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Exercise duration during a brief pre-transplant step test independently predicts overall survival, ICU admission, and invasive mechanical ventilation after hematopoietic cell transplantation.

In a single-center retrospective cohort of 3,458 adult HCT recipients, each additional minute of exercise during a 3-minute step test was associated with lower mortality (HR 0.90, 95% CI 0.82-0.99), lower odds of ICU admission (OR 0.80, 95% CI 0.69-0.92), and lower odds of invasive mechanical ventilation (OR 0.70, 95% CI 0.55-0.89) after full adjustment. Oxygen desaturation did not predict any outcome after hemoglobin adjustment.

Last updated: Jul 27, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Exercise Duration During a Brief Step Test Independently Predicts Outcomes After Hematopoietic Cell Transplantation.

observational

Zhang Z, Torghabeh MH, Hogan WJ, Alkhateeb H, Krowka MJ, Pennington KM, Niven AS, Yadav H · Transplantation and cellular therapy (2026)

Participants: 3458
Duration: Median follow-up 4.5 years
Intervention: 3-minute step exercise test performed before hematopoietic cell transplantation
Outcome: Overall survival, ICU admission within 120 days, invasive mechanical ventilation within 120 days
Effect Size: HR 0.90 per minute for mortality; OR 0.80 per minute for ICU admission; OR 0.70 per minute for mechanical ventilation
Population: 3,458 adult hematopoietic cell transplant recipients (2,648 autologous, 810 allogeneic) at a single center between 2005 and 2024

Result: In a single-center retrospective cohort of 3,458 adult HCT recipients, each additional minute of exercise during a 3-minute step test was associated with lower mortality (HR 0.90, 95% CI 0.82-0.99), lower odds of ICU admission (OR 0.80, 95% CI 0.69-0.92), and lower odds of invasive mechanical ventilation (OR 0.70, 95% CI 0.55-0.89) after full adjustment. Oxygen desaturation did not predict any outcome after hemoglobin adjustment.

PubMed: 42492814DOI: 10.1016/j.jtct.2026.07.022

Mechanism Graph

Step test measures functional capacity and exercise tolerance
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Lower exercise duration reflects poorer pre-transplant fitness
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Poor fitness is associated with increased post-transplant complications and mortality
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Result: Exercise duration independently predicts outcomes beyond standard pulmonary function tests and hemoglobin

Limitations

  • ⚠Single-center retrospective design limits generalizability
  • ⚠Potential unmeasured confounders (e.g., frailty, comorbidities) not fully accounted for

Frequently Asked Questions

What is the 3-minute step test used in this study?▼

It is a brief exercise test where patients step up and down for up to 3 minutes while pulse oximetry and heart rate are recorded; exercise duration and oxygen desaturation are measured.

Does oxygen desaturation during the step test predict outcomes?▼

No, after adjusting for hemoglobin, oxygen desaturation did not predict overall survival, ICU admission, or mechanical ventilation. The unadjusted association was confounded by hemoglobin levels.

How much does each additional minute of exercise improve survival?▼

Each additional minute of exercise was associated with a 10% reduction in mortality risk (HR 0.90) and a 20% reduction in odds of ICU admission.

Was this study conducted in autologous or allogeneic transplant patients?▼

Both; the cohort included 2,648 autologous and 810 allogeneic HCT recipients, and the analysis adjusted for transplant type.

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References

  1. 1.Zhang Z, Torghabeh MH, Hogan WJ, Alkhateeb H, Krowka MJ, Pennington KM, Niven AS, Yadav H. "Exercise Duration During a Brief Step Test Independently Predicts Outcomes After Hematopoietic Cell Transplantation.." Transplantation and cellular therapy, 2026. PMID: 42492814 DOI: 10.1016/j.jtct.2026.07.022
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.