Potential Benefits of a 6-Week Exercise and Mindfulness-Based Telehealth Training for HCT Survivors to Meet the Challenges of the COVID-19 Pandemic - a Feasibility Study

Background: Impairment of quality of life (QOL) such as reduced physical fitness and psycho-social dysfunction, is a recognized late effect of HCT, a life-saving procedure. Guided exercise and mindfulness-based stress management (MBSM) programs, delivered alone or in combination, have shown promise in improving patient's QOL mainly in the inpatient setting. Delivery of equitable and effective interventions in outpatient settings is challenging but may be addressed via telecommunication technology, reducing clinic visits and infection transmission. The aim of this study is to examine the feasibility and efficacy of a virtual and home-based program of combined exercise and MBSM via videoconference.

Methods: Patients attending our post-HCT outpatient clinic were invited to participate (SVH HREC approval 12/175). Eligibility criteria included aged 18-75 years, >6 months post allogeneic HCT and the basic skills to access the online training and assessment packages. Patients with severe medical and psychological problems were excluded by their clinicians. Consented participants attended an initial in-person introductory session and were provided materials including booklet and audio recordings for skill practice. This was followed by once weekly exercise and MBSM training for 6 weeks via videoconferencing. Assessments were performed pre, and then virtually post training, and at 3, 6 and 12 months. Assessment session included: 6-minute walk test (6-MWT), Modified Bruce Test (MBT), sit-to-stand (STS), hand grip strength (HGS). Subjective measures were Goal Attainment Scale, Karnofsky Score, FACT-BMT, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, and Godin-Shephard Leisure Time Index. Linear mixed-effects model was used for outcome comparisons. This maximum likelihood approach utilizes all acquired data points and manages missing data points by missing at random (MAR) assumption. P values were adjusted using Holm-Sidak method for multiple comparisons.

Results: Twenty-four eligible patients responded to the invitation and completed the program (54% male, median age 53 years (33 - 73), median time post-HCT of 37 months (13 - 68), 38% rural/remote). Based on participant feedback surveys at 6 months, this combined modality telehealth program was found to be well-accepted and safe.

The 6-MWT scores were significantly higher at 3 and 12 months (M=646.5m, SD=53.34 and M=615.33m, SD= 94.95, respectively; both p < 0.01) compared to baseline (M=566.94, SD=145.22). The MBT, the only test that required participants to attend the clinic was ceased after 3 months as changes in 6-MWT paralleled changes in MBT. STS Test was significantly higher at 3 and 12 months (M=19.53, SD=6.93, p<0.01 and M=19.07 SD= 8.0; both p < 0.05) compared to baseline (M=15.14, SD=6.44). For the upper limb assessment, dominant hand grip was significantly stronger at 3, and 12 months (M=35.09, SD=9.83; p< 0.01) compared to baseline (M=29.07, SD=9.79). A significantly higher FACT-BMT total and FACT-G scores were found at 3 months (M=123.37, SD=15.12 and M=91.23, SD=11.76; p< 0.01) compared to baseline (M=116.44, SD=14.16 and M=88.25, SD=12.52 respectively), and a trend non-significant at 12 months.

Conclusion: A 6-week internet and home-based exercise and MBSM programme was an acceptable, safe, and potentially effective intervention for sustained improvement of some QOL outcomes in HCT survivors. The positive findings of this feasibility study provided valuable data for the design of a multicentre RCT that is underway .