Impact of walking ability and physical condition on fatigue and anxiety in hematopoietic stem cell transplantation recipients immediately before hospital discharge.

Purpose: This study analyzed the influence of walking ability and physical condition on fatigue and anxiety at hospital discharge in patients receiving hematopoietic stem cell transplantation (HSCT).

Method: A total of 25 subjects were assessed after receiving HSCT until discharge. The Japanese Cancer Fatigue Scale and the State-Trait Anxiety Inventory were used to assess fatigue and anxiety. Relationships of fatigue and anxiety status respective to walking ability variables: leg muscle strength (knee extension, ankle plantar flexion and ankle dorsiflexion strength) and average number of daily steps, and physical condition variables (food intake, febrile days, body mass index, and serum albumin) were examined with correlations and stepwise multiple regression analysis.

Results: Subjects with later achievement of adequate food intake after HSCT (β = 0.62) and weaker knee extension strength per body mass at discharge (β = -0.42) reported higher fatigue (adjusted R(2) = 0.53, p = 0.00). Knee extension strength per body mass at discharge was correlated with an average step-count from 51 to 80 days after HSCT (r = 0.51, p = 0.01). In subjects whose Body Mass Index was above 23.5, weaker ankle dorsiflexion strength per body mass prior to transplantation reported higher fatigue at discharge (adjusted R(2) = 0.97, p = 0.00). Subjects with later achievement of food intake after HSCT (β = 0.59) and more days with fever reported higher anxiety (adjusted R(2) = 0.47, p = 0.00).

Conclusion: Post-HSCT fatigue was affected by a delay in adequate food intake and diminished muscle strength. The results of this study show the importance of encouraging walking for maintaining muscle endurance.