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Koenig C, Ammann RA, Schneider C, Wyss J, Roessler J, Brack E. Continuous timely monitoring of core temperature with two wearable devices in pediatric patients undergoing chemotherapy for cancer - a comparison study. Support Care Cancer 2024; 32:188. [PMID: 38400942 PMCID: PMC10894150 DOI: 10.1007/s00520-024-08366-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Pediatric patients with cancer often develop chemotherapy-induced fever in neutropenia (FN), requiring emergency broad-spectrum antibiotics. Continuous temperature monitoring can lead to earlier FN detection and therapy with improved outcomes. We aimed to compare the feasibility of continuous core temperature monitoring with timely data availability between two wearable devices (WDs) in pediatric oncology patients undergoing chemotherapy. METHODS In this prospective observational two-center study, 20 patients (median age: 8 years) undergoing chemotherapy simultaneously wore two WDs (CORE®, Everion®) for 14 days. The predefined goal was core temperature recorded in sufficient quality and available within ≤ 30 min during ≥ 18/24 h for ≥ 7/14 days in more than 15 patients. RESULTS More patients reached the goal with CORE® (n = 13) versus Everion® (n = 3) (difference, 50% p < 0.001). After correcting for the transmission bottleneck caused by two WDs transmitting via one gateway, these numbers increased (n = 15 versus n = 14; difference, 5%; p = 0.69). CORE® measurements corresponded better to ear temperatures (n = 528; mean bias, - 0.07 °C; mean absolute difference, 0.35 °C) than Everion® measurements (n = 532; - 1.06 °C; 1.10 °C). Acceptance rates for the WDs were 95% for CORE® and 89% for Everion®. CONCLUSION The CORE® fulfilled the predefined feasibility criterion (15 of 20 patients) after correction for transmission bottleneck, and the Everion® nearly fulfilled it. Continuous core temperature recording of good quality and with timely data availability was feasible from preschool to adolescent patients undergoing chemotherapy for cancer. These results encourage the design of randomized controlled trials on continuously monitored core temperature in pediatric patients. TRIAL REGISTRATION CLINICALTRIALS gov (NCT04914702) on June 7, 2021.
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Affiliation(s)
- Christa Koenig
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland.
| | - Roland A Ammann
- , StatConsult Ammann, Burgdorf, Switzerland
- Faculty of Medicine, University of Bern, CH-3010, Bern, Switzerland
| | - Christine Schneider
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Johanna Wyss
- Department of Pediatric Oncology and Hematology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Jochen Roessler
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Eva Brack
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
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Elnaggar RK, Osailan AM, Elbanna MF, Abd-Elmonem AM. Effectiveness of a dose-graded aerobic exercise regimen on cardiopulmonary fitness and physical performance in pediatric survivors of acute lymphoblastic leukemia: a randomized clinical trial. J Cancer Surviv 2024:10.1007/s11764-024-01534-1. [PMID: 38267738 DOI: 10.1007/s11764-024-01534-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE To determine whether a 12-week supervised dose-graded aerobic exercise (D-GAE) training, when implemented in conjunction with traditional rehabilitation, could help pediatric survivors of acute lymphoblastic leukemia (ALL) enhance their cardiopulmonary capacity and improve their physical performance. METHODS Fifty-eight pediatric survivors of ALL (age 13.78 ± 2.47 years; boys 60.34%) were assigned at random to either undergo the D-GAE in addition to the traditional physical rehabilitation (D-GAE group; n = 29) or the traditional physical rehabilitation solely (control group; n = 29). The cardiopulmonary fitness (peak oxygen uptake (VO2peak), ventilatory equivalent (VEq/VO2), minute ventilation (VE, L/min), oxygen pulse (O2P), maximum heart rate (HRmax), 1-min heart rate recovery (HRR1), and respiratory exchange ratio (RER)) and physical performance (6-min walk test (6-MWT), timed up and down stairs (TUDS), and 4 × 10-m shuttle run test (4 × 10mSRT)) were assessed on the pre- and post-intervention occasions. RESULTS The mixed-model ANOVA revealed a meaningful increase of VO2peak (P = .002), VE (P = .026), O2P (P = .0009), HRmax (P = .004), and HRR1 (P = .011), and reduction of VEq/VO2 (P = .003) and RER (P = .003) in the D-GAE group compared with the control group. Besides, the analysis detected a favorable increase in the physical performance for the D-GAE group (6-MWT (P = .007), TUDS (P < .001), 4 × 10mSRT (P = .009)). CONCLUSION A 12-week D-GAE program in conjunction with traditional rehabilitation holds promise in enhancing cardiopulmonary fitness and improving the physical performance of pediatric survivors of ALL. Clinicians and physical rehabilitation professionals can, therefore, integrate the D-GAE into the traditional rehabilitation protocols for such a patient population to optimize their cardiopulmonary fitness and physical function, while also facilitating a gradual transition to practice and adaption. IMPLICATIONS FOR CANCER SURVIVORS The favorable outcomes of this study bolster the inclusion of D-GAE as a crucial element in the care and rehabilitation of pediatric survivors of ALL. By embracing these findings, healthcare professionals and oncologists can contribute to mitigating the long-term cardiopulmonary and physical complications associated with cancer treatments and fostering a state of enhanced well-being and increased physical activity among survivors.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
| | - Ahmad M Osailan
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohammed F Elbanna
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amira M Abd-Elmonem
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Shabanian J, Capaldi JM, Luna-Lupercio B, Finster LJ, Noskoff K, Gan H, Davies S, Whiteway SL, Shirazipour CH. Healthcare providers' promotion of physical activity among child and adolescent cancer survivors: strategies and challenges. J Cancer Surviv 2023; 17:1546-1560. [PMID: 35759086 PMCID: PMC9244136 DOI: 10.1007/s11764-022-01218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/19/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE This study aims to investigate how healthcare providers (HCPs) promote physical activity (PA) to child and adolescent cancer survivors. METHODS Semi-structured interviews were conducted with HCPs (n = 16; women n = 12; men n = 4) who provide care for cancer survivor youth (age 3 to 18). Participants represented 7 professions, including child life specialists, oncologists, nurse practitioners, physical therapists, and social workers. A reflexive thematic analysis was conducted to explore the techniques that HCPs use to promote PA for this patient population and ways PA promotion can improve. RESULTS HCPs use five strategies to promote PA to cancer survivor youth: (1) broadening the definition of PA, (2) tailoring PA recommendations, (3) including families, (4) connecting patients to programming, and (5) promoting patient motivation. CONCLUSIONS This research highlights techniques that HCPs use to promote PA to young cancer survivors and reveals the need for additional ways to support HCPs to improve PA promotion for child and adolescent cancer survivors. While HCPs emphasized the importance of PA for this patient population, they navigate barriers that limit the quality of PA discussions. IMPLICATIONS FOR CANCER SURVIVORS Further research should explore interventions to improve PA promotion and PA participation among child and adolescent cancer survivors. By understanding the perspectives of HCPs, patients, and their families, PA promotion strategies can be improved, and more programs that support both patients and practitioners may be developed.
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Affiliation(s)
- Julia Shabanian
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | - Jessica M Capaldi
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | - Bianca Luna-Lupercio
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | - Laurel J Finster
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | | | - Hilary Gan
- Teen Cancer America, Los Angeles, CA, USA
| | | | - Susan L Whiteway
- Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University Health Sciences, Bethesda, MD, USA
| | - Celina H Shirazipour
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA.
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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Haemmerli M, Ammann RA, Roessler J, Koenig C, Brack E. Vital signs in pediatric oncology patients assessed by continuous recording with a wearable device, NCT04134429. Sci Data 2022; 9:89. [PMID: 35301334 PMCID: PMC8931088 DOI: 10.1038/s41597-022-01182-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/19/2022] [Indexed: 12/13/2022] Open
Abstract
Pediatric patients with cancer are at high risk for severe infections. Changes in vital signs, triggered by infections, may be detected earlier by continuous recording with a wearable device than with discrete measurements. This prospective, observational single-center feasibility study consecutively recruited pediatric patients undergoing chemotherapy for cancer. The WD Everion® was used for 14 days in each of the 20 patients on study to continuously record vital signs. Nine different vital signs and health indicators derived from them, plus six quality scores. This resulted in 274 study days (6576 hours) with 85’854 measuring points, which are a total of 772’686 measurements of vital signs and health indicators, plus 515’124 quality scores. Additionally, non-WD data like side effects, acceptability of the WD and effort for investigators were collected. In this manuscript, we present the methods of acquisition and explanations to the complete data set, which have been made publically available on open access and which can be used to study feasibility of continuous multi-parameter recording of vital signs by a WD. Measurement(s) | Vital signs continiously | Technology Type(s) | Wearable Device | Factor Type(s) | Core temperature • Galvanic skin response • Health score • Heart rate • Heart rate variability • Oxygen saturation • Skin temperature • Skin blood perfusion | Sample Characteristic - Organism | Homo sapiens |
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Affiliation(s)
- Marion Haemmerli
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland A Ammann
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Kinderaerzte KurWerk, Burgdorf, Switzerland
| | - Jochen Roessler
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christa Koenig
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Brack
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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24-Hour Movement Behaviors in Children with Chronic Disease and Their Healthy Peers: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052912. [PMID: 35270604 PMCID: PMC8910254 DOI: 10.3390/ijerph19052912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 12/04/2022]
Abstract
Background: Time spent in 24-h movement behaviors is important to health and wellbeing in childhood, but levels of these behaviors in children with chronic disease are unknown. Methods: A case-control-study included 80 children with chronic disease; 20 with type 1 diabetes mellitus (T1DM), 20 with juvenile idiopathic arthritis (JIA), 20 with congenital heart disease (CHD), 20 with cystic fibrosis (CF); pair-matched individually for age, sex, and timing of measures with 80 healthy children. Habitual time spent in movement behaviors and step counts were all measured with an activPAL accelerometer over 7 days. Comparisons against recommendations and differences between the groups were made. Results: Time spent in physical activity and step counts/day were significantly lower in T1DM and CHD groups compared to controls. Only 20/80 children with chronic disease and 29/80 controls met step count recommendations. Sedentary time was significantly higher in children with CF compared to controls. Time spent asleep was slightly greater in children with chronic disease, significant only for the JIA group. Sleep disruption was consistently greater in those with chronic disease, reaching significance for T1DM, CHD, and CF groups. Conclusions: For some groups of children with chronic disease, 24-h movement behaviors may differ substantially from recommendations, and slightly but systematically from their healthy peers. Optimizing levels of 24-h movement behaviors should confer a number of benefits for child health, development, and wellbeing.
