Stem Cell Transplant Rehab: What to Expect
Regular exercise both before and after your stem cell transplant will prevent you from losing your strength and overall activity levels. However, exercising too hard or improperly may be harmful. This page provides guidelines to help you exercise effectively in order to promote a sense of well-being and cope with cancer-related fatigue. Before starting any new exercise routine, it is important to check with your doctor.
A physical therapist and/or an occupational therapist will work with you to design an exercise program for both during and after your hospital stay.
We encourage you to make exercise a regular part of your life and become an active participant in your treatment and recovery.
Guidelines for Safe Exercise
Understanding Your Lab Values
It is very important that you know your latest blood cell counts (lab val¬ues) before exercising. Platelet counts, hemoglobin (HEE-mo-glo-bin) levels, and hematocrit (hee-MAT-oh-crit) levels will change every time you get a blood transfusion. While you are in the hospital, your nurse will update you on your lab values. If you have just received a blood transfusion, ask your primary nurse for your most recent values. As an outpatient, ask your nurse practitioner for your lab values each time you visit the doctor’s office.
Platelets are blood cells that help your blood to clot and prevent spontaneous bleeding. If your platelet count is low (below 5,000), exercise may cause internal bleeding and so should be avoided. If your platelet count is above 10,000 but under 50,000, exercise is permitted, but should be limited.
Follow the guidelines below for platelet lab values when you choose an exercise or other activity.
|Blood Lab Values||Range||Walking||Biking||Exercises|
|Platelets||>50,000||No limitations||No limitations||No limitations
|30-50,000||No limitations||No resistance on bike||To tolerance, light resistance
|21-30,000||No limitations||No resistance on bike||To tolerance, no weights|
|11-20,000||No limitations||No biking||To tolerance, no resistance|
Monitor for signs of bleeding or bruising
|No biking||No exercise|
|<5,000||Essential daily No biking No exercise activities limited to in-room activities, only as needed (bathroom privileges only); watch for symptoms such as dizziness, shortness of breath, rapid heart rate||No biking||No exercise|
Signs that you are over-exerting include:
- Bleeding from your gums, mouth, nose, or ears, or in the whites of your eyes
- Easy bruising
- Blood in your urine, stool, or both
- Excessive menstrual bleeding
- Take the precautions listed below to help prevent bleeding:
- Avoid forceful blowing of your nose.
- Avoid holding your breath during exercise or while having a bowel movement.
- Be very aware of your surroundings to avoid falls, cuts, or bumping into objects.
- Do not lift weights; do not carry or move heavy objects.
- If you feel weak or unsteady, use appropriate support (for example, a walker or cane), and do not get out of bed without someone to help you.
If your hemoglobin or hematocrit levels are too low, your body will not have enough oxygen to meet the increased demand required for exercise. It is important to check your most recent hemoglobin and hematocrit levels before you exercise. Follow the guidelines below for hemoglobin and hematocrit lab values when you choose an exercise or other activity.
|Blood Lab Values||Range||Walking||Biking||Exercises|
|Hemoglobin||>12||No limitations||No limitations||No limitations|
|8-12||Short distances essential daily activities
||Short intervals, 5-10 minutes||To tolerance|
|Watch for symptoms such as dizziness, leg cramping, shortness of breath, rapid heart rate
||<8||To tolerance||No biking||Active range of motion, no resistance|
|Hematocrit||>25%||No limitations||No limitations||No limitations|
|<25%||To tolerance||No biking Active||Active range of motion, no resistance|
Signs that you may be exercising too hard when your oxygen levels are low (anemia) include:
- Shortness of breath
- Leg cramping
- Exercise intolerance
- Light-headedness or dizziness
- Rapid heart rate
- Gait disturbance
- Tingling or numbness in arms or legs
Checking Your Heart and Breathing Rates
It is important that you know your heart rate before, during, and after exercise. Knowing your heart rate allows you to make sure you are exercising at a pace that is right for your level of fitness. To check your heart rate, take your pulse before, during, and immediately after exercising. The average resting heart rate is between 60 and 100 beats per minute. The best places to find a pulse are in the wrist and neck.
To find your radial pulse (Figure 1 above), place your index (closest to thumb) finger and middle finger over the artery on the thumb side of your wrist. You may need to press down gently on your wrist to feel your pulse.
To find your carotid pulse (Figure 2 on previous page), place your index and middle fingers on either side of your neck below your jaw.
To take your pulse, count the beats you feel for 60 seconds, or count the beats for 15 seconds and multiply that number by 4. This number is your heart rate. When exercising, you should be working at close to your target heart rate. Follow this formula: ([220 - your age] x 0.6 (60%) = target heart rate).
