Exercise for Sarcopenia in Allogeneic Hematopoietic Stem Cell Transplant Patients

项目摘要/摘要 造血干细胞移植(HSCT)是治疗血液病患者的一种既有效又严格的治疗方法。 恶性肿瘤。在造血干细胞移植后的头两年，与治疗相关的并发症，如原发病 复发、移植物抗宿主病和造血干细胞移植治疗相关的心脏和肌肉骨骼毒性 估计存活率为60%-70%。HSCT引起的副作用和并发症会带来后遗症 对患者的功能能力和心理幸福感产生负面影响。因此，HSCT收件人是 有患心血管疾病、骨质疏松症和骨质疏松症等并存疾病的风险。由于 HSCT症状负担增加，HSCT受者报告体力活动水平下降58%， 进一步使骨骼肌量的丧失、骨密度的丧失和功能能力的降低永久化。 运动已作为一种成功的康复策略应用于HSCT受者，以恢复 骨骼肌量、肌力和有氧能力，同时改善与健康相关的 生活质量。虽然康复锻炼是有效的，但它们并没有解决预防身体健康的作用 和精神衰退。康复训练，定义为在药物治疗开始前的运动训练， 已被证明在结直肠癌和肺癌患者的设置中具有价值，以积极改变患者的 复苏轨迹。尽管康复治疗对其他癌症实体有好处，但证据很少。 这项研究调查了接受造血干细胞移植前锻炼的效果。Improve-BMT试验解决了这个问题 知识差距，主要侧重于监测和报告目标功能状态，直至100天 移植后。我将利用这项计划中的临床试验(NCT03886909)来量化和描述 阻力与有氧运动相结合的康复方案对骨骼肌群、肌体质量的影响 成分，以及接受造血干细胞移植患者的骨密度。为了达到这一目标，我们将进行双重- 于移植前及移植后100天行能量X线骨密度仪扫描。通过这一研究经验和 建议的博士后奖学金，我将了解进行高质量的人类临床试验，临床 为HSCT患者提供运动处方，并将接受身体行为和解释方面的培训 成分测量。

Project Summary/Abstract Hematopoietic stem cell transplant (HSCT) is a curative yet rigorous treatment for patients with hematologic malignancies. During the first two years post-HSCT, treatment-related complications such as primary disease relapse, graft-versus-host-disease, and HSCT therapy-related cardio- and musculoskeletal-toxicity contribute to an estimated 60-70% survival rate. Side effects and complications caused by HSCT carry late-effects that negatively impact patients' functional capacity and psychological well-being. As a result, HSCT recipients are at risk of developing co-morbidities such as cardiovascular disease, sarcopenia, and osteoporosis. Due to the increased HSCT symptom burden, HSCT recipients report a 58% decrease in physical activity levels which further perpetuates the loss of skeletal muscle mass, bone density loss, and decreased functional capacity. Exercise has been employed as a successful rehabilitative strategy in HSCT recipients to recuperate losses in skeletal muscle mass, muscular strength and aerobic capacity while concomitantly improving health-related quality of life. While rehabilitative exercises are effective, they do not address the role of preventing physical and mental declines. Prehabilitation, defined as exercise training prior to the start of a medical therapy, has been documented to be valuable in the setting of colorectal and lung cancer patients to positively alter patients' recovery trajectory. Despite the benefits of prehabilitation in other cancer entities, there is a paucity of evidence that investigates the effects of exercise prior to receiving HSCT. The IMPROVE-BMT trial addresses this knowledge gap, with a primary focus on monitoring and reporting objective functional status until 100 days post-transplant. I will take advantage of this planned clinical trial (NCT03886909) to quantify and describe the effects of a combined resistance and aerobic exercise prehabilitation program on skeletal muscle mass, body composition, and bone density for patients receiving a HSCT. To achieve this aim we will conduct a dual- energy x-ray absorptiometry scan at baseline and 100 days post-HSCT. Through this research experience and proposed post-doctoral fellowship, I will learn about the conduct of high quality human clinical trials, clinical exercise prescription for HSCT patients, and will receive training in conduct and interpretation of body composition measurements.