van Haren, I.E., Timmerman, H., Potting, C.M., Blijlevens, N.M., Staal, J.B., & Nijhuis-van der Sanden, M.W. (2013). Physical exercise for patients undergoing hematopoietic stem cell transplantation: Systematic review and meta-analyses of randomized controlled trials. Physical Therapy, 93, 514–528. 

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STUDY PURPOSE: To summarize and analyze the evidence provided by randomized, controlled trials (RCTs) on physical exercise interventions among patients with cancer undergoing HSCT

TYPE OF STUDY: Systematic review and meta-analysis

Search Strategy

DATABASES USED: Electronic online literature databases, such as PubMed, CINAHL®, EMBASE, the Cochrane Library, and PEDro. Additional studies were found through manual search of reference lists
KEYWORDS: stem cell, stem cell transplantation, bone marrow transplantation, hematologic stem cell transplantation, exercise, exercise program, exercise testing, physical activity, physical therapy, physiotherapy, training, functionality (MESH terms or free-text words), and randomized clinical trial.
INCLUSION CRITERIA: RCT meeting: (a) original article published before October 1, 2011; (b) involving patients aged 18 years or older diagnosed with cancer and undergoing HSCT; (c) physical exercise being the main component of the intervention; and (d) published in English.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 232 originally retrieved; 180 excluded by title and abstract

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane collaborative tool for assessing for risk of bias used for bias; two of the authors scored articles. If a disagreement occurred, a third author reviewed.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 11 (14 articles met criteria; three were reports of the same study looking at different outcomes and, therefore, excluded) used in qualitative systematic review; three studies used in the meta-analysis; for outcome of fatigue, six studies examined effect of exercise on fatigue and two of these were included in meta-analysis
  • TOTAL PATIENTS INCLUDED IN REVIEW = 734; for meta-analysis, 148; for fatigue meta-analysis, 115
  • SAMPLE RANGE ACROSS STUDIES: 18–135 for total, 33–81 for meta-analysis, and 34–81 for fatigue meta-analysis
  • KEY SAMPLE CHARACTERISTICS: Several countries; allogeneic or autologous HSCT; multiple myeloma, any type of leukemia or lymphoma. No other demographic data provided

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active treatment, post HSCT; intervention initiated either during hospitalization or after discharge
  • APPLICATIONS: Elder care


Only six of the studies examined the effect of exercise on fatigue. In meta-analysis of 115 patients (two studies), exercise significantly reduced fatigue at discharge (n = 115; SMD = 0.53; 95% CI [0.16, 0.91], p = .005). The meta-analysis indicated that training during hospitalization has a positive effect on fatigue in patients receiving an allogeneic HSCT.

Results of meta-analysis could not be confirmed through individual review of the other four studies, as only two showed statistically significant effect for fatigue in favor of the exercise group.

Physical functioning could not be evaluated by meta-analysis due to differences in study design and outcomes, but the majority of the studies did suggest a positive effect of exercise on functioning.


Exercise intervention during hospitalization can have a positive effect on fatigue at discharge for patients undergoing HSCT.


  • Literature search limited to English
  • Heterogeneity of type and timing of exercise intervention

Nursing Implications

Best outcomes were seen at discharge, suggesting that starting interventions before or just after transplantation are most effective. Further research into the optimal exercise program is needed.

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