You should be aware of your breathing rate before, during, and after exercise. The average breathing rate at rest is 12 to 15 breaths per minute. To determine your breathing rate, place a hand on your chest or stomach. Count the number of times your chest or stomach rises and falls in 15 seconds — each rise and fall counts as 1 — then multiply that number by 4. To determine if you are exercising too hard, perform the “talk test.” You should be able to talk while exercising. If you have difficulty talking, you are exercising too hard. Slow down until you can talk comfortably while exercising.
- Begin by doing each exercise _____ times and slowly progress so you are doing _____ repetitions of each exercise.
- Do exercises _____ times a day as tolerated. If performing exercises more than once a day, spread out sessions to maximize your energy for other daily activities.
- When allowed to use resistance or weights, begin doing _____ repetitions of each exercise using _____ pounds or using a _____ color exercise band. Gradually progress repetitions to _____.
- Once you are able to perform 30 repetitions of an exercise, you may progress weight by _____ pounds or to the next color band. When changing weight, cut your repetitions down to _____.
- Perform each exercise slowly in a controlled manner in each direction.
- Remember: Do not hold your breath while exercising. Holding your breath can cause your blood pressure to rise unnecessarily. Try counting softly to avoid holding your breath. You can also coordinate your breathing during exercise.
- Stop exercises if you experience pain or severe shortness of breath, light-headedness, or dizziness.
Perform these exercises lying on your back (supine position) on a firm surface such as a firm bed or the floor.
- Elbow Flexion (Biceps Curls) - Lie with your arms straight at your sides. Place a rolled towel under your elbow. Slowly bend your elbow, bringing your hand toward your shoulder. Slowly return your arm to the starting position. Repeat with the other elbow.
- Elbow Extension (Triceps) - Lie with your elbow bent and pointed toward the ceiling. Slowly straighten your elbow and hold for 3 seconds. Return your arm to the starting position. Repeat with the other elbow.
- Shoulder Abduction - Lie with your arms straight at your sides. Breathe in through your nose, slide your arms out to the sides, and raise them over your head. Breathe out through your mouth while lowering your arms back to your sides.
- Shoulder Flexion - Lie with your arms straight at your sides. Slowly raise one arm over your head and back as far as it comfortably will go. Your elbow should be straight. Slowly return your arm to the starting position. Repeat with the other arm.
- Ankle Flexion (Pumps) - Place a rolled towel under your calf. Point your toes up toward your body, then down away from your body.
- Hip Flexion (Heel Slides) - Lie with your legs straight and slightly apart. Bend one knee and slide your heel on the bed or floor toward your chest. Slide your heel back to starting position. Repeat with the other leg.
- Hip Abduction - Lie with your legs straight. Slide one leg out to the side as far as possible, keeping your toes pointed toward the ceiling. Return your leg to the starting position. Repeat with the other leg.
- Straight Leg Raises - Bend one knee, placing your foot flat on the bed or floor. Keep your other leg straight, toes pointed up. Slowly raise the straight leg about 12 inches off the bed or floor. Tighten your thigh muscle to keep your knee straight. Slowly lower your leg to the bed or floor. Repeat with the other leg.
- Bridging - Bend both knees, keeping your feet flat on the bed or floor. Raise your hips off the surface and push down with your legs. Return to starting position.
- Quad Sets - Recline on your back with your leg as straight as possible. Tighten the muscles on top of your thigh by pressing your knee into the bed. (Your leg should still be straight and lying on the bed.) Hold for 5 seconds. Do not hold your breath. Relax. Repeat with the other leg.
- Glut Sets - Recline on your back. Keep both legs out straight. Squeeze your buttocks together as tightly as possible. Hold for 5 seconds. Relax.
- Hamstring Sets - Recline on your back. Keeping one leg straight, bend the other to a height of about 6 inches. Tighten the bent leg by digging down and back with the heel. Hold for 5 seconds, then relax.
- Short Arc Quads - Place a rolled towel under your knee to bend it about 6 inches. Raise your foot until your knee is straight. Hold for 5 seconds, then relax.
Perform these exercises sitting in a straight-back chair.
Remember: Do not hold your breath.
- Elbow Flexion (Biceps Curls) - Bend your elbow and bring your hand toward your shoulder. Slowly straighten your elbow. Repeat with the other elbow.
- Elbow Extension (Triceps) - Hold your arm above your head with your elbow pointed toward the ceiling. Slowly straighten your elbow. Slowly return your arm to the starting position. Repeat with the other elbow.
- Shoulder Abduction - Breathe in through your nose and raise your arms out at your sides and over your head. Breathe out through your mouth and lower your arms back to your sides.
- Overhead Press - Hold your arms out at your sides with your elbows bent and fingers pointing straight up toward the ceiling. Slowly raise your arms above your head until your elbows are straight. Then slowly return your arms to the starting position.
- Ankle Flexion (Pumps) - Point your toes on one foot up to the ceiling. Then slowly point your toes down to the floor. Repeat with other foot.
