Strides for Strength: Increasing Physical Activity During Hospitalization for Hematopoietic Cell Transplantation

While hematopoietic cell transplantation (HCT) is a potentially curative treatment for many patients facing hematologic cancers, it is also a challenging modality that can lead to declines in physical activity, mental state, and quality of life. A hallmark symptom of HCT is severe fatigue, and the Oncology Nursing Society (ONS) has recognized exercise as its only evidence-based recommendation. Nursing staff recognized the need for an intervention to increase activity for their patients. The Strides for Strength program was created, in collaboration with physical therapy, to inspire patients to move. Strides for Strength features a self-tracking program that aims to improve patient outcomes and decrease transplant complications. Patients can achieve either a Half Marathon or Marathon, and awards are given for completion. Community members donated medals from local races that are given to patients as symbols of support. Staff gather at the finish line for every patient to celebrate the accomplishment. Strides for Strength has been successfully adopted and has been overwhelmingly popular among patients, with over 87% of new patients choosing to participate. Adaptations have been made for patients with physical limitations to foster inclusion. Patient participation continues to be evaluated, and clinical outcomes continue to be monitored.

STRIDES FOR STRENGTH: Increasing Physical Activity During Hospitalization for Hematopoietic Cell Transplantation Cassidy Kotobalavu MS, RN, OCN; Shannon Bethel BSN, RN; Haley Midgley BSN, RN, OCN; Rachael Carlson RN, OCN; Brett Fechter PT, DPT, NCS; Jennifer Jones MHL, BSN, RN, OCN Huntsman Cancer Institute at the University of Utah BACKGROUND & SIGNIFICANCE RESULTS While hematopoietic cell transplantation (HCT) is a potentially curative treatment for many patients facing hematologic cancers, it is also a complex and challenging modality that can lead to declines in physical activity, mental state, and quality of life (Kolke, 2019). As time progresses throughout the acute posttransplant period, symptom severity only increases as quality-oflife decreases. A hallmark symptom of HCT is severe fatigue, which may last for years following treatment (Hacker, 2017), and the Oncology Nursing Society (ONS) has recognized physical exercise as its only evidence-based recommendation for cancerrelated fatigue (Mitchell, 2014). • The Strides for Strength program has been successfully adopted by the unit, and has been overwhelmingly popular among patients, with over 87% of new patients choosing to participate since implementation. • Clinical staff have shown tremendous engagement in the program and are continually looking for ways to further motivate their patients. • Additional adaptations to the program have been made for patients with physical limitations to foster inclusion. PURPOSE • The nursing staff on an inpatient unit that cares primarily for hematopoietic cell transplantation patients at an academic cancer institute recognized the need for an intervention to increase physical activity for their patients. • The “Strides for Strength” program was created, in collaboration with physical therapy, to inspire patients to stay motivated to move and achieve their daily activities throughout their hospitalization. • Strides for Strength features a self-tracking exercise program that aims to: • Improve patient outcomes • Decrease transplant complications associated with low physical activity, anxiety, depression and other HCT-associated side effects. INTERVENTIONS • All patients are given the option of participating in Strides for Strength upon admission. Patients are introduced to the program in the outpatient clinic prior to admission. • Education is provided on the physical and mental health benefits of exercise, including increased energy, improved sleep, strengthened immune system, and potentially reduced length of stay. • By ambulating in the hallways, patients self-track their laps and mark off completed miles as they go. • Patients can achieve either a Half Marathon or Marathon. Certificates and customized silicone bracelets are given out as awards. • Community members donated medals from local and national races that are given out to patients as symbols of support. • Staff gather at the finish line for every patient that completes the program to celebrate the accomplishment. DISCUSSION The Strides for Strength program aims to encourage hematopoietic cell transplantation patients in increasing physical activity while improving patient outcomes. Patient participation continues to be evaluated, and clinical outcomes continue to be monitored and analyzed. Acknowledgements: A special thanks to the 5K BMT Shared Governance committee, particularly Shannon Bethel, who were the spark to this project and made it possible! References: Hacker, E.H., Fink, A.M., Peters, T., Park, C., Fantuzzi, G., & Rondelli, D. (2017). Persistent fatigue in hematopoietic stem cell transplantation survivors. Cancer Nursing, 40(3), 174-183. Kolke, S.M., Kuhlenschmidt, M., Bauer, E., Anthony, M.K., Gittleman, H., Caimi, P.F., & Mazanec, S.R. (2019). Factors influencing patients’ intention to perform physical activity during hematopoietic cell transplantation. Oncology Nursing Forum, 46(6), 746-756. Mitchell, S.A., Hoffman, A.J., Clark, J.C., DeGennaro, R.M., Poirier, P., Robinson, C.B., & Weisbrod, B.L. (2014). Putting evidence into practice: An update of evidence-based interventions for cancer-related fatigue during and following treatment. Clinical Journal of Oncology Nursing, 18(Suppl. 3), 38–58. https://doi.org/ 10.1188/14.CJON.S3.38-58