High-intensity exercise training for the management of persistent fatigue following allogeneic hematopoietic stem cell transplantation: a prospective pilot study

Background Persistent fatigue impairs quality-of-life after allogeneic hematopoietic stem cell transplantation (alloHSCT), and evidence-based interventions are lacking. We investigated the feasibility of combined aerobic and resistance training for long-term survivors post-alloSCT with persistent fatigue in a prospective, single-center, single-cohort pilot study.Methods Consecutive adults (median age 60 years) with NCCN-defined fatigue persisting >3 months, at a median of 29 months (range 12–54) post-alloHSCT, were recruited. The participants completed a 12-week exercise intervention combining cardiopulmonary exercise test (CPET)-targeted high-intensity aerobic and progressive resistance training, via mixed telehealth and in-person sessions.Results Thirteen of 18(72%) eligible participants enrolled, and 11(85%) completed the intervention with 94% attendance, with 100% of the participants stating that they were very (7/11) or quite (4/11) satisfied, meeting the primary feasibility endpoint. Telehealth satisfaction was rated as neutral to slightly positive across the measured domains. In addition, fatigue improved from baseline to eight weeks (mean FACIT-F 30.6 ± 11.5 to 38.4 ± 10.7), alongside overall quality-of-life, and anxiety/depression symptoms. Clinically significant improvements in cardiorespiratory fitness, six-minute walk distance, and strength measures were also observed.Conclusion Personalized combined high-intensity aerobic and resistance exercise training is feasible, demonstrating preliminary efficacy for managing persistent fatigue in long-term alloHSCT survivors. Larger controlled studies are warranted to confirm these findings.