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Prehabilitation (prehab) and stem cell transplant

Debbie, Clinical Nurse Specialist, in hospital with a patient

Prehabilitation (prehab) is an important part of preparing for your stem cell transplant or CAR T-cell therapy. Your hospital might work with you through their own prehab programme, or you might have to be a bit more independent with your prehab — with support from your medical team and Anthony Nolan.

This webpage covers:

What is prehab?

Prehab is about getting your mind and body ready and as fit as possible for your stem cell transplant or CAR T-cell therapy.

Prehab focuses on four main areas:

Important: Prehab may not be possible for some people. You may feel too unwell, or there might not be time before your treatment to engage properly in prehab. This is OK. Your medical team will only put you through a stem cell transplant or CAR T-cell therapy if you are well enough, and they will support you to find ways to still experience the benefits listed on this page.

Diet

Eating well with good nutrition will help to put your body in the best condition possible before your transplant or CAR T-cell therapy. It will help you feel strong, keep your body healthy, and can help with your sleep and mental health too.

It’s also important to learn more about your diet during recovery. Read more on our Diet after a stem cell transplant webpage.

Exercise

Physical activity before your transplant or CAR T-cell therapy will also help to prepare your body. It can help it cope with the stress it will be under during your treatment and recovery. It will also, like good nutrition, help with your sleep and mental health, especially if you’re feeling anxious. Keeping active during recovery is important too.

Read our Exercise and keeping active webpage to find out more.

Mental health

Having a stem cell transplant or CAR T-cell therapy can be tough. You'll probably be feeling lots of different emotions beforehand, from relief and hope, to worry and confusion. All these feelings are valid. It’s important to process them in a healthy way and prepare yourself for any tricky times ahead, like feeling very poorly or coping with being in isolation. Being mentally prepared is just as important as being physically prepared.

Read more about looking after your mental health on our Your mental health after a stem cell transplant webpage.

Lifestyle

Prehab can also involve consideration of your lifestyle choices, like smoking or drinking alcohol. It’s important to think about how they might affect your recovery.

Important:

Smoking and alcohol may affect medication you are on. Make sure to check this with your medical team.

You can find out what a prehab programme can look like in the What is included in a prehab programme? section below.

Approach prehab with an open mind and listen to the advice they give you as it will be for your own good. It is a long, hard journey but you will come out the other side feeling so much better. Try and stay positive as I found being positive helped my recovery. Also, trust your team, as although this is all new and very worrying for you, your team are the experts in this field and they want the best for you.

Maria, who had a stem cell transplant at University Hospital of Wales to treat acute myeloid leukaemia (AML)

What is the difference between prehab and general preparation for transplant?

Prehab is a more structured programme to prepare you for transplant or CAR T-cell therapy. It can involve more appointments, medical tests, and questionnaires.

Prehab is likely to give you more benefits after treatment than general preparation — although of course, this is also beneficial.

I so wish I had been fortunate enough to be involved in a prehab project as my muscle wastage was acute and took two years to build back up. I was so fatigued, any level of activity was a struggle and I believe passionately that prehab could have helped with some of this. My mental health post-transplant, along with my whole family’s, was compromised and with the right level of investment in prehab, this could have been a very different journey.

Joanna, who had a stem cell transplant at University Hospital Southampton to treat acute myeloid leukaemia (AML)
Joanna, who had a stem cell transplant to treat acute myeloid leukaemia (AML), and her family

Why is prehab important before stem cell transplant or CAR T-cell therapy?

There are lots of possible benefits if you take part in prehab before your transplant or CAR T-cell therapy:

  • You can be as healthy and fit as possible before your treatment.
  • You may recover quicker after treatment.
  • You can feel mentally stronger to cope with your treatment.
  • You are less likely to have some complications and side effects.
  • You can cope better with any side effects you do experience.
  • You might have a shorter stay in hospital.
  • You can feel more empowered and in control of yourself and your stem cell transplant or CAR T-cell therapy journey — one of the most important benefits of all.

This is a long, positive list of benefits, but they can only happen if you take part in prehab in a meaningful way. This might feel overwhelming and intimidating, especially if you’re feeling very unwell. But we, along with your medical team, are here to help make it as accessible as possible for you.

This is the time you can make the difference before surrendering to the medicine... Because I didn't have much time to prepare, the few days I had were filled with tests, scans and pre-treatment pathway. It would have been good to talk to a counsellor during this time as it’s all a bit surreal!

Mel, who had a stem cell transplant at St George's Hospital, London to treat chronic myelomonocytic leukaemia (CMML)

What is included in a prehab programme?

All prehab programmes will look a bit different at every hospital. In general, they will cover:

  • screening, where you will complete some questionnaires and have some basic tests to understand your overall health
  • assessment, where your medical team will assess your needs and may ask you to complete more tests, like fitness tests
  • intervention, where your medical team will work with you through a prehab programme based on your needs
  • monitoring, where your medical team will monitor your progress and measure any impact.

Here is a general step-by-step guide for what you can expect:

  • You will have an appointment with your medical team about your prehab programme.
  • You might be shown a presentation or some videos all about prehab.
  • You might complete a questionnaire about your current fitness levels, diet, lifestyle and mental health.
  • You might have some medical tests to find out what your current fitness levels are.
  • You might have appointments with:
    • a physiotherapist to work on your fitness.
    • a dietitian to give you the best nutrition plan.
    • a pharmacist to talk through your medications.
    • a clinical psychologist to talk about your general wellbeing and mental health.
    • an occupational therapist to talk about practical support you might need during recovery, like home adaptations.
  • You might have conversations about your priorities and what’s important to you. This is called Advance Care Planning and can help with future decision-making around your care.
  • You will likely continue to have appointments with your medical team to monitor your progress.

I saw a physiotherapist to gauge my fitness and had to do several timed tasks. They used these scores to compare after the transplant. I had several scans — echocardiogram, chest X-ray, lung function test, and they checked my kidney function by measuring my urine over set time. I spoke to a psychologist for my mental health and the impact a stem cell transplant could have. I also saw a dietician and pharmacist. Overall, my body had a thorough MOT.

Maria, who had a stem cell transplant at University Hospital of Wales to treat acute myeloid leukaemia (AML)

Will my hospital provide prehab?

Your hospital might provide a prehab programme. But not all hospitals do. It will depend on the resources they have.

Check with your medical team to see if they provide a prehab programme. If they don’t:

  • ask your medical team if they can suggest any resources so you can still take part in some prehab before your transplant or CAR T-cell therapy
  • do some research to learn more about prehab and how you could take part — you can find resources from other charities and NHS trusts at the bottom of this webpage
  • speak to other patients on our Patients and Families forum to see if they took part in prehab, and ask what they did.

You can feel like everything is out of your control, so take some control where you can. Ask questions, keep as mobile as you can, and drink lots of water — before, during and after transplant. Every little helps!

Jennifer, who had a stem cell transplant at St Bartholomew’s Hospital (Barts), London to treat Philadelphia positive acute lymphoblastic leukaemia (ALL)
Jennifer, a patient, and her husband in Dubrovnik
Jennifer, who had a stem cell transplant to treat Philadelphia positive acute lymphoblastic leukaemia (ALL), and her husband

Prehab support and resources

Information published: 12/02/2024
Next review due: 12/02/2027

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