Author(s): GARRIDO, E., HIGES-NÚÑEZ, E., HIGES-NÚÑEZ, F., MORENO-ACHA, S., VICO-PLAZA, J., YAGÜE-PEÑUELAS, R., SANTANA-SOSA, E., BLANCO-ELVIRA, J., PUENTE-GÓMEZ, B., GONZÁLEZ-SAIZ, L., SIERRA-RAMOS, A., IGLESIAS-PRADO, M., MARMOL-PEREZ, A., YANGUAS-CASÁS, N., LUCIA, A., FIUZA-LUCES, C., Institution: INSTITUTO DE INVESTIGACIÓN I+12, Country: SPAIN, Abstract-ID: 2111

INTRODUCTION:
Pediatric HSCT is associated with prolonged hospitalization, isolation, and physical deconditioning. Although supervised exercise has shown benefits in pediatric oncology, its implementation in real-world HSCT settings remains limited. This study evaluated the implementation of a supervised exercise and health counseling program in pediatric HSCT units using the RE-AIM framework.
METHODS:
A hybrid type 1 design combining a randomized controlled trial and an implementation study was conducted in three pediatric HSCT units. 58 children and adolescents with cancer undergoing HSCT participated in a structured supervised exercise and health counseling program delivered during hospitalization and up to 8-9 weeks post-discharge. Outcomes were assessed using the RE-AIM framework. Reach was summarized using evaluation feasibility and attrition rates. Adoption was assessed by examining whether functional assessments were administered by healthcare staff or research staff. Implementation and Maintenance were explored through semi-structured interviews with patients and families using reflexive thematic analysis.
RESULTS:
76 patients were assessed for eligibility, of whom 58 children and adolescents (76%; aged 4-17 years; 57% male; 78% leukemia) were enrolled and randomized. 18 patients were not included due to medical or logistical reasons. Statistically significant differences were observed in evaluation feasibility across assessments (chi-square = 288.7; p < 0.001). Simple functional tests showed high completion rates (80%), whereas instrument-based or logistically complex assessments showed lower completion rates (55%). Attrition rate was 23.4%, with no dropouts related to safety concerns or low program acceptability. All eligible HSCT units participated (n=3), with 85 healthcare professionals involved, of whom 21 decided to participate Overall completion of functional assessments was high. Although nursing staff contributed to test administration, research staff were required to ensure completion of all evaluations. 16 interviews were conducted, with 12 included in the qualitative analysis. Participants described the program as safe, adaptable, and as a source of emotional well-being and normality, while fatigue, pain, emotional burden, and clinical variability were identified as main barriers. Patients and families emphasized the need for integration into routine HSCT care and continuation after discharge.
CONCLUSION:
The supervised exercise program was feasible and well adopted in pediatric HSCT units, supporting its integration into routine HSCT care and highlighting the need for qualified exercise professionals.