed (SVB;  p0.018). Exercise training lead to improvement of the global fitness measured by pVO₂max (p.0.0029), and influenced also HRV (VA p0.086; CS p 0.098); in 7 pair-matched patient subset HRV was significantly changed in all parameters (VA p.0.045, SVB p.0.01, CS p.0.01).

Summary/Conclusion: Exercise training is feasible and able to improve significantly physical fitness of patients with hematological malignancy. Training is also related to improvement in autonomic dysfunction and could potentially contribute to better survival. Further investigation is needed in this area.

Keywords: Lymphoid malignancy, Prognosis, Quality of life

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