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Morales JS, Valenzuela PL, Velázquez-Díaz D, Castillo-García A, Jiménez-Pavón D, Lucia A, Fiuza-Luces C. Exercise and Childhood Cancer-A Historical Review. Cancers (Basel) 2021; 14:cancers14010082. [PMID: 35008246 PMCID: PMC8750946 DOI: 10.3390/cancers14010082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/18/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Childhood cancer survivors are at risk of developing important adverse effects, but there is growing evidence that physical exercise could help in this regard. The present review summarizes the history of pediatric exercise oncology and the main milestones achieved along the way. Overall, physical exercise appears to be safe and beneficial even during the most aggressive phases of pediatric cancer treatment and can represent an effective coadjuvant therapy for attenuating cancer-related adverse effects. Abstract Childhood cancer survivors are at risk of developing important adverse effects, many of which persist for years after the end of treatment. The implementation of interventions aiming at attenuating tumor/treatment-associated adverse effects is therefore a major issue in pediatric oncology, and there is growing evidence that physical exercise could help in this regard. The present review aims to summarize the main milestones achieved in pediatric exercise oncology. For this purpose, we conducted a systematic review of relevant studies written in English in the electronic database PubMed (from inception to 14 August 2021). This review traces the field of pediatric exercise oncology throughout recent history based on three fundamental pillars: (i) exercise during childhood cancer treatment; (ii) exercise during/after hematopoietic stem cell transplantation; and (iii) exercise after childhood cancer treatment. Accumulating evidence––although still preliminary in many cases––supports the safety and potential benefits of regular exercise (with no major contraindications in general) in the childhood cancer continuum, even during the most aggressive phases of treatment. Exercise can indeed represent an effective coadjuvant therapy for attenuating cancer-related adverse effects.
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Affiliation(s)
- Javier S. Morales
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cádiz, 11519 Cadiz, Spain; (J.S.M.); (D.V.-D.); (D.J.-P.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cadiz, Spain
| | - Pedro L. Valenzuela
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (P.L.V.); (A.L.)
- Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), 28041 Madrid, Spain
| | - Daniel Velázquez-Díaz
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cádiz, 11519 Cadiz, Spain; (J.S.M.); (D.V.-D.); (D.J.-P.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cadiz, Spain
| | | | - David Jiménez-Pavón
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cádiz, 11519 Cadiz, Spain; (J.S.M.); (D.V.-D.); (D.J.-P.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cadiz, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (P.L.V.); (A.L.)
- Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), 28041 Madrid, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Carmen Fiuza-Luces
- Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), 28041 Madrid, Spain
- Correspondence: ; Tel.: +34-91-779-2713
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7
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Aktolan T, Acar-Tek N. Prevalence of Obesity/Abdominal Obesity and Related Factors in Pediatric ALL Survivors. J Am Coll Nutr 2021; 41:50-56. [PMID: 34264161 DOI: 10.1080/07315724.2020.1846635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Obesity has been increasingly recognized in pediatric acute lymphoblastic leukemia (ALL) survivors. The aim of the current study was to determine the prevelance and related factors of obesity/abdominal obesity and evaluate the association between nutrition and overweight/obesity after cancer treatment in pediatric ALL survivors. METHOD An observational retrospective cohort study was performed among 67 volunteers (aged 5-15). Participants completed 3 consecutive days (2 weekdays and 1 weekend day) recording food consumption and physical activity simultaneously. Weight, height, and waist circumference measurements were performed in remission period, and retrospective data were obtained from patient records. We examined data at three periods: diagnosis, end of treatment, and remission. Subjects were classified into four groups according to body mass index for age z score (BAZ): underweight, normal weight, overweight, and obese. Abdominal obesity was defined waist-to-height ratio ≥ 0.5. RESULTS Prevalence of overweight, obesity, and abdominal obesity were 25.3%, 23.9%, 38.8%, respectively in remission. BAZ at diagnosis and at treatment completion, dietary energy intake, and physical activity were associated with an increased risk of being overweight/obese in remission (p < .05). Gender, age at diagnosis, cranial radiotherapy, and treatment risk category were not significant (p > .05). CONCLUSIONS As in obesity, abdominal obesity was found an important problem in pediatric ALL survivors. Therefore, nutritional targets are needed to prevent obesity. Survivors should be closely monitored in terms of nutritional status during and after treatment and informed about and supported for healthy lifestyle (balanced and adequate nutrition, increase in physical activity).
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Affiliation(s)
- Teslime Aktolan
- Nutrition and Diet Policlinic, Akyurt Devlet Hastanesi, Akyurt, Ankara, Turkey
| | - Nilüfer Acar-Tek
- Faculty of Health Science, Department of Nutrition and Dietetic, Gazi University, Emek, Ankara, Turkey
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8
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Koenig C, Ammann RA, Kuehni CE, Roessler J, Brack E. Continuous recording of vital signs with a wearable device in pediatric patients undergoing chemotherapy for cancer-an operational feasibility study. Support Care Cancer 2021; 29:5283-5292. [PMID: 33655413 PMCID: PMC7925259 DOI: 10.1007/s00520-021-06099-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Pediatric patients with cancer are at high risk for severe infections. Infections can trigger changes of vital signs long before clinical symptoms arise. Continuous recording may detect such changes earlier than discrete measurements. We aimed to assess the feasibility of continuous recording of vital signs by a wearable device (WD) in pediatric patients undergoing chemotherapy for cancer. METHODS In this prospective, observational single-center study, pediatric patients under chemotherapy wore the Everion® WD for 14 days. The predefined patient-specific goal was heart rate recorded in good quality during ≥18/24 h per day, on ≥7 consecutive days. The predefined criterion to claim feasibility was ≥15/20 patients fulfilling this patient-specific goal. RESULTS Twenty patients were included (median age, 6 years; range, 2-16). Six patients aged 3-16 years fulfilled the patient-specific goal. Quality of heart rate recording was good during 3992 of 6576 (61%) hours studied and poor during 300 (5%) hours, and no data was recorded during 2284 (35%) hours. Eighteen of 20 participants indicated that this WD is acceptable to measure vital signs in children under chemotherapy. CONCLUSION The predefined feasibility criterion was not fulfilled. This was mainly due to important compliance problems and independent of the WD itself. However, continuous recording of vital signs was possible across a very wide age range in pediatric patients undergoing chemotherapy for cancer. We recommend to study feasibility in the Everion® again, plus in further WDs, applying measures to enhance compliance. TRIAL REGISTRATION ClinicalTrials.gov (NCT04134429) on October 22, 2019.
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Affiliation(s)
- Christa Koenig
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Roland A Ammann
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Kinderaerzte KurWerk, Burgdorf, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jochen Roessler
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Brack
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Elnaggar RK. Within 5-year off-chemotherapy: How the cardio-respiratory response to exercise is related to energy expenditure, fatigue, and adiposity in children with acute lymphoblastic leukaemia? Eur J Cancer Care (Engl) 2021; 30:e13418. [PMID: 33523541 DOI: 10.1111/ecc.13418] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 11/30/2020] [Accepted: 01/15/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To explore the cardio-respiratory response to exercise and examine the relationships among specific measures of cardio-respiratory function, energy expenditure (EE), fatigue and adiposity in children survivors of acute lymphoblastic leukaemia (ALL). METHODS Seventy survivors of ALL (13.31 ± 2.60 years) and 34 controls from the siblings (12.71 ± 2.36 years) participated and were assessed for submaximal and maximal exercise capacity, body composition, EE and fatigue. RESULTS ALL survivors had significantly lower submaximal (VO2 ; p = 0.002) and maximal (VO2peak ; p ˂ 0.001) cardio-respiratory capacity than their controls. At the submaximal exercise test, EE was significantly lower in ALL survivors (p < 0.001), but the heart rate (HR) was significantly higher (p = 0.005). The VO2 and HR were significantly correlated [r (95%CI) = 0.689 (0.542 to 0.795), p < 0.001]. The VO2peak negatively associated with adiposity [r (95%CI) = -0.368 (-0.554 to -0.145), p = 0.002]. Fatigue significantly correlated with the VO2peak [r (95%CI) = 0.581 (0.401 to 0.718), p < 0.001] and adiposity [r (95%CI) = -0.303 (-0.502 to 0.073), p = 0.012]. CONCLUSION Children survivors of ALL experience low cardio-respiratory fitness within 5-year off-chemotherapy. Associations exist between measures of cardio-respiratory fitness, EE, fatigue and adiposity. However, it has not yet been proven whether these are cause or effect.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Santos SDS, Moussalle LD, Heinzmann-Filho JP. EFFECTS OF PHYSICAL EXERCISE DURING HOSPITALIZATION IN CHILDREN AND ADOLESCENTS WITH CANCER: A SYSTEMATIC REVIEW. ACTA ACUST UNITED AC 2020; 39:e2019313. [PMID: 33027320 PMCID: PMC7537404 DOI: 10.1590/1984-0462/2021/39/2019313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/19/2020] [Indexed: 04/08/2023]
Abstract
Objective: To identify the effects of exercise programs during hospitalization on
children and adolescents with cancer. Data source: This is a systematic review, carried out in PubMed/ Medical Literature
Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean
Health Sciences Literature (LILACS), Scientific Electronic Library Online
(SciELO), Latin American and Caribbean Center on Health Sciences Information
(BIREME), and Physiotherapy Evidence Database (PEDro). We selected studies
that included children and adolescents diagnosed with cancer (solid or
hematologic) and submitted to exercise protocols during hospitalization.
