JMIR Publications

ABSTRACT

Background:

Cancer and chemotherapy can cause gait disturbances and increase fall risk in older adults with myeloid neoplasms (MN). Exercise may improve gait but research is lacking.

Objective:

We assessed gait changes following a mobile health exercise intervention during two cycles of outpatient chemotherapy (8-12 weeks).

Methods:

In a single arm pilot study, we included adults aged ≥60 with MN undergoing chemotherapy. GO-EXCAP integrates a progressive aerobic walking and resistance exercise program with a mobile app. We assessed gait using a waist-worn G-Walk motion sensor during a 6-minute walk at pre- and post-intervention. Spatio-temporal outcomes included cadence (steps/minute), velocity (meters/minute), normalized stride (stride length normalized over height), and swing duration (percentage of the gait cycle during which a foot is in the air when walking). Regularity outcomes that measure gait rhythm included variability of normalized stride and variability of swing duration. Variability for both outcomes was quantified as the standard deviation across all gait cycles. We calculated Cohen's d effect sizes (ES) for change in gait outcomes and used Spearman’s to correlate changes in daily steps and resistance exercise duration with gait outcomes.

Results:

We included 13 patients (mean age=71 years). Averaged daily steps were 3084 at pre- and 3757 at post-intervention. Patients performed resistance exercises for 25 min/day, 4 days/week at low intensity (rate of perceived exertion 3/10). At post-intervention, patients had increased cadence (+5 steps/minute; ES=0.38) and decreased variability in normalized stride (mean=-1.4; ES=-0.18) and swing duration (mean=-0.10%; ES=-0.15). Increased daily steps correlated with decreased swing duration variability (r=-0.72, p=0.01). Resistance exercise duration correlated with increased cadence (r=0.54, p=0.06) and velocity (r=0.56, p=0.05).

Conclusions:

GO-EXCAP shows promise in improving gait in older adults with MN. Better adherence to exercise correlated with improved gait outcomes. Clinical Trial: ClinicalTrials.gov identifier: NCT04035499