Efeitos do treinamento muscular inspiratório durante o tratamento oncológico e impactos a longo prazo do transplante de células-tronco hematopoiéticas na qualidade de vida e nível de atividade física

Abstract

Introduction: Cancer treatment is associated with respiratory muscle dysfunction and reduced functional capacity, negatively impacting physical activity and quality of life, even after hospital discharge. Inspiratory muscle training (IMT) has been proposed as a non-pharmacological rehabilitation strategy; however, gaps remain regarding its effectiveness and standardization. In addition, the long-term effects of hematopoietic stem cell transplantation (HSCT) on these outcomes are not yet fully understood. Objective: To evaluate the effects of IMT in cancer patients and analyze the protocols used. Additionally, to investigate quality of life and physical activity levels in the long term after HSCT, comparing them with individuals without cancer and across different diagnoses (multiple myeloma and lymphomas). Methods: This study comprised a systematic review with meta-analysis combined with a crosssectional descriptive study. The review was conducted according to the PRISMA guidelines, with searches performed in MEDLINE/PubMed, PEDro, BIREME, Web of Science, SCOPUS, and EMBASE. Randomized controlled trials involving adults undergoing cancer treatment were included. Methodological quality was assessed using the RoB 2 and GRADE tools. Analyses considered mean, standard deviation, and sample size, with heterogeneity assessed using Cochran’s Q test and the I² index (p < 0.05). The cross-sectional study included adults who underwent HSCT between 2018 and 2023, divided into three groups: up to 2 years post-transplant (n=36), more than 2 years post-transplant (n=46), and a control group (n=70). Quality of life was assessed using the EORTC QLQ-C30, and physical activity level was assessed using the Baecke questionnaire. Chi-square or Fisher’s exact test, one-way ANOVA, Student’s t-test, and Pearson or Spearman correlations were used, along with effect size analysis (partial η², Cohen’s d, and r). Results: IMT significantly improved inspiratory muscle strength and functional capacity compared to the control group. No significant differences were observed in peripheral muscle strength or quality of life. A high heterogeneity of protocols was identified, with no standardization regarding load, duration, or frequency. Patients who underwent HSCT presented worse quality of life compared to the control group, with statistically significant and clinically relevant differences. No differences were observed between groups up to and beyond 2 years post-transplant. Regarding physical activity, the control group showed the highest levels, followed by the group beyond 2 years, and finally the group up to 2 years post-transplant. No relevant differences were found between multiple myeloma and lymphoma diagnoses. Conclusion: IMT improves inspiratory muscle strength and functional capacity in cancer patients, although protocol standardization is still lacking. HSCT appears to be associated with persistent impairments in quality of life and reduced levels of physical activity, regardless of time since transplantation. A trend toward improvement in physical activity levels over time was observed. Furthermore, the impact on these outcomes is similar across the different oncological diagnoses studied.