Studies involving patients with other pathologies or with a medical
contraindication for exercise were excluded. We used the following search
strategy: Neoplasm OR Leukemia OR Cancer OR Tumor OR Medical Oncology AND
Hospitalization OR Inpatient Care Units OR Intrahospital AND Exercise. The
methodological quality of the studies was analyzed by the PEDro scale. Data synthesis: Among the 626 articles found, only 9 fulfilled the inclusion criteria,
obtaining a regular methodological quality. The samples had 172
participants, aged 4 to 18 years. Only 6 studies presented both intervention
group and control group. The intervention group received strength, aerobic,
and muscle stretching exercises, and games, among others. The control group
received the standard treatment. The studies varied regarding time,
frequency, intensity, and type of exercise. Most studies showed an increase
in muscle strength (4/5), followed by an improvement in physical fitness
(2/3) and functional capacity (2/4). No adverse events were reported during
the interventions. The methodological quality was considered regular. Conclusions: The findings suggest that. during hospitalization of children and
adolescents with cancer, exercise improves muscle strength, physical
fitness, and functionality.
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Grimshaw SL, Taylor NF, Mechinaud F, Conyers R, Shields N. Physical activity for children undergoing acute cancer treatment: A qualitative study of parental perspectives. Pediatr Blood Cancer 2020; 67:e28264. [PMID: 32277806 DOI: 10.1002/pbc.28264] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little is known about how to facilitate participation in physical activity among children receiving acute cancer treatment. OBJECTIVE To understand the parental perspectives on physical activity for children during acute cancer treatment and explore strategies to overcome physical inactivity. METHODS A qualitative study was completed. Data were collected via semistructured interviews with parents of children (aged 4-18 years) who were in their first nine months of cancer treatment. Data were analyzed thematically. RESULTS Twenty parents were interviewed. A childhood cancer diagnosis and subsequent treatment were described as setting in motion a spiral of physical inactivity. Parents identified movement restrictions as a result of commencing treatment and the hospital environment as factors initiating this decline. Parents described the subsequent impact of movement restrictions on their child over time including loss of independence, isolation, and low motivation. These three consequences further contributed to an inability and unwillingness to be physically active. Parents responded in a variety of ways to their child's inactivity, and many were motivated to overcome the barriers to physical activity yet exhibited a reduced capacity to do so. Suggested intervention strategies highlighted the need for comprehensive support from the organization providing treatment. CONCLUSIONS Reasons for reduced physical activity in children receiving acute treatment for cancer are complex and multifactorial. Inactivity cannot be addressed by children and parents alone but requires support from the oncology team through changes to the environment, services, and policies to promote physical activity. These findings may be used to inform targeted, effective, and feasible physical activity interventions.
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Affiliation(s)
- Sarah L Grimshaw
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Francoise Mechinaud
- Unité Hématologie-Immunologie, Hôpital Robert Debré, Paris, France.,APHP Nord-Université de Paris, Paris, France
| | - Rachel Conyers
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia.,The Royal Children's Hospital, Children's Cancer Centre, Parkville, Melbourne, Victoria, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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12
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13
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Alvarez-Pitti J, Casajús Mallén JA, Leis Trabazo R, Lucía A, López de Lara D, Moreno Aznar LA, Rodríguez Martínez G. [Exercise as medicine in chronic diseases during childhood and adolescence]. An Pediatr (Barc) 2020; 92:173.e1-173.e8. [PMID: 32061527 DOI: 10.1016/j.anpedi.2020.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/30/2022] Open
Abstract
Physical activity (PA) and exercise improve the overall quality of life, as well as prevent the onset of diseases in healthy children and adolescents, and as an aid to treat prevalent chronic diseases in childhood. PA and exercise are like medicine, but sedentary lifestyle and inactivity cause disease. In this article, the existing scientific evidence in this field is reviewed and recommendations for professionals involved in child health are updated. A good knowledge of how to prescribe exercise and PA in paediatrics in different diseases is necessary. Interventions to avoid inactivity of children and adolescents must be supported by the appropriate increase in the level of PA, through integration and training programs, which achieve both an overall improvement of the neuromuscular physical condition and also physical, cognitive, and psychosocial performance. The Health Promotion Committee of Spanish Paediatric Association proposes strategies that help to obtain this objective, aiming to improve the health of our patients through the practice of exercise and the increase in PA.
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Affiliation(s)
- Julio Alvarez-Pitti
- Unidad contra la Obesidad y el Riesgo Cardiovascular, Servicio de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España; Comité de Promoción de la Salud, Asociación Española de Pediatría, Madrid, España; CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España.
| | - José A Casajús Mallén
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo GENUD (Growth, Exercise, Nutrition and Development), Universidad de Zaragoza, Zaragoza, España; Departamento de Fisiatría y Enfermería, Área de Educación Física y Deportiva, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, España
| | - Rosaura Leis Trabazo
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Departamento de Pediatría, Hospital Clínico Universitario de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, España; Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, España
| | - Alejandro Lucía
- Laboratorio de Fisiología del Ejercicio, Universidad Europea de Madrid. Facultad de Ciencias de la Salud
| | | | - Luis A Moreno Aznar
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo GENUD (Growth, Exercise, Nutrition and Development), Universidad de Zaragoza, Zaragoza, España; Instituto Agroalimentario de Aragón (IA2), Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón, Zaragoza), Zaragoza, España
| | - Gerardo Rodríguez Martínez
- Comité de Promoción de la Salud, Asociación Española de Pediatría, Madrid, España; Grupo GENUD (Growth, Exercise, Nutrition and Development), Universidad de Zaragoza, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón, Zaragoza), Zaragoza, España; Red Salud Materno Infantil y del Desarrollo (SAMID, RETICS ISCIII, España), Baracaldo, Vizcaya, España
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14
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Trends in age- and sex-adjusted body mass index and the prevalence of malnutrition in children with cancer over 42 months after diagnosis: a single-center cohort study. Eur J Pediatr 2020; 179:91-98. [PMID: 31659466 PMCID: PMC6942564 DOI: 10.1007/s00431-019-03482-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 01/06/2023]
Abstract
The adequate nutritional status of pediatric cancer patients is particularly important to enable them to cope with the demands of the disease and its treatment and to maintain normal growth. Malnutrition and obesity have both been associated with reduced survival and increased drug toxicity. We investigated trends in the age- and sex-adjusted body mass index (ISO-BMI) and the prevalence of malnutrition in a Finnish cohort of 139 consecutive children receiving chemotherapy for cancer, with a follow-up period of 42 months after diagnosis. In total, 28% (39/139) of the patients experienced malnutrition (ISO-BMI < 17 or > 10% weight loss), and 12% (16/139) had a nasogastric tube or underwent gastrostomy. Patients with acute or chronic myeloid leukemia (5/10), central nervous system (CNS) tumors (5/13), or solid tumors (13/31) most frequently suffered from malnutrition. There was a significant increase in the ISO-BMI of patients with acute lymphoblastic leukemia (ALL) (+ 2.1 kg/m2) and lymphomas (+ 2.4 kg/m2) during the first 6 months, and the ISO-BMI of patients with ALL remained higher at 42 months compared to baseline (+ 1.9 kg/m2).Conclusion: The cumulative incidence of malnutrition in Finnish pediatric cancer patients is comparable to that reported in other populations. The nutritional status of patients with acute myeloid leukemia, CNS tumors, or solid tumors should be monitored with extra care to facilitate early intervention in the case of impending malnutrition.What is known:• Both malnutrition and obesity are associated with reduced survival and increased drug toxicity in pediatric cancer patients.What is new:• Overall, 28 % of Finnish children receiving chemotherapy for cancer suffer from malnutrition during the first 42 months following the initial cancer diagnosis. • ISO-BMI curves from initial diagnosis to 42 months after diagnosis are provided for patients with different types of cancer.
