Abstract
Background: Hematopoietic stem cell transplant (HSCT) recipients experience a high physical and emotional symptom burden that can impact their physical functioning. Prior work has suggested that HSCT survivors do not meet American Cancer Society guidelines for recommended levels of moderate-to-vigorous physical activity. Yet, few studies have specifically examined physical activity during acute recovery, particularly around day +100 post-HSCT, a pivotal timepoint during which many patients begin to return to regular activities. Further, much of the existing evidence on physical activity levels in oncology populations have relied on patient-reported outcome measures, which generally have poor agreement with objective measures, such as accelerometry, the standard physical activity measure. The present study examined accelerometry-measured physical activity levels around day +100 post-HSCT and identified sociodemographic and clinical characteristics associated with physical activity during acute recovery post-HSCT.
Methods: We conducted a secondary analysis of cross-sectional data collected as part of a single-center pilot randomized clinical trial at the Dana-Farber Cancer Institute (NCT05147311) from August 2021 to August 2022. Adult patients (≥18 years old) diagnosed with a hematologic malignancy who underwent inpatient allogeneic HSCT at Dana-Farber Cancer Institute within 100 days after transplantation were eligible for participation. Sociodemographic data was collected via patient self-report measures and clinical data was collected via the electronic health record. We used ActiGraph wGT3X-BT accelerometers (ActiGraph, Pensacola, FL) to measure physical activity during waking hours. All statistical analyses were conducted using RStudio 2024.09.0 Build 375 (© 2009–2024 Posit Software, PBC). Descriptive statistics (i.e., mean, standard deviation) were calculated for continuous variables and proportions for categorical variables. For group comparisons, key sociodemographic and clinical variables were dichotomized. Between-group comparisons of physical activity metrics were conducted using two-sample Welch's t-tests, which accommodate unequal variances and unequal sample sizes, with p-values <0.05 indicating statistical significance.
Results: The present study included 63 participants (mean age = 61, 50.8% female, 92.1% White). Most participants completed college (68.3%) and reported an annual household income >$75,000 (66.7%). The most common diagnosis was leukemia (69.8%). Mean total accelerometer wear time over the course of seven days during waking hours was 83 hours (SD = 26). On average, participants engaged in 13 minutes of moderate-to-vigorous physical activity per day totaling 81 minutes weekly. Daily average step count was 3,679 and weekly average was 23,094 steps. Significant between-group differences were found for education level such that participants with a college education or more demonstrated higher one-week levels of total moderate-to-vigorous physical activity (p=0.012), average daily moderate-to-vigorous physical activity (p=0.025), total step count (p=0.019), and daily step count (p=0.025). Similarly, between-group differences were found between income level such that participants with household yearly income >$75,000 demonstrated higher one-week levels of total moderate-to-vigorous physical activity (p=0.0063) and daily moderate-to-vigorous physical activity (p=0.0033).
Conclusion: Results suggest that adult HSCT survivors with fewer years of education and lower income may be at greater risk of low levels of physical activity. Study findings identify potentially vulnerable cohorts of HSCT survivors at risk for low physical activity and offer potential targets for future interventions to increase physical activity.
