BACKGROUND: Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematologic malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multicomponent activity intervention could attenuate reductions in cardiorespiratory fitness and exercise cardiac function (co-primary end points) in adults undergoing allo-SCT. METHODS: Sixty-two adults scheduled for allo-SCT were randomized to a 4-month activity program (activity; n = 30) or usual care (UC; n = 32). Activity comprised a multicomponent exercise training (3 days. week-1) and sedentary time reduction (>= 30 minutes. day-1) program and was delivered throughout hospitalization (= 4 weeks) and for 12 weeks after discharge. Physiological assessments conducted before admission and at 12 weeks after discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake ((Formula: see text)), exercise cardiac magnetic resonance imaging for peak cardiac (CIpeak) and stroke volume (SVIpeak) index, echocardiography-derived left ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (cTn-I (troponin-I) and BNP (B-type natriuretic peptide)). RESULTS: Fifty-two participants (84%) completed follow-up (25 activity and 27 UC); median (interquartile range (IQR)) adherence to the activity program was 74% (41% to 96%). There was a marked decline in (Formula: see text) in the UC program (-3.4 mL kg-1 min-1 (95% CI -4.9 to -1.8)) that was attenuated with activity (-0.9 mL kg-1 min-1 (95% CI -2.5 to 0.8); interaction p = 0.029). Activity preserved exercise cardiac function, with preservation of CIpeak (0.30 L min-1 m-2 (95% CI -0.34 to 0.41)) and SVIpeak (0.6 mL m-2 (95% CI -1.3 to 2.5)), both of which declined with UC (CIpeak, -0.68 L min-1 m-2 (95% CI -1.3 to -0.32); interaction p = 0.008; SVIpeak -2.7 mL m-2 (95% CI -4.6 to -0.9); interaction p = 0.014). There were no treatment effects of activity on cardiac biomarkers or echocardiographic indices. CONCLUSIONS: Intervening during and after allo-SCT with a multicomponent activity program during and after allo-SCT is beneficial for preserving a patient's cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality after allo-SCT. REGISTRATION: URL: https://anzctr.org.au/; UNIQUE IDENTIFIER: ACTRN12619000741189.
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