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15
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Shank J, Chamorro-Viña C, Guilcher GMT, Langelier DM, Schulte F, Culos-Reed SN. Evaluation Tools for Physical Activity Programs for Childhood Cancer: A Scoping Review. J Pediatr Oncol Nurs 2019; 37:163-179. [PMID: 31847707 DOI: 10.1177/1043454219891987] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Research on the benefits of physical activity (PA) in childhood cancer has been translated into a handful of community-based programs. However, to foster further translation, an understanding of how to evaluate participant outcomes would be beneficial to provide feedback to participants and stimulate future research. Such a review would provide a summary of acceptable tools for work in this area. The purpose of this scoping review was to identify the evaluation tools that have been used in PA/exercise studies or programs for childhood cancer. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies included in the review used physical and psychosocial evaluation tools within PA and exercise programs or research for childhood cancer. In addition, studies with measures of health behavior such as PA levels and activities of daily living were included. Tools that assessed physical fitness and physical performance were excluded. Information on the types of evaluation tools used, mean age of participants, and type of cancer was extracted. Psychometric properties of each evaluation tool are reported. The most commonly assessed patient outcomes were motor performance, fatigue, well-being, functional mobility, and quality of life. Less commonly reported patient outcomes were hope, self-efficacy, and self-perception. None of the evaluation tools reported in the PA/exercise and pediatric oncology literature assess physical literacy. This review was the first step in a knowledge translation process, identifying evaluation tools that have been used in PA/exercise programs in childhood cancer survivors, that will guide the development and evaluation of current and future community-based programs.
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Affiliation(s)
- Jena Shank
- University of Calgary, Calgary, Alberta, Canada
| | - Carolina Chamorro-Viña
- University of Calgary, Calgary, Alberta, Canada.,Kids Cancer Care Foundation of Alberta, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | | | - S Nicole Culos-Reed
- University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
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16
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Swartz MC, Allen K, Deer RR, Lyons EJ, Swartz MD, Clifford T. A Narrative Review on the Potential of Red Beetroot as an Adjuvant Strategy to Counter Fatigue in Children with Cancer. Nutrients 2019; 11:E3003. [PMID: 31817919 PMCID: PMC6949985 DOI: 10.3390/nu11123003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 01/04/2023] Open
Abstract
Cancer-related fatigue (CRF) is a debilitating adverse effect among children with cancer and a significant barrier to physical activity (PA) participation. PA interventions are effective at reducing fatigue and improving both quality of life (QOL) and functional outcomes in children with cancer. However, 50-70% of children with cancer do not meet PA guidelines. Thus, adjuvant methods are needed to increase PA participation. Given the growing interest in the use of beetroot juice to reduce exercise-induced fatigue, our narrative review evaluated the potential use of beetroot to improve PA participation to counter CRF and improve QOL. Our review of 249 articles showed a lack of published clinical trials of beetroot in children and adults with cancer. Trials of beetroot use had been conducted in a noncancer population (n = 198), and anticancer studies were primarily in the preclinical phase (n = 40). Although results are promising, with beetroot juice shown to counter exercise-induced fatigue in a variety of athletic and patient populations, its use to counter CRF in children with cancer is inconclusive. Pilot and feasibility studies are needed to examine the potential benefits of beetroot to counter CRF, increase PA participation, and improve QOL in children with cancer.
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Affiliation(s)
- Maria C. Swartz
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA
| | - Kaitlyn Allen
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1124, USA; (K.A.); (E.J.L.)
| | - Rachel R. Deer
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1137, USA;
| | - Elizabeth J. Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1124, USA; (K.A.); (E.J.L.)
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center, School of Public Health, 1200 Pressler St., Houston, TX 77030, USA;
| | - Tom Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK;
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle NE2 4HH, UK
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17
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Rehorst-Kleinlugtenbelt L, Bekkering W, van der Torre P, van der Net J, Takken T. Physical activity level objectively measured by accelerometery in children undergoing cancer treatment at home and in a hospital setting: A pilot study. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2019. [DOI: 10.1016/j.phoj.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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18
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Physical Activity and Quality of Life of Healthy Children and Patients with Hematological Cancers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152776. [PMID: 31382561 PMCID: PMC6696059 DOI: 10.3390/ijerph16152776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/13/2019] [Accepted: 08/01/2019] [Indexed: 01/23/2023]
Abstract
The aim was to assess the level of physical activity and the quality of life of children undergoing cancer treatment, during and after the completion of the treatment. Eighty-eight children aged 11–15 were enrolled. Three groups of children were assessed, i.e., children undergoing cancer treatment (n = 30), children after cancer treatment (n = 28), and healthy children (n = 30). The level of physical activity in children was assessed using the questions from the Health Behavior in School-Aged Children (HBSC) questionnaire. The assessment of children’s quality of life was conducted using the KIDSCREEN-10 Index. The chi-square test was used to assess the statistical significance of the differences in the results between the study groups in the case of both HBSC and KIDSCREEN-10 questionnaires. Children undergoing cancer treatment did not perform any physical activity of at least 60 min (in total) per day, during the week. Therefore, they did not meet the recommendations related to the appropriate level of daily physical activity (Moderate-to-Vigorous Physical Activity; MVPA). Children after cancer treatment and healthy children significantly more frequently undertook physical activity. The quality of life of children with cancer is significantly lower and different from the quality of life of healthy children.
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19
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Physical Fitness of School-Age Children after Cancer Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081436. [PMID: 31018493 PMCID: PMC6518261 DOI: 10.3390/ijerph16081436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 01/28/2023]
Abstract
The aim of the study was to assess physical fitness of school-age children after cancer treatment. The study was comprised of one hundred and fifty six children-children after cancer treatment (n = 71, mean age 11.22 ± 3.11 years) vs. healthy children previously untreated for cancer (n = 85, mean age 10.71 ± 1.22 years). Physical fitness was assessed indirectly based on a ball throw (assessment of strength, coordination, and upper limb speed), long jump (assessment of jumping ability, speed, and coordination), and a 60 m run (assessment of speed). The analysis was performed based on the Student's t-test for independent samples and the analysis of variance and the post-hoc least significant difference test (LSD test). Children from the study group threw the ball closer and had shorter long jump performance compared to the control group, i.e., 12.93 [m] vs. 19.79 [m], respectively (p < 0.001) and 2.46 [m] vs. 2.70 [m], respectively (p = 0.02). However, their mean running time was longer, i.e., 13.33 [s] vs. 11.73 [s], respectively (p = 0.01). Division according to sex showed additionally significantly shorter ball throw distance in the study group in both girls (p = 0.001) and boys (p < 0.001), significantly shorter jump length in the group of girls (p = 0.01), and significantly longer running time in the group of boys (p = 0.04). Children treated for cancer are characterized by decreased physical fitness, and motor ability is sex-dependent. Both groups showed decreased strength, coordination, and upper limb speed. Additionally, worse jumping ability was found in girls whereas decreased speed was observed in boys.
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20
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Alias H, Mohd Nazi NA, Lau Sie Chong D. Participation in Physical Activity and Physical Education in School Among Children With Acute Lymphoblastic Leukemia After Intensive Chemotherapy. Front Pediatr 2019; 7:73. [PMID: 30937299 PMCID: PMC6431648 DOI: 10.3389/fped.2019.00073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/21/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Low physical activity (PA) level has been reported among survivors of childhood acute lymphoblastic leukemia (ALL). The present study was performed to determine the level of participation in general PA and physical education in school (PES) among children with ALL who completed intensive chemotherapy and identify possible barriers that influence adherence to PA and PES. Methods: A cross-sectional, single-center study was conducted over 1 year in a tertiary pediatric hematology and oncology referral center in Kuala Lumpur, Malaysia. A total of 47 children with ALL aged 7-18 years old who were off-treatment and attended school on a regular basis were recruited. A modified structured questionnaire adapted from the Youth Risk Behavior Surveillance System, Division of Adolescent and School Health, the Centers for Disease Control and Prevention (CDC) was used to assess the children's level of PA and PES participation. Results: Among the 47 children will ALL included herein, 11 (23.4%) were physically active for at least 60 min a day for 5 days or more, following CDC recommendations. The median duration from completion of intensive chemotherapy was 4.95 years (25th, 3.29; 75th, 7.95). Younger age at study entry (median, 8.7 years old vs. 12.2 years old) and younger age at diagnosis (median, 2.9 years old vs. 4.3 years old) were significantly associated with higher PA level. Almost all children (45/47, 95.7%) participated in PES. Barriers to non-participation in PES mainly included exhaustion or fear of injury. Conclusions: Majority of the children with ALL included herein had low levels of daily PA after intensive chemotherapy. Nonetheless, their participation in PES was encouraging. PA should thus be promoted during and after cessation of ALL treatment to prevent long-term health risks and improve overall quality of life.
