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      Changes in muscle performance among older adults with myeloid malignancies engaging in a mobile health (mHealth) exercise intervention: a single arm pilot study

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          Abstract

          Background

          Older adults with cancer are vulnerable to declines in muscle performance (e.g., strength, speed, duration of muscular contraction), which are associated with worse cancer-related outcomes. Exercise-based interventions can mitigate these declines, but evidence of their effect among older adults with myeloid malignancies receiving outpatient treatment is limited. We explore change in muscle performance among patients in a single arm pilot study of a mobile health (mHealth) exercise intervention.

          Methods

          Patients ≥ 60 years old with myeloid malignancies receiving outpatient chemotherapy completed a home-based resistance band and walking exercise program [EXercise for Cancer Patients (EXCAP)© ®] delivered via a mobile application with symptom monitoring [(Geriatric Oncology-EXCAP (GO-EXCAP)] lasting 2 cycles of chemotherapy (approximately 8–12 weeks). Clinical exercise physiologists provided instruction and ongoing support. Upper and lower extremity peak torque (maximum force, newton-meters, Nm), total work (force over entire movement, Nm), and average power (speed of force, watts, W) were assessed using the BIODEX System 4 isokinetic dynamometer. Muscle activation (motor recruitment, millivolts, mV) was captured using the BTS FREEEMG 1000. We report descriptive statistics and within-patient differences from baseline to post-intervention using Wilcoxon signed rank tests (α = 0.10) and effect size (ES, Cohen’s d, 0.20 ≤ small < 0.50, large ≥ 0.80), and explore differences by exercise level (resistance exercise, daily steps).

          Results

          A total of 25 patients completed baseline assessments, 23 with muscle performance data at baseline, 16 at post-intervention. Of these, most were male ( n = 10, 62.5%) and had acute myeloid leukemia ( n = 9, 56.3%). From baseline to post-intervention there were improvements in left shoulder peak torque [mean change = 2.45 (Standard Deviation = 2.41), p = 0.004] and average power [2.29 (3.05), p = 0.033]. Muscle activation increased for left rectus femoris [0.04 (0.04), p = 0.074], right and left biceps brachii [0.03 (0.04), p = 0.012; 0.03 (0.05), p = 0.098, respectively], and left pectoralis major [0.02 (0.03), p = 0.064]. Several measures of peak torque/total work and all measures of muscle activation showed ES ≥ 0.20 for improvement. There were no statistically significant decreases from baseline to post-intervention.

          Conclusions

          Older adults with myeloid malignancies participating in a mHealth exercise intervention had stable to improved muscle performance. Further research is needed to establish the preliminary efficacy of this intervention for improving physical performance in this population at high risk for decline.

          Trial registration

          clinicaltrials.gov NCT04035499 (registered July 29th, 2019).

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12877-024-05668-w.

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          Most cited references58

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          The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia.

          The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues was last updated in 2008. Since then, there have been numerous advances in the identification of unique biomarkers associated with some myeloid neoplasms and acute leukemias, largely derived from gene expression analysis and next-generation sequencing that can significantly improve the diagnostic criteria as well as the prognostic relevance of entities currently included in the WHO classification and that also suggest new entities that should be added. Therefore, there is a clear need for a revision to the current classification. The revisions to the categories of myeloid neoplasms and acute leukemia will be published in a monograph in 2016 and reflect a consensus of opinion of hematopathologists, hematologists, oncologists, and geneticists. The 2016 edition represents a revision of the prior classification rather than an entirely new classification and attempts to incorporate new clinical, prognostic, morphologic, immunophenotypic, and genetic data that have emerged since the last edition. The major changes in the classification and their rationale are presented here.
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            Using Effect Size-or Why the P Value Is Not Enough.

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              The Loss of Skeletal Muscle Strength, Mass, and Quality in Older Adults: The Health, Aging and Body Composition Study

              The loss of muscle mass is considered to be a major determinant of strength loss in aging. However, large-scale longitudinal studies examining the association between the loss of mass and strength in older adults are lacking.
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                Author and article information

                Contributors
                marielle_jensenbattaglia@urmc.rochester.edu
                kahpoh_loh@urmc.rochester.edu
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                9 January 2025
                9 January 2025
                2025
                : 25
                : 22
                Affiliations
                [1 ]James P. Wilmot Cancer Institute, Rochester, New York USA
                [2 ]Department of Public Health Sciences, University of Rochester Medical Center, ( https://ror.org/00trqv719) Rochester, USA
                [3 ]Princeton University, ( https://ror.org/00hx57361) New Jersey, United States
                [4 ]Emory University, ( https://ror.org/03czfpz43) Atlanta, USA
                [5 ]Department of Surgery, University of Rochester Medical Center, ( https://ror.org/00trqv719) New York, USA
                [6 ]Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, James P. Wilmot Cancer Institute, ( https://ror.org/00trqv719) 601 Elmwood Avenue, Box 704, Rochester, New York 14642 USA
                Article
                5668
                10.1186/s12877-024-05668-w
                11715464
                39789445
                911bd6a7-8969-4e7c-a4b8-dbe32fae3acf
                © The Author(s) 2025

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

                History
                : 17 May 2024
                : 30 December 2024
                Funding
                Funded by: National Cancer Institute
                Award ID: UG1CA189961
                Award ID: R00CA237744
                Categories
                Research
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2025

                Geriatric medicine
                geriatric hematology,myeloid malignancies,fitness,exercise intervention
                Geriatric medicine
                geriatric hematology, myeloid malignancies, fitness, exercise intervention

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