Feasibility of whole body vibration during intensive chemotherapy in patients with hematological malignancies - a randomized controlled pilot study

Abstract

Background: Hospitalized cancer patients undergoing intensive or high-dose chemotherapy often experience a considerable decline in functional performance associated with the increased risk of adverse health events. Exercises, particularly resistance-based exercises that may counteract this decline are restricted by therapy-related side effects. Since whole body vibration (WBV) is known to efficiently stimulate the neuromuscular system without significantly raising blood pressure, we hypothesize that especially WBV is particularly feasible even during intensive or high-dose chemotherapy (primary endpoint) and thus induces beneficial functional adaptations.

Methods: Twenty hospitalized patients with hematological malignancies scheduled for intensive or high-dose chemotherapy were randomly allocated to an intervention group (IG) undergoing WBV, or an active control group (CG) cycling. Feasibility was determined by comparing the IG's and CG's training compliance. Furthermore, to assess feasibility, WBV-induced changes in chemotherapy-related side effects, blood pressure, and heart rate immediately after exercising were documented. To assess patients' functional performance, we measured jump height (cm), the duration (sec) of performing the chair rising- (CRT) and timed-up-and-go test (TUG), maximum power output during jumping and CRT (watt/kg) as well as sway path (mm) during balance tasks.

Results: Training compliance was similar between groups (IG: median 62%, range 39-77; CG: 67%, 58-100; p = 0.315). Moreover, we observed neither the IG's reported side effects worsening, nor any increase in blood pressure after WBV. IG's jump height (+ 2.3 cm, 95%CI 0.1-4.4, p = 0.028) and TUG performance (- 1.3 s, 95%CI -2.53 - -0.65, p = 0.027) improved significantly, while sway paths in semi-tandem stance were augmented after the intervention (eyes open: + 60 mm, 95%CI 2-236, p = 0.046; eyes closed: + 88 mm, 95%CI 49-214, p = 0.028). The CG's performances did not change over time. Maximum power output during CMJ and CRT and time during CRT did not change.

Conclusion: Our study is the first proving the feasibility of WBV during intensive/high-dose chemotherapy of hospitalized cancer patients. Additionally, WBV-induced neuromuscular adaptations resulted in functional benefits relevant to patients' autonomy. We believe that WBV can be implemented as an alternative training method during intensive chemotherapy, although the relative benefit compared to conventional resistance training requires more evaluation in future studies.

Trial registration: German Register of Clinical Trials No.: DRKS00004338 , prospectively registered on 11/30/2012.

Keywords: Activities of daily living; Acute leukemia; Bone marrow neoplasm; Cancer therapy; Exercise therapy; Intervention study; Postural balance.

Fig. 1

Flow diagram of study recruitment

Fig. 2

Feasibility of WBV - Rate of training compliance and individual training perception. a Distribution of training compliance for IG and CG. Box-and-whisker plots showing the lower quartile (25th percentile), median (50th percentile), upper quartile (75th percentile) and degree of dispersion as 95% confidence interval (95% CI). b Percentage distribution of individual training’s perception after WBV following the question “Did the exercise session do you any good?/Did the workout make you feel good?”. Quite good 63.27%, very good: 29.97%, marginally good 6.66%, not good at all 0%