Physical Activity’s Impact in Lymphoma Patient’s Outcomes Open Access

Abstract

PURPOSE: The impact of physical activity (PA) on survival in lymphoma patients is not known. We evaluated the association of PA and change in PA with overall (OS), lymphoma-specific (LSS) and event-free (EFS) survival in a prospective cohort of newly diagnosed lymphoma patients enrolled 2002-2012. As a follow up, we performed a feasibility study of a prospective PA intervention in lymphoma patients undergoing autologous stem cell transplant at Emory.

METHODS: Leisure Score Index (mLSI) was calculated from self-reported level of usual adult PA at enrollment (baseline) and at 3-years post-diagnosis (FU3), grouping patients by active versus insufficiently active by national PA guidelines. Associations of PA with survival were assessed using hazard ratios (HRs) and 95% confidence intervals (CI) from Cox models stratified by lymphoma subtype and adjusted for age, sex, baseline BMI and comorbidity score; change scores were adjusted for baseline PA. 

A feasibility single-arm study was performed at Emory. Patients performed 150 minutes of PA per week on a stationary bicycle or by walking. PA was self-recorded and validated by an Apple Watch.  Data was collected from date of hospitalization to discharge. Feasibility, the primary outcome, was assessed by average weekly minutes of PA performed by self-report.  Validation of moderate intensity PA was shown by heart rate (HR) monitoring (goal 40% of HR reserve). 

RESULTS: 3,060 participants were evaluable at baseline and 1,371 at FU3. Active patients had superior survival from baseline [HR (CI): OS 0.82 (0.72-0.94); LSS 0.74 (0.61-0.90); EFS 0.92 (0.82-1.02)] and FU3 [HR (CI): OS 0.64 (0.46-0.88); LSS 0.32 (CI 0.18-0.59); EFS 0.82 (0.61-1.10)] compared to insufficiently active. An increase in mLSI from baseline to FU3 (versus stable mLSI) was associated with superior OS (HR=0.70, CI 0.49-1.00) and LSS (HR=0.49, CI 0.26-0.94). These results were consistent across subgroups.  Our feasibility study in 10 patients showed a 60% adherence rate by self-report, with 75% of PA validated by HR.

CONCLUSIONS: Higher PA among newly diagnosed lymphoma patients and 3-year survivors is associated with OS, LSS and EFS. An increase in PA after diagnosis is associated with improved survival outcomes. Prospective PA interventions are feasible but need further study.

Table of Contents

I.         Introduction p.1-2

II.     Background p.3-5

III.  Methods p.6-11

IV.  Results p.12-16

V. Discussion p.17-21

VI.  References p.22-29

VII. Tables / Figures p. 30-47

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Oncology
Keyword	Digital Health Lymphoma Physical Activity
Committee Chair / Thesis Advisor	Jonathon Cohen, MD, MS, Emory University
Committee Members	Jeffrey Collins, MD, MS, Emory University Amita Manatunga, PhD, Emory University

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