- Hip Flexion (Marching) - Lift your knee up toward your chest while keeping your back straight. Return to the starting position. Repeat with the other knee.
- Knee Extension (Long Arc Quads) - Keeping your thigh on the chair, slowly straighten your knee. Slowly return to the starting position.
Cervical (Neck) Exercises
These exercises should be performed while sitting in a straight-back chair. You should feel a stretch in your neck while doing these exercises. Do not continue if you have pain in your neck.
Remember: Do not hold your breath.
- Neck Flexion and Retraction - There are 2 parts to this exercise. First, tilt your head forward, keep your mouth closed, and lower your chin to your chest. Hold for 8 seconds. Return to starting position. Second, pull your chin in without tilting your head up or down. Hold for 8 seconds.
- Neck Rotation - Slowly turn your head to the right, then to the left. Hold each position for 8 seconds.
- Lateral (Side) Neck Flexion - Keep your shoulders level. Tilt your head to one side, as if touching your ear to your shoulder. Hold for 8 seconds. Return to starting position. Repeat on the other side.
These exercises should be done while lying on your back on a firm bed or the floor. You may feel a stretch in your lower back or thigh muscles while doing these exercises. Do not continue if you feel pain.
- Knee to Chest - Lie with your legs straight and slightly apart. Bend one knee and raise it to your chest. Place both hands on the back of your thigh and hold the position for 8 seconds. Slowly return your leg to the starting position. Repeat with the other leg.
- Double Knee to Chest - Bend your knees and place your feet flat on the bed or floor. Lift one leg and raise the knee to your chest. Lift the other leg and raise the knee to your chest, so that both knees are at your chest. Place your hands on the backs of your thighs and hold your legs in this position for 8 seconds. Slowly lower both legs, one at a time, to the starting position.
- Trunk Rotation - Bend your knees and place both feet flat on the bed or floor. Roll your knees to one side, keeping your shoulders flat on the bed or floor. Hold for 8 seconds. Return your legs to the starting position and repeat to the other side. Hold for 8 seconds.
- Posterior Pelvic Tilt - Bend your knees and place both feet flat on the bed or floor. Tighten your stomach and tilt your hips forward until your lower back is flat on the bed or floor. Hold for 8 seconds. Return to the starting position.
Perform these exercises while standing. You may hold onto a table or chair for support.
Remember: Do not hold your breath.
- To begin: Stand and repeat the elbow flexion, elbow extension, shoulder abduction, and hip flexion (marching) exercises under “Sitting Exercises”.
- Standing Trunk Rotation - Stand with your hands on your hips and feet slightly apart. Turn your hips to one side and look over your shoulder. Hold for 8 seconds. Turn to the other side and hold for 8 seconds.
- Hip Abduction - Raise your leg out to the side, keeping toes pointed ahead. Return to starting position. Repeat with the other leg.
- Hip Extension - Keeping your legs and back straight, extend one leg out behind you. Return to starting position. Repeat with the other leg.
- Knee Flexion - Bend your knee and raise your foot toward your buttocks. Return to starting position. Repeat with the other leg.
- Knee Extension (Knee Bends) - Keeping your feet on the floor and slightly apart, bend your knees and lower your body halfway down toward the floor. Keep your back straight. Return to starting position.
Another important part of your daily exercise program is aerobic exercise. Aerobic exercise helps you increase your muscle strength and endurance by increasing the amount of oxygen to your body. Walking and riding a stationary bicycle provide good aerobic workouts.
Take your pulse before you begin and at regular intervals during your workout. You should be exercising at close to your target heart rate ([220 - your age] x 0.6 (60%) = target heart rate).
Begin your walking program by walking across the room and back. Do this for ____ minute(s). Walk at a comfortable pace, gradually increasing the length of your walking program by walking for 1 minute longer each time you walk. Progress until you can walk comfortably for ____ minutes.
Begin by riding at a comfortable pace with low pedal resistance, meaning the bicycle can be pedaled without difficulty, for ____ minute(s). Gradually increase the length of your workout by riding for 1 minute longer each time you ride. Progress until you can ride comfortably for ____ minutes.
Note: Do not ride if you are dizzy or lightheaded or have chest pain, or if your platelet count is below 20,000.
Good posture keeps your body in line and protects the muscles, bones, and ligaments in your back from stress and injury. Make good posture a habit by practicing good posture daily. Be aware of your posture at all times. For good posture, follow these guidelines:
- Keep head level.
- Tuck in chin.
- Relax shoulders.
For good posture while sitting, follow these guidelines:
- Tuck in chin.
- Pull chest and shoulders back.
- Use a rolled towel or other support behind lower back (lumbar region).
- Keep knees level or below hips.
Signs of poor posture include:
- Protruding chin and head
- Slumped shoulders
Other special instructions:
Revised November 2010