Individualized physical activity program for older adults undergoing chemotherapy for hematologic malignancies

Older adults with hematologic malignancies are at high risk of treatment-related functional decline. Although physical activity (PA) may mitigate these effects, evidence in older adults with acute myeloid leukemia (AML) and non-Hodgkin lymphoma (NHL) remains limited. We evaluated the feasibility and exploratory effects of a 6-month individualized PA program delivered during and after chemotherapy in this population.

The OncoGeriatric and Individualized Physical Activity (OCAPI) study is a single-arm, prospective feasibility study evaluating a 6-month individualized PA program in AML/NHL patients ≥65 years receiving chemotherapy ± immunotherapy. The PA program included supervised and unsupervised sessions, an activity tracker, and motivational phone calls. The primary outcome was progam adherence. Secondary outcomes were feasibility metrics (recruitment, retention, adherence, safety, and patient satisfaction) assessed throughout the study, and exploratory effectiveness measures (physical condition, PA behavior, and patient-reported and geriatric outcomes) evaluated at baseline, three, and six months.

Forty-two participants were enrolled. Rates of recruitment and retention were 59% and 88%, respectively. Adherence was 66% for supervised sessions, and < 5% for unsupervised ones. Activity trackers were worn 63% of the prescribed time and 75% of scheduled calls were completed. No exercise-related adverse events occurred. Patient satisfaction was high (96%). Perceived usefulness was 91% for supervised sessions, 54% for unsupervised sessions, 84% for the activity tracker, and 86% for motivational calls. At three months, in the overall cohort, handgrip strength showed a decline and balance an improvement, but there were no changes in other performance, patient-reported, or geriatric outcomes. Changes in limb strength and walking endurance may varied by diagnosis, with NHL patients tending to improve, and AML ones tending to decline. At six months, among all participants, walking endurance improved significantly and clinically (+53 m in the 6-Minute Walk Test, p = 0.01), while left-hand grip strength declined. Nutritional status and quality of life also showed improvement, with no notable changes in other outcomes.

The individualized PA program was feasible and safe for older patients with AML/NHL during chemotherapy. Exploratory effectivenness findings suggest that patients improved walking endurance and quality of life and diagnosis-specific functional trajectories. Larger multicenter trials are needed to confirm these preliminary observations.