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Affiliation(s)
- Hamidah Alias
- Department of Pediatrics, UKM Medical Center, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nur Adlina Mohd Nazi
- Department of Pediatrics, UKM Medical Center, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Doris Lau Sie Chong
- Department of Pediatrics, UKM Medical Center, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
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Cox CL, Zhu L, Kaste SC, Srivastava K, Barnes L, Nathan PC, Wells RJ, Ness KK. Modifying bone mineral density, physical function, and quality of life in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26929. [PMID: 29286560 PMCID: PMC5821547 DOI: 10.1002/pbc.26929] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The early effects of childhood acute lymphoblastic leukemia (ALL) include decreased physical function, bone mineral density (BMD/g/cm2 ), and health-related quality of life (HRQL). We assessed the capacity of a physical therapy and motivation-based intervention, beginning after diagnosis and continuing through the end of treatment, to positively modify these factors. PROCEDURE A 2.5-year randomized controlled trial of 73 patients aged 4-18.99 years within 10 days of ALL diagnosis assessed BMD at baseline (T0 ) and end of therapy (T3 ), strength, range of motion, endurance, motor skills, and HRQL at baseline (T0 ), 8 (T1 ), 15 (T2 ), and 135 (T3 ) weeks. RESULTS There were no significant changes between groups (intervention, n = 33; usual care, n = 40) in BMD (P = 0.059) at T3 or physical function and HRQL at T0 -T3 . While BMD declined in both the intervention (T0 = -0.21, T3 = -0.55) and usual care (T0 = -0.62, T3 = -0.78) groups, rates of decline did not differ between groups (P = 0.56). Univariate analysis (n = 73) showed associations of higher T3 bone density with body mass index T1 (P = 0.01), T2 (P = <0.0001), T3 (P = 0.01), T3 ankle flexibility/strength (P = 0.001), and T2 parent (P = 0.02)/T0 child (P = 0.03) perceptions of less bodily pain. CONCLUSIONS The intervention delivered during treatment was not successful in modifying BMD, physical function, or HRQL. Physical activity, at the level and intensity required to modify these factors, may not be feasible during early treatment owing to the child's responses to the disease and treatment. Future studies will consider intervention implementation during late maintenance therapy, extending into survivorship.
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Affiliation(s)
| | - Liang Zhu
- The University of Texas Health Science Center at Houston, TX
| | - Sue C. Kaste
- St. Jude Children's Research Hospital, Memphis, TN
- The University of Tennessee Health Science Center, Memphis, TN
| | | | - Linda Barnes
- St. Jude Children's Research Hospital, Memphis, TN
| | - Paul C. Nathan
- The Hospital for Sick Children, University of Toronto, Toronto, CA
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Elmesmari R, Reilly JJ, Martin A, Paton JY. Accelerometer measured levels of moderate-to-vigorous intensity physical activity and sedentary time in children and adolescents with chronic disease: A systematic review and meta-analysis. PLoS One 2017. [PMID: 28640907 PMCID: PMC5480890 DOI: 10.1371/journal.pone.0179429] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Context Moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) are important for child and adolescent health. Objective To examine habitual levels of accelerometer measured MVPA and ST in children and adolescents with chronic disease, and how these levels compare with healthy peers. Methods Data sources: An extensive search was carried out in Medline, Cochrane library, EMBASE, SPORTDiscus and CINAHL from 2000–2017. Study selection: Studies with accelerometer-measured MVPA and/or ST (at least 3 days and 6 hours/day to provide estimates of habitual levels) in children 0–19 years of age with chronic diseases but without co-morbidities that would present major impediments to physical activity. In all cases patients were studied while well and clinically stable. Results Out of 1592 records, 25 studies were eligible, in four chronic disease categories: cardiovascular disease (7 studies), respiratory disease (7 studies), diabetes (8 studies), and malignancy (3 studies). Patient MVPA was generally below the recommended 60 min/day and ST generally high regardless of the disease condition. Comparison with healthy controls suggested no marked differences in MVPA between controls and patients with cardiovascular disease (1 study, n = 42) and type 1 diabetes (5 studies, n = 400; SMD -0.70, 95% CI -1.89 to 0.48, p = 0.25). In patients with respiratory disease, MVPA was lower in patients than controls (4 studies, n = 470; SMD -0.39, 95% CI -0.80, 0.02, p = 0.06). Meta-analysis indicated significantly lower MVPA in patients with malignancies than in the controls (2 studies, n = 90; SMD -2.2, 95% CI -4.08 to -0.26, p = 0.03). Time spent sedentary was significantly higher in patients in 4/10 studies compared with healthy control groups, significantly lower in 1 study, while 5 studies showed no significant group difference. Conclusions MVPA in children/adolescents with chronic disease appear to be well below guideline recommendations, although comparable with activity levels of their healthy peers except for children with malignancies. Tailored and disease appropriate intervention strategies may be needed to increase MVPA and reduce ST in children and adolescents with chronic disease.
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Affiliation(s)
- Rabha Elmesmari
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland
- Al-Fatah Hospital, Medical School, Benghazi University, Benghazi, Libya
| | - John J. Reilly
- University of Strathclyde, Physical Activity for Health Group, Glasgow, Scotland
| | - Anne Martin
- Usher Institute for Population Health Sciences and Informatics, Edinburgh, Scotland
| | - James Y. Paton
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland
- * E-mail:
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Objectively measured versus self-reported physical activity in children and adolescents with cancer. PLoS One 2017; 12:e0172216. [PMID: 28207820 PMCID: PMC5312936 DOI: 10.1371/journal.pone.0172216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
Objective Existing research recognizes low levels of physical activity in pediatric patients with cancer, but much uncertainty exists about their capability to self-reflect physical activity levels. The objective of this study was to compare results of subjective self-reports and objective accelerometers regarding levels of daily walking as well as moderate-to-vigorous physical activities. Methods Results of the objective assessment tool StepWatchTM Activity Monitor and self-reporting with a standardized questionnaire were compared in 28 children and adolescents during cancer treatment. Results The patients were 13.8±2.8 years of age and 3.4±2.0 months after cancer diagnosis. The Bland-Altman plots indicated a fairly symmetrical under- and over-estimation for daily minutes of walking with the limits of agreement ranging from -100.8 to 87.3 min (d = -6.7 min). Mean difference for moderate-to-vigorous physical activity was almost zero but limits of agreement are ranging from -126.8 to 126.9 min. The comparison for the days with at least 60 min of moderate-to-vigorous physical activity showed a marked difference with 3.0±2.6 self-reported days versus only 0.1±0.4 measured days. Conclusions These findings suggest that physical activity in pediatric cancer patients should preferably be assessed with objective methods. Greater efforts are needed to implement supervised exercise interventions during treatment incorporating methods to improve self-reflection of physical activity.
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Hung SH, Rankin A, Virji-Babul N, Pritchard S, Fryer C, Campbell KL. Associating Physical Activity Levels with Motor Performance and Physical Function in Childhood Survivors of Acute Lymphoblastic Leukemia. Physiother Can 2017; 69:57-64. [PMID: 28154445 DOI: 10.3138/ptc.2015-67lhc] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This cross-sectional, observational study investigated whether physical activity (PA) levels are associated with motor performance and physical function in children after treatment for acute lymphoblastic leukemia (ALL). Method: Participants aged 8-13 years who had completed treatment for ALL (3-36 months post-treatment) were tested at their oncology long-term follow-up appointment at the British Columbia Children's Hospital. PA level was measured using the Physical Activity Questionnaire for Older Children (PAQ-C). Motor performance was measured using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, Short Form (BOT-2 SF), and physical function was measured using the 6-minute walk test (6MWT). Results: Thirteen children completed testing. PAQ-C scores were not associated with BOT-2 SF or 6MWT performance. Eleven children (85%) performed below the norm for the 6MWT. Children with elevated body mass index had poorer 6MWT but similar PAQ-C scores. Conclusion: PA was not found to be associated with motor performance and physical function. Participants who were overweight or obese had poorer 6MWT performance, which may indicate the need for closer monitoring of post-treatment weight status and physical function in the oncology follow-up setting.
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Affiliation(s)
- Stanley H Hung
- Department of Physical Therapy, University of British Columbia
| | - Anne Rankin
- Department of Physical Therapy, University of British Columbia
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Description of a Community-Based Exercise Program for Children With Cancer: A Sustainable, Safe, and Feasible Model. REHABILITATION ONCOLOGY 2017. [DOI: 10.1097/01.reo.0000000000000051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Yildiz Kabak V, Duger T, Uckan Cetinkaya D. Investigation of the Effects of an Exercise Program on Physical Functions and Activities of Daily Life in Pediatric Hematopoietic Stem Cell Transplantation. Pediatr Blood Cancer 2016; 63:1643-8. [PMID: 27145378 DOI: 10.1002/pbc.26038] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of this study was to determine the effectiveness of an implemented exercise program for children throughout the hematopoietic stem cell transplantation (HSCT) process. PROCEDURE Twenty-two children aged between 3 and 17, who were earlier selected for HSCT, were divided into two groups-intervention and control. Children's physical function, functional performance, and activities of daily life (ADL) were assessed before HSCT, at discharge, and 1 month later. The exercise program, which consisted of strengthening, endurance, stretching, and relaxation exercises, was implemented to the intervention group for 5 days a week throughout hospitalization; and these exercises were given as home program at discharge. RESULTS The results of the supervised exercise program during hospitalization showed that the children's physical function and functional performance increased statistically significantly in the intervention group (P < 0.05) and decreased statistically significantly in the control group (P < 0.05). For the ADL, no difference was found between the two groups (P ˃ 0.05). CONCLUSIONS The present study determined that the exercise program had positive effects throughout the HSCT process, but these effects did not continue during the follow-up period. Exercise programs implemented by physiotherapists are important for children undergoing HSCT, and after transplantation it is necessary to continue supervised exercise program during follow-up.
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Affiliation(s)
- Vesile Yildiz Kabak
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Tulin Duger
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Duygu Uckan Cetinkaya
- Faculty of Medicine, Department of Pediatric Bone Marrow Transplantation, Hacettepe University, Ankara, Turkey
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Efficacy of Exercise Interventions in Patients with Acute Leukemia: A Meta-Analysis. PLoS One 2016; 11:e0159966. [PMID: 27463234 PMCID: PMC4962985 DOI: 10.1371/journal.pone.0159966] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/09/2016] [Indexed: 02/06/2023] Open
Abstract
Background Decreased physical performance and impaired physiological and psychological fitness have been reported in patients with acute leukemia (AL). We performed a meta-analysis to assess the efficacy of exercise in patients with AL. Methods In this meta-analysis, the electronic databases MEDLINE, Embase, Cochrane, Web of Science, SPORTDiscus, CINAHL and PEDro were searched through November 2015. Three authors participated in the study selection, data extraction and quality assessment. The instrument used for quality assessment was derived from the Cochrane Handbook for Systematic Reviews of Interventions. Analyses were performed according to the recommendations of The Cochrane Collaboration using Review Manager 5.3. Results Nine trials (8 randomized controlled trials and 1 quasi-experimental design trial) with 314 AL participants were included in this meta-analysis. The pooled standardized mean differences between the exercise and control groups were 0.45 (95% confidence interval (CI): 0.09 to 0.80, P value = 0.01, P for heterogeneity = 0.23, I2 = 28%) for cardiorespiratory fitness and 0.67 (95% CI: 0.28 to 1.06, P value = 0.0007, P for heterogeneity = 0.14, I2 = 43%) for muscle strength. Based on the data for fatigue, anxiety, and depression, there were no significant differences in these parameters between the exercise and control groups. Conclusions Exercise has beneficial effects on cardiorespiratory fitness, muscle strength and functional mobility; however, no significant improvements in fatigue, anxiety, depression or quality of life were observed. Further large-scale randomized trials are needed to assess the safety, feasibility and efficacy of exercise programs for AL patients.
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Hooke MC, Gilchrist L, Tanner L, Hart N, Withycombe JS. Use of a Fitness Tracker to Promote Physical Activity in Children With Acute Lymphoblastic Leukemia. Pediatr Blood Cancer 2016; 63:684-9. [PMID: 26756736 DOI: 10.1002/pbc.25860] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/27/2015] [Accepted: 11/06/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children with cancer identify fatigue as a pervasive symptom, which increases during the corticosteroid pulse in acute lymphoblastic leukemia (ALL) maintenance. The FitBit is a fitness tracker that downloads activity measurements to the Internet in real time. In this feasibility study, we explored if children who received daily FitBit coaching for 2 weeks before a maintenance steroid pulse had an increase in steps per day and determined the relationship between steps per day prepulse and fatigue postpulse. PROCEDURE Seventeen children in ALL maintenance, aged 6-15, wore the FitBit for 3 days to establish a baseline. A tailored weekly step goal was then set with the child and parent. Daily emails with feedback and FitBit screenshots were sent over the 2-week intervention. Self-report of fatigue was measured at baseline, after 2 weeks (i.e. before the steroid pulse), and after 5 days of steroids. RESULTS There was a trend toward increased steps per day from weeks 1-2 (P = 0.079); fatigue was low and did not increase during the corticosteroid pulse. A significant correlation (r = -0.66, P = 0.005) was found between the steps per day during week 2 and fatigue after the steroid pulse with higher steps associated with lower fatigue. CONCLUSIONS The intervention was feasible in this small sample. The average steps each time period (week 1, week 2, and during steroids) was over 10,000, demonstrating that children with ALL can be active during treatment. Physical activity may be protective of fatigue during a corticosteroid pulse.
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Affiliation(s)
- Mary C Hooke
- School of Nursing, University of Minnesota, Minneapolis, Minnesota.,Children's Minnesota, Minneapolis, Minnesota
| | | | - Lynn Tanner
- Children's Minnesota, Minneapolis, Minnesota
| | - Nicole Hart
- Children's Minnesota, Minneapolis, Minnesota
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Braam KI, van der Torre P, Takken T, Veening MA, van Dulmen‐den Broeder E, Kaspers GJL. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev 2016; 3:CD008796. [PMID: 27030386 PMCID: PMC6464400 DOI: 10.1002/14651858.cd008796.pub3] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND A decreased physical fitness has been reported in patients and survivors of childhood cancer. This is influenced by the negative effects of the disease and the treatment of childhood cancer. Exercise training for adult cancer patients has frequently been reported to improve physical fitness. In recent years, literature on this subject has also become available for children and young adults with cancer, both during and after treatment. This is an update of the original review that was performed in 2011. OBJECTIVES To evaluate the effect of a physical exercise training intervention on the physical fitness (i.e. aerobic capacity, muscle strength, or functional performance) of children with cancer within the first five years from their diagnosis (performed either during or after cancer treatment), compared to a control group of children with cancer who did not receive an exercise intervention.To determine whether physical exercise within the first five years of diagnosis has an effect on fatigue, anxiety, depression, self efficacy, and HRQoL and to determine whether there are any adverse effects of the intervention. SEARCH METHODS We searched the electronic databases of Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and PEDro; ongoing trial registries and conference proceedings on 6 September 2011 and 11 November 2014. In addition, we performed a handsearch of reference lists. SELECTION CRITERIA The review included randomized controlled trials (RCTs) and clinical controlled trials (CCTs) that compared the effects of physical exercise training with no training, in people who were within the first five years of their diagnosis of childhood cancer. DATA COLLECTION AND ANALYSIS Two review authors independently identified studies meeting the inclusion criteria, performed the data extraction, and assessed the risk of bias using standardized forms. Study quality was rated by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria. MAIN RESULTS Apart from the five studies in the original review, this update included one additional RCT. In total, the analysis included 171 participants, all during treatment for childhood acute lymphoblastic leukaemia (ALL).The duration of the training sessions ranged from 15 to 60 minutes per session. Both the type of intervention and intervention period varied in all the included studies. However, the control group always received usual care.All studies had methodological limitations, such as small numbers of participants, unclear randomization methods, and single-blind study designs in case of one RCT and all results were of moderate to very low quality (GRADE).Cardiorespiratory fitness was evaluated by the 9-minute run-walk test, timed up-and-down stairs test, the timed up-and-go time test, and the 20-m shuttle run test. Data of the 9-minute run-walk test and the timed up-and-down stairs test could be pooled. The combined 9-minute run-walk test results showed significant differences between the intervention and the control groups, in favour of the intervention group (standardized mean difference (SMD) 0.69; 95% confidence interval (CI) 0.02 to 1.35). Pooled data from the timed up-and-down stairs test showed no significant differences in cardiorespiratory fitness (SMD -0.54; 95% CI -1.77 to 0.70). However, there was considerable heterogeneity (I(2) = 84%) between the two studies on this outcome. The other two single-study outcomes, 20-m shuttle run test and the timed up-and-go test, also showed positive results for cardiorespiratory fitness in favour of the intervention group.Only one study assessed the effect of exercise on bone mineral density (total body), showing a statistically significant positive intervention effect (SMD 1.07; 95% CI 0.48 to 1.66). The pooled data on body mass index showed no statistically significant end-score difference between the intervention and control group (SMD 0.59; 95% CI -0.23 to 1.41).Three studies assessed flexibility. Two studies assessed ankle dorsiflexion. One study assessed active ankle dorsiflexion, while the other assessed passive ankle dorsiflexion. There were no statistically significant differences between the intervention and control group with the active ankle dorsiflexion test; however, in favour of the intervention group, they were found for passive ankle dorsiflexion (SMD 0.69; 95% CI 0.12 to 1.25). The third study assessed body flexibility using the sit-and-reach distance test, but identified no statistically significant difference between the intervention and control group.Three studies assessed muscle strength (knee, ankle, back and leg, and inspiratory muscle strength). Only the back and leg strength combination score showed statistically significant differences on the muscle strength end-score between the intervention and control group (SMD 1.41; 95% CI 0.71 to 2.11).Apart from one sub-scale of the cancer scale (Worries; P value = 0.03), none of the health-related quality of life scales showed a significant difference between both study groups on the end-score. For the other outcomes of fatigue, level of daily activity, and adverse events (all assessed in one study), there were no statistically significant differences between the intervention and control group.None of the included studies evaluated activity energy expenditure, time spent on exercise, anxiety and depression, or self efficacy as an outcome. AUTHORS' CONCLUSIONS The effects of physical exercise training interventions for childhood cancer participants are not yet convincing. Possible reasons are the small numbers of participants and insufficient study designs, but it can also be that this type of intervention is not as effective as in adult cancer patients. However, the first results show some positive effects on physical fitness in the intervention group compared to the control group. There were positive intervention effects for body composition, flexibility, cardiorespiratory fitness, muscle strength, and health-related quality of life (cancer-related items). These were measured by some assessment methods, but not all. However, the quality of the evidence was low and these positive effects were not found for the other assessed outcomes, such as fatigue, level of daily activity, and adverse events. There is a need for more studies with comparable aims and interventions, using a higher number of participants that also include diagnoses other than ALL.
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Affiliation(s)
- Katja I Braam
- VU University Medical CenterDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057Room 6 D 120AmsterdamNetherlands1007 MB
| | - Patrick van der Torre
- Wilhelmina Children's Hospital, University Medical Center UtrechtChild Development and Exercise CenterPO Box 85090UtrechtNetherlands3508 AB
| | - Tim Takken
- Wilhelmina Children's Hospital, University Medical Center UtrechtChild Development and Exercise CenterPO Box 85090UtrechtNetherlands3508 AB
| | - Margreet A Veening
- VU University Medical CenterDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057Room 6 D 120AmsterdamNetherlands1007 MB
| | - Eline van Dulmen‐den Broeder
- VU University Medical CenterDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057Room 6 D 120AmsterdamNetherlands1007 MB
| | - Gertjan JL Kaspers
- VU University Medical CenterDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057Room 6 D 120AmsterdamNetherlands1007 MB
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Cardiorespiratory fitness and physical activity in children with cancer. Support Care Cancer 2015; 24:2259-2268. [PMID: 26581899 PMCID: PMC4805718 DOI: 10.1007/s00520-015-2993-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 10/26/2015] [Indexed: 12/21/2022]
Abstract
Purpose This study assessed cardiorespiratory fitness (CRF), physical activity (PA), and sedentary behavior (SB), as well as factors associated with these outcomes in children during or shortly after cancer treatment. Methods Cross-sectionally, CRF data, obtained by the cardiopulmonary exercise test, and PA and SB data, obtained by an accelerometer, were assessed in children with cancer (8–18 years old). Linear regression models were used to determine associations between CRF, PA, or SB and patient characteristics. Results Among 60 children with cancer, mean age 12.6 years, 35 boys, 28 % were during cancer treatment. CRF, reported as the z score of VO2peak, showed that 32 children had a VO2peakz score which was −2 below the predicted value. CRF was significantly associated with PA and SB: each additional activity count per minute resulted in 0.05 ml/kg/min VO2peak increase and each additional minute sedentary reduced VO2peak by 0.06 ml/kg/min. Multiple linear regression models of PA and SB showed that decreased activity was significantly associated with higher age, being fatigued, being during childhood cancer treatment (p < 0.001), or having a higher percentage of fat mass. The multiple linear regression model showed that lower CRF was significantly associated with increased fatigue, being during cancer treatment, having a higher percentage of fat mass, and lower belief of own athletic competence (p < 0.001). Conclusion This study revealed that children during or shortly after cancer treatment have low CRF scores. The most inactive children had a higher fat mass, were fatigued, older, and during childhood cancer treatment. Unexpectedly, treatment-related factors showed no significant association with activity behavior.
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van Dijk-Lokkart EM, Braam KI, van Dulmen-den Broeder E, Kaspers GJL, Takken T, Grootenhuis MA, Streng IC, Bierings M, Merks JH, van den Heuvel-Eibrink MM, Veening MA, Huisman J. Effects of a combined physical and psychosocial intervention program for childhood cancer patients on quality of life and psychosocial functioning: results of the QLIM randomized clinical trial. Psychooncology 2015; 25:815-22. [PMID: 26509236 DOI: 10.1002/pon.4016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although survival rates in childhood cancer have improved, prevention and reduction of late effects remain important. This study evaluates the effects of a combined physical exercise and psychosocial intervention on health-related quality of life (HrQoL) and psychosocial functioning in childhood cancer patients. METHODS In this multicenter randomized controlled trial, cancer patients (aged 8-18 years) and their parents filled in questionnaires on HrQoL, depressive symptoms, behavioral problems, and self-esteem. Measurements were conducted at baseline, shortly after the 12-week intervention period and 12 months after baseline. Generalized estimating equations analyses were performed to assess short-term and long-term psychosocial effects. RESULTS Of the 174 eligible patients, 68 (39.1%) participated. The intervention group consisted of 30 participants at baseline [mean age 13.0 (SD 3.0) years; 53% male], 26 at short-term and 22 at long-term follow-up. The 'care as usual' control group consisted of 38 participants at baseline [mean age 12.6 (SD 3.1) years; 53% male], 33 at short-term and 31 at long-term follow-up. Overall, the intervention did not improve psychosocial functioning and HrQoL. According to parent-proxy reports, the intervention leads to a greater improvement on pain-related HrQoL on both the short (β = 13.4; 95% CI: 3.0; 23.8) and long term (β = 13.0; 95% CI: 1.6; 24.4) and to greater improvement on procedural anxiety immediately after the intervention (β = 12.6; 95% CI: 1.9; 23.3). CONCLUSION A combined physical and psychosocial training for children with cancer did not have effects on HrQoL or psychosocial functioning, with exception of modest positive effects on parent-reported pain and procedural anxiety Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Katja I Braam
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Gertjan J L Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina's Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial department, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Isabelle C Streng
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc Bierings
- Department of Pediatric Oncology/Hematology, Wilhelmina's Childrens Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Johannes H Merks
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Margreet A Veening
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap Huisman
- Department of Medical Psychology, Wilhelmina's Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
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van Dijk-Lokkart EM, Braam KI, Huisman J, Kaspers GJL, Takken T, Veening MA, Bierings M, Merks JH, Grootenhuis MA, van den Heuvel-Eibrink M, Streng IC, van Dulmen-den Broeder E. Factors influencing childhood cancer patients to participate in a combined physical and psychosocial intervention program: Quality of Life in Motion. Psychooncology 2014; 24:465-71. [PMID: 25285989 DOI: 10.1002/pon.3677] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND For a multi-center randomized trial investigating the effects of a 12-week physical and psychosocial intervention program for children with cancer, we invited 174 patients (8-18 years old) on treatment or within 1 year after treatment; about 40% participated. Reasons for non-participation were investigated. METHODS Eligible patients received written and verbal information about the study. Those declining to participate were asked to complete questionnaires concerning: reasons for non-participation, daily physical activity, health-related quality of life (HrQoL), and behavioral problems. Participants completed the same questionnaires at baseline (excluding 'reasons for non-participation'). RESULTS Of 174 eligible patients, 106 did not participate; of these, 61 (57.5%) completed the one-time survey. The main reasons for non-participation as reported by the parents were 'too time consuming' and 'participation is too demanding for my child', while children most frequently reported 'too time consuming' and 'already frequently engaged in sports'. No differences between participants and non-participants were found for age, HrQoL, parental-reported behavior problems, sport participation, school type, BMI, and perceived health. A greater distance from home to hospital resulted in reduced participation (β: -0.02; p = 0.01). Non-participants rated their fitness level higher (p = 0.03). Participating children (11-18 years old) reported more behavioral problems (p = 0.02), in particular internalizing problems (p = 0.06). CONCLUSIONS Participation of childhood cancer patients in an intensive physical and psychosocial intervention program seems related to the burden of the intervention and the travel distance from home to hospital. In general, non-participants rated their fitness level higher compared with participants. Patients with more (internalizing) behavioral problems seem more likely to participate in the study.
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Kauhanen L, Järvelä L, Lähteenmäki PM, Arola M, Heinonen OJ, Axelin A, Lilius J, Vahlberg T, Salanterä S. Active video games to promote physical activity in children with cancer: a randomized clinical trial with follow-up. BMC Pediatr 2014; 14:94. [PMID: 24708773 PMCID: PMC4234290 DOI: 10.1186/1471-2431-14-94] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 03/21/2014] [Indexed: 01/14/2023] Open
Abstract
Background Low levels of physical activity, musculoskeletal morbidity and weight gain are commonly reported problems in children with cancer. Intensive medical treatment and a decline in physical activity may also result in reduced motor performance. Therefore, simple and inexpensive ways to promote physical activity and exercise are becoming an increasingly important part of children’s cancer treatment. Methods The aim of this study is to evaluate the effect of active video games in promotion of physical activity in children with cancer. The research is conducted as a parallel randomized clinical trial with follow-up. Patients between 3 and 16 years old, diagnosed with cancer and treated with vincristine in two specialized medical centers are asked to participate. Based on statistical estimates, the target enrollment is 40 patients. The intervention includes playing elective active video games and, in addition, education and consultations for the family. The control group will receive a general recommendation for physical activity for 30 minutes per day. The main outcomes are the amount of physical activity and sedentary behavior. Other outcomes include motor performance, fatigue and metabolic risk factors. The outcomes are examined with questionnaires, diaries, physical examinations and blood tests at baseline and at 2, 6, 12 and 30 months after the baseline. Additionally, the children’s perceptions of the most enjoyable activation methods are explored through an interview at 2 months. Discussion This trial will help to answer the question of whether playing active video games is beneficial for children with cancer. It will also provide further reasoning for physical activity promotion and training of motor skills during treatment. Trial registration ClinicalTrials.gov identifier: NCT01748058 (October 15, 2012).
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Affiliation(s)
- Lotta Kauhanen
- Department of Nursing Science, University of Turku, Lemminkäisenkatu 1, FI-20014 Turku, Finland.
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Clinical exercise interventions in pediatric oncology: a systematic review. Pediatr Res 2013; 74:366-74. [PMID: 23857296 DOI: 10.1038/pr.2013.123] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/07/2013] [Indexed: 11/08/2022]
Abstract
Studies in pediatric oncology have shown a positive effect of physical activity on disease- and treatment-related side effects. Although several reviews have approved the benefits of therapeutic exercise for adult cancer patients, no systematic review exists summarizing the evidence of physical activity in pediatric oncology. We identified a total of 17 studies using the PubMed database and Cochrane library. To evaluate the evidence, we used the evaluation system of the Oxford Center for Evidence-Based Medicine 2001. The findings confirm that clinical exercise interventions are feasible and safe, especially with acute lymphoblastic leukemia (ALL) patients and during medical treatment. No adverse effects have been reported. Positive effects were found on fatigue, strength, and quality of life. Single studies present positive effects on the immune system, body composition, sleep, activity levels, and various aspects of physical functioning. Child-specific aspects such as cognitive abilities, growth, adolescence, and reintegration into peer-groups, school, and sports have barely been taken into consideration. The evidence for exercise interventions in pediatric oncology is rated level "3." Although the results are very promising, future research of high methodological quality and focusing on child-specific aspects is needed to establish evidence-based exercise recommendations, particularly for childhood cancer patients.
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Soares-Miranda L, Fiuza-Luces C, Lassaletta A, Santana-Sosa E, Padilla JR, Fernández-Casanova L, Lorenzo-González R, López-Mojares LM, Pérez M, Pérez-Martínez A, Lucia A. Physical Activity in Pediatric Cancer patients with solid tumors (PAPEC): Trial rationale and design. Contemp Clin Trials 2013; 36:106-15. [DOI: 10.1016/j.cct.2013.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/23/2013] [Accepted: 05/29/2013] [Indexed: 01/21/2023]
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Viña CC, Wurz AJ, Culos-Reed SN. Promoting physical activity in pediatric oncology. Where do we go from here? Front Oncol 2013; 3:173. [PMID: 23875168 PMCID: PMC3709134 DOI: 10.3389/fonc.2013.00173] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 06/18/2013] [Indexed: 12/16/2022] Open
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Beulertz J, Bloch W, Prokop A, Baumann FT. Specific deficit analyses in motor performance and quality of life of pediatric cancer patients--a cross-sectional pilot study. Pediatr Hematol Oncol 2013; 30:336-47. [PMID: 23495850 DOI: 10.3109/08880018.2013.776155] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although survival rates in childhood cancer have distinctly improved, pediatric cancer patients often experience various disease- and treatment-related side effects with long-term consequences. Despite current studies investigating inactivity and limitations in physical functioning and quality of life in pediatric cancer patients, only little information regarding specific deficits in physical functioning and quality of life has been available until now. No study has yet analyzed these parameters from a global perspective and then identified specific deficits in a mixed childhood cancer population. Within this cross-sectional pilot study, motor performance and quality of life of 26 pediatric cancer patients were assessed after inpatient medical treatment, using standardized motor test batteries (MOT 4-6; DMT 6-18) and a quality of life questionnaire (KINDL®). Reference data have been mainly provided by the German "Children and Young People Health Survey" (KiGGS). Patients achieved lower motor performance scores (p = .000) (more than 27% below the average of healthy peers). Specific deficits were identified in motor speed and motor control (4-6 years), as well as in endurance, strength and coordination under time pressure (6-17 years). In terms of quality of life, no significant differences were examined compared to healthy children of the same age. The results of this study confirm that children with oncological diseases frequently have specific motor problems. Future research in pediatric oncology must investigate the impact of targeted, individualized exercise interventions addressing these specific deficits.
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Affiliation(s)
- Julia Beulertz
- Institute of Cardiovascular Research and Sport Medicine, Department of Molecular and Cellular Sport Medicine, German Sport University, Cologne, Germany.
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Braam KI, van der Torre P, Takken T, Veening MA, van Dulmen-den Broeder E, Kaspers GJL. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev 2013:CD008796. [PMID: 23633361 DOI: 10.1002/14651858.cd008796.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND A decreased physical fitness and impaired social functioning has been reported in patients and survivors of childhood cancer. This is influenced by the negative effects of disease and treatment of childhood cancer and by behavioural and social elements. Exercise training for adults during or after cancer therapy has frequently been reported to improve physical fitness and social functioning. More recently, literature on this subject became available for children and young adults with cancer, both during and after treatment. OBJECTIVES This review aimed to evaluate the effect of a physical exercise training intervention (at home, at a physical therapy centre, or hospital based) on the physical fitness of children with cancer, in comparison with the physical fitness in a care as usual control group. The intervention needed to be offered within the first five years from diagnosis.The second aim was to assess the effects of a physical exercise training intervention in this population on fatigue, anxiety, depression, self efficacy, and health-related quality of life and to assess the adverse effects of the intervention. SEARCH METHODS For this review the electronic databases of CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, and ongoing trial registries were searched on 6 September 2011. In addition, a handsearch of reference lists and conference proceedings was performed in that same month. SELECTION CRITERIA The review included randomised controlled trials (RCTs) and clinical controlled trials (CCTs) that compared the effects of physical exercise training with no training, in people who were within the first five years of their diagnosis of childhood cancer. DATA COLLECTION AND ANALYSIS By the use of standardised forms two review authors independently identified studies meeting the inclusion criteria, performed the data extraction, and assessed the risk of bias. Quality of the studies was rated by using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria. MAIN RESULTS Five articles were included in this review: four RCTs (14, 14, 28, and 51 participants) and one CCT (24 participants). In total 131 participants (74 boys, 54 girls, three unknown) were included in the analysis, all being treated for childhood acute lymphoblastic leukaemia (ALL). The study interventions were all implemented during chemotherapy treatment.The duration of the training sessions ranged from 15 to 60 minutes per session. Both the type of intervention, as well as the intervention period, which ranged from 10 weeks to two years, varied in all the included studies. In all included studies the control group received care as usual.All studies had methodological limitations, such as small numbers of participants, unclear randomisation methods, and single-blind study designs in case of an RCT.Cardiorespiratory fitness was studied by the use of the nine-minute run-walk test, the timed up-and-down stairs test, and the 20-m shuttle run test. Only the up-and-down stairs test showed significant differences between the intervention and the control group, in favour of the intervention group (P value = 0.05, no further information available).Bone mineral density was assessed in one study, in which a statistically significant difference in favour of the exercise group was identified (standardised mean difference (SMD) 1.07; 95% confidence interval (CI) 0.48 to 1.66; P value < 0.001). Body mass index was assessed in two studies. The pooled data on this item did not show a statistically significant difference between the intervention and control study group.Flexibility was assessed in three studies. In one study the active ankle dorsiflexion method was used to assess flexibility and the second study they used the passive ankle dorsiflexion test. No statistically significant difference between the intervention and control group was identified with the active ankle dorsiflexion test, whereas with the passive test method a statistically significant difference in favour of the exercise group was found (SMD 0.69; 95% CI 0.12 to 1.25; P value = 0.02). The third study assessed body flexibility by the use of the sit-and-reach distance test; no statistically significant difference between the intervention and control group was identified.One study assessed the effects of an inspiratory muscle training programme aimed to train the lung muscles and increase physical fitness. This study reported no significant effect on either inspiratory or expiratory muscle strength. Two other studies using either knee and ankle strength changes by hand-held dynamometry or the number of completed push-ups (with knees on the ground) and a peripheral quantitative computed tomography of the tibia to determine the muscle mass did not identify statistically significant differences in muscle strength/endurance.The level of daily activity, health-related quality of life, fatigue, and adverse events were assessed in one study only; for all these items no statistically significant differences between the intervention and control group were found.None of the included studies evaluated the outcomes activity energy expenditure, time spent exercising, anxiety and depression, or self efficacy. AUTHORS' CONCLUSIONS The effects of physical exercise training interventions for childhood cancer participants are not yet convincing due to small numbers of participants and insufficient study methodology. Despite that, first results show a trend towards an improved physical fitness in the intervention group compared to the control group. Changes in physical fitness were seen by improved body composition, flexibility, and cardiorespiratory fitness. However, the evidence is limited and these positive effects were not found for the other assessed outcomes, such as muscle strength/endurance, the level of daily activity, health-related quality of life, and fatigue. There is a need for more studies with comparable aims and interventions, using higher numbers of participants and for studies with another childhood cancer population than ALL only.
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Affiliation(s)
- Katja I Braam
- Department of Pediatrics, Division of Oncology/Hematology,VU University Medical Center, Amsterdam, Netherlands
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Beulertz J, Bloch W, Prokop A, Baumann F. Bewegungstherapie in der pädiatrischen Onkologie. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-2887-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Winter CC, Müller C, Hardes J, Gosheger G, Boos J, Rosenbaum D. The effect of individualized exercise interventions during treatment in pediatric patients with a malignant bone tumor. Support Care Cancer 2013; 21:1629-36. [PMID: 23292667 DOI: 10.1007/s00520-012-1707-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND While research on exercise interventions during anticancer treatment is well-established in adults, only very few studies exist in children. However, pediatric patients experience great limitations to being physically active, and appropriate interventions are desired. PROCEDURE The present study aimed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor. The parameter of interest was physical activity (PA). Patients' PA during home stays was assessed 6 weeks as well as 3, 6, 12, and 18 months post-surgery. Patients were distinguished into an intervention group and a control group. All patients received endoprosthetic replacement of the affected bone in the same institution. RESULTS A constant increase in all PA parameters was observed during follow-up. Exercise interventions were possible and appeared worthwhile. The intervention group showed better PA results at all measurements; however, no significant differences between groups were found. Furthermore, differences decreased especially after the cessation of the intervention. General problems in reaching appropriate power and compliance were observed. CONCLUSIONS Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial. Such interventions should be implemented in adjuvant care; however, future research is needed to understand more about the effects of different interventions.
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Affiliation(s)
- Corinna C Winter
- Institute of Experimental Musculoskeletal Medicine (IEMM) Motion Analysis Lab, University Hospital Münster, Münster, Germany.
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A Comprehensive Healthy Lifestyle Program for Children Receiving Treatment for Acute Lymphoblastic Leukemia: Feasibility and Preliminary Efficacy