The pediatrician and medical care of the child with cancer

Exercise interventions in children with cancer: a review

The purpose of this review is to summarize literature that describes the impact of exercise on health and physical function among children during and after treatment for cancer. Relevant studies were identified by entering the following search terms into Pubmed: aerobic training; resistance training; stretching; pediatric; children; AND cancer. Reference lists in retrieved manuscripts were also reviewed to identify additional trials. We include fifteen intervention trials published between 1993 and 2011 that included children younger than age 21 years with cancer diagnoses. Nine included children with an acute lymphoblastic leukemia (ALL) diagnosis, and six children with mixed cancer diagnoses. Generally, interventions tested were either in-hospital supervised exercise training or home based programs designed to promote physical activity. Early evidence from small studies indicates that the effects of exercise include increased cardiopulmonary fitness, improved muscle strength and flexibility, reduced fatigue and improved physical function. Generalizations to the entire childhood cancer and childhood cancer survivor populations are difficult as most of the work has been done in children during treatment for and among survivors of ALL. Additional randomized studies are needed to confirm these benefits in larger populations of children with ALL, and in populations with cancer diagnoses other than ALL.

Effects of acute exercise on neutrophils in pediatric acute lymphoblastic leukemia survivors: a pilot study

PURPOSE

This nonrandomized controlled trial was designed to investigate the effects of acute exercise on neutrophil count and function in children and adolescents receiving maintenance treatment for acute lymphoblastic leukemia (ALL) compared to matched controls.

METHODS

Participants (n = 10; 4 ALL patients and 6 healthy matched controls) were males between the ages of 7 to 18 years. On visit 1, participants completed an incremental exercise test to volitional exhaustion on a treadmill to determine peak aerobic fitness (VO(2peak)). On visit 2, participants completed a 30-minute exercise session consisting of an intermittent run-walk on a treadmill at 70% to 85% of VO(2) peak with blood sampling completed at 5 time points: fasting, preexercise, postexercise, 1-hour postexercise, and 2-hour postexercise.

RESULTS

A significant increase in absolute neutrophil count from preexercise to postexercise was observed in both groups (P = 0.011). Neutrophil oxidative capacity was significantly depressed in the ALL group at the basal level (P = 0.029), however, it increased in both groups after exercise and stimulation.

CONCLUSIONS

This preliminary study suggests that 30 minutes of moderate intensity exercise in ALL patients receiving maintenance therapy provides a similar neutrophil response to that of healthy age and sex-matched controls.