Physical Activity Improves Quality of Life, Fitness Among Older Adults With CLL

Physical activity can help support quality of life and improve physical fitness in adults with chronic lymphocytic leukemia (CLL), according to new results of a pilot study.

Specifically, data showed a physical activity intervention increased leisure time physical activity in patients and decreased fatigue. These changes were associated with an increased CD4:CD8 T-cell ratio and reduced proportion of T-cell subsets that have previously been associated with poor outcomes in patients with CLL.

Previous research has shown “higher physical fitness is associated with reduced chronic inflammation in patients with CLL,” the study authors wrote. “Further, 12 weeks of high-intensity interval training with muscle endurance-based resistance training in treatment-naïve adults with CLL resulted in improved immune function.”

The latest findings were published in European Journal of Haematology.

Researchers collected physical function measures and blood samples from 24 patients enrolled in a 16-week trial of at-home aerobic and/or resistance exercise. Of these, half were receiving targeted therapy. The mean patient age was around 63, and all patients completed the intervention.

Although a healthy diet and regular physical activity are recommended for all adults, those with CLL who have higher levels of physical activity and are more physically fit “have been shown to have fewer treatment side effects and slower in vitro tumor expansion,” authors wrote.

To test whether there would be an inverse relationship between physical function and T cells in patients with CLL, the researchers assessed 8 male and 16 female patients recruited from the Leukemia Center at MD Anderson. These individuals were a subset of participants from a larger trial that examined the efficacy of a lifestyle intervention for patients with the disease.

All participants were randomly assigned to 1 of 16 combinations of interventions based on aerobic exercise only or aerobic exercise with resistance training; telephone coaching vs no telephone coaching; text messages or no text messages; and self-monitoring for 4 to 7 days a week or 1 day a week.

The interventions did not aim to improve any one physical function metric, but rather to increase overall physical activity and reduce fatigue.

Analyses revealed:

• Godin leisure-time physical activity score increased from baseline to 16 weeks (mean difference: 14.61; P < .01) and fatigue decreased (mean difference: 6.71; P < .001)
• At baseline, lower fatigue correlated with a lower proportion of CD8+ T cells (τ = 0.32; P = .03) and cardiorespiratory fitness inversely correlated with the percentage of PD-1+CD8+ T cells (τ = –0.31, P = .03)
• At 16 weeks, cardiorespiratory fitness inversely correlated with the proportion of PD-1+CD4+ T cells (τ = –0.34, P = .02)
• Reduced fatigue at 16 weeks correlated with an increased CD4:CD8 ratio (τ = 0.36, P = .02) and lower percentage of HLA-DR+PD-1+CD4+ T cells (τ = –0.37, P = .01)

The investigation is the first of its kind, to the authors knowledge, that assesses the relationship between differentiated T cells and physical function in patients with CLL.

The lack of a control group marks a limitation to the study. Due to low sample sizes, researchers were also unable to compare results between groups.

“These findings further support the use of exercise to improve physical fitness and quality of life in patients with cancer,” the authors wrote.

“Future exercise interventions involving CLL patients should utilize controlled interventions to investigate impacts on immune cell function including pro-inflammatory cytokines, which have been associated with high levels of fatigue in other types of cancer,” they concluded.

Reference

Crane JC, Gordon MJ, Basen-Engquist K, et al. Relationships between T-lymphocytes and physical function in adults with chronic lymphocytic leukemia: Results from the HEALTH4CLL pilot study. Eur J Haematol. Published online March 22, 2023. doi:10.1111/ejh.13958