February 18, 2020

A physiotherapist’s guide to exercise before, during and after a stem cell transplant

A physiotherapist’s guide to exercise before, during and after a stem cell transplant


Claire Mason is a senior physiotherapist at Northern Ireland Cancer Centre, working in haematology with a range of patients, including those who have received a stem cell transplant. Claire shares with us some specialist advice about managing physical health before and after transplant, as well as side effects such as fatigue, and how to take recovery at your own pace.

We know that having a stem
cell transplant can change your physical health and daily life – what is your
advice for preparing for a transplant?

It
is important to do some physical activity, anything you can to help prepare. It
can put you in the best physical condition for going into transplant. This is
known as prehabilitation and more research is currently being done to show its
positive effects.

One
perspective is that we all have a ‘strength bank account’: the less activity
you do, you get depleted, and if you don’t put some strength back in again
before your treatment, then you’re going to use up all your ‘strength bank
account’. This can worsen transplant side effects. Ideally you can ‘save’
strength by building it up beforehand for when you need it later.

You
can do this with some sort of physical activity, depending on where you’re
starting from – which can just be going for a walk. It’s also helpful to do
some sort of strengthening work. This doesn’t mean ‘pumping iron’ weights – it
can be as simple as sitting down to standing up repeatedly, as if it were an
exercise. Strengthening is important and carries into your daily functions,
such as lifting things into cupboards, squatting down to get things out of the
fridge and more.

If
you’re not sure where to start with preparing physically, seek out help. There
are great resources out there from Anthony Nolan as well as ‘Move More’ by
Macmillan, who can signpost local support. Even if you’re fatigued and can’t do
a lot, a small amount is always better than nothing.

What are the potential
physical side effects following a stem cell transplant?

Every patient has such an individual response to their treatment and transplant.  A common one is experiencing a change in your weight, including muscle mass loss. The loss of muscle mass means it takes a lot more energy to do even the simple things in life such as getting up, showering, or any task where you’re expending energy.

Fatigue
is another frequently reported side effect, the severity varying from person to
person. It can be made worse if your appetite or taste has been affected which
can often leave you lacking in energy.

How long will these side
effects last?

It’s
difficult to say exactly what’s ‘normal’ but it depends on your treatment and
how your body has been affected.

Once
your blood counts come up again and your new immune system kicks in, your
symptoms will slowly start to improve. Some patients feel that at around three
months, they start to notice improvements. Hopefully you’ll be less fatigued
and may notice you’ve built up some strength through your recovery phase,
starting to adjust to life after transplant and eating better.

What support and guidance can
a physiotherapist provide?

A
physiotherapist can provide guidance and advice to the individual patient and
their needs. Doing small things can really add up – for example, just getting
out of bed and spending time in your chair is important while in hospital so
you are using your postural muscles. Walking around the ward when you are
allowed to also builds up energy for getting home. It’s not very exciting, but
it can all add up!

The
more patients move in hospital, the more they will be able to do the things
they want to do at home. At Northern Ireland Cancer Centre, where we offer an
inpatient service, my role is about giving guidance and encouragement to do
physical activity while you’re going through a transplant. It’s such an
important part of the transplant recovery experience, alongside nutrition and
sleep. As long as your immune system has started to recover, we know that
keeping active and out of bed can help limit your risk of developing an
opportunistic chest infection.

I
had one patient who did three minutes on the bike every day and she just loved
the psychological boost she got from that. It gave her ownership over something
– it helped her fatigue too, which carried through to when she got home. There
is an exercise bike in each of the transplant rooms on the ward here. It’s all
about people knowing that it is safe to do physical activity and gentle
strengthening, tailored to where the person is at in their transplant journey. It’s
important to check with whoever is looking after you on the ward that day, that
your blood results, particularly your platelets, are at a safe level to
exercise. Your healthcare team will help to work this out for you.

How can physical exercise and
rehabilitation help after transplant?

Physical
activity is linked to improved quality of life as well as a reduction in some
side effects, namely fatigue. It’s more than the physical side – it’s about
ownership, taking some control back and doing something positive for yourself.

Even
if you’re not into traditional ‘exercise’, a little bit of physical activity
can help.  If you’ve had a rough time, it
can give you something to focus on and have a positive mental health impact
too. The more activity you do, then hopefully the more your confidence will
come back, and you can do the things you enjoy more often.

Fatigue
is one of the most common symptoms that patients face. How can patients manage
fatigue? 

Everyone
is likely to have fatigue to some degree. We are lucky that we have
occupational therapy here that can give more specialist advice, as well as
strategies in how to help.

It’s
best to avoid doing everything in the morning as this may make you exhausted
for the rest of the day. It’s important to pace tasks out into small nuggets of
activity, and then rest afterwards. It’s good to be motivated and want to do
things yourself, but there are times when it is better to ask for some help.
For example, someone to help you do the shopping, if this is something that
really takes it out of you.

Within
that, even if you’re tired, some of those periods are recommended to be spent
doing some form of physical activity and strengthening. This can be getting out
for a short walk, even 10 minutes – you need to start somewhere to help with
the fatigue. The phrase ‘rest up until you feel better’ can be
counterproductive!

You
support a wide range of patients post-transplant. Is there a patient recovery
story that stands out for you?

The
one that stands out to me was a patient who was an older gentleman who was very
proactive and wanted to help himself as much as possible. He had said the best
piece of advice he’d had from someone was ‘don’t go home and sit in the chair
all day.’

He
used to give presentations to patient groups, and he had a picture of his chair
in his living room. When it all felt too much, he would look at that chair and
think ‘sitting there is not what will get me through this.’ He slowly increased
his physical activity even though he was so tired, which was great, making him
feel better and stronger. He built up to doing short bike rides and walking his
daughter’s dog.

Lastly, what advice would you
give to a patient who is struggling after their transplant?

The
main thing is that you’re not on your own, there are services out there for you
that you can be signposted to – such as local charities and support groups – as
well as working with your Clinical Nurse Specialist and team who are a great
source of information.

Going
online for information is also good, but stick to recommended, trusted sites
such as the Anthony Nolan website and its resources as it really shows you’re
not alone in this and other people have gone through it too.



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