What is the role of prehabilitation prior to an autologous stem cell transplant?

What is the role for prehabilitation prior to autologous stem cell transplant?

What I tell my patients is like, if you were an athlete and you were going to the Olympics, you train, right? You train probably for multiple years. You go to the Olympics and then you may have an outlook for getting a medal. Right. So it's kind of similar for transplant. Right. The best shape you come to transplant, the better your outcomes in terms of like, less deconditioning. Right. And a faster outlook for recovery.

So yes, I weigh in my patients is like, I don't need to go to the gym. I start lifting weights, running, like five miles a day. What I ask thing is like, schedule yourself to do some low, low impact exercises, right? What are those, like? Walking? Walking is great, right? You can walk, like, about, like, half an hour every day, right? You don't need to be a once split again, 15 minutes each time. You could do more than that. I would say half an hour a day purposely walking. It's not like, oh, I have to walk, no, you purposely are going to walk. That's one thing.

The other thing is like, you know, these small weights or those resistant elastic bands are things that will help you to keep the tone in your muscle, especially in your core. So your respiratory muscles and those things, you know, are very important to also be in good shape, right? I don't need you to build muscle. I just needed to, to give them function. Right. And then chair exercises. Right. Like sitting standing without using your hands. Right. So that keeps these some big muscles in your legs and your, your thighs active. Right. So that you can walk. You can do. Because if you get sick during transplant and you spend time in bed, naturally, we are going to lose, not only bone mass, but we are going to lose a lot of muscle mass. Right? And we're not eating as we supposed to be, right? Our protein ingestion is going to be significantly reduced. Then that also impacts your muscle, right? So the best way you can prepare for that day better.

I would say once you get diagnosed with myeloma, Smoking I would say once you get diagnosed with myeloma, if you are a smoker, you should stop, right? You should make every effort. It's not easy. It's a very difficult thing to stop smoking. So there are multiple programs in many of the clinics, for example, here in Florida, even this they have a program where they help you quit smoking. You know, there are nicotine patches, lozenges, all the medications also. Right. That will help you are quit. And most of the clinics, including ours, we have, so say smoking cessation programs that patients can be enrolled.

Also, there is some literature on how smoking contributes to the resistance of therapy to the cancer cells. Right. So that's also another reason to stop smoking, right? Yeah. Stopping smoking is vital. Right. And also, you know, it will positively impact your respiratory system. Right? You still get smoking even though it's going to take a while for, for your lungs to fully recover. Right? Is the right step.

What should individuals considering transplant know about alcohol use? Low moderate consumption. Right. Like a glass of wine. Like when your dinner, is. Okay, right, right. But if you are a more heavy drinker, like, you know, like, if you are doing, like, a six pack of day, probably not a good idea, right? You need to start coming down with those things, right? Because there are other things that are being affected by alcohol. Right? Your bone marrow is affected by alcohol. Your liver is affected by alcohol. So there are other things that you know, you also need to be mindful because you are going to be going through therapy. Then you are going to have a better life, life changing, in fact, better be like transplant. Right.

Is there a role for physical therapy prior to the transplant? If you are not able to do it by yourself, right. Like for example, there are patients who have like fractures in their spine, right? That that produces pain. They may have need to have surgery. Like for example, those patients are excellent candidates for physical therapy. Basically the prescription that I give to the patients is, physical therapy evaluation for strengthening and conditioning. And then they go to the physical therapy. They usually do this outpatient or at home. And then what I tell them is like when you learn what the physical therapy is telling you to do, then you continue doing that. So as a way of keeping up with activities.

Are there situations where prehabilitation could make non-negligible patients eligible for transplant? Sometimes I see patients who are in a wheelchair. This is not a candidate for transplant at that time. Right. But with physical therapy, with a pre rehabilitation process, those patients can get off their wheelchair and start walking. Can have like, a good recovery and then be considered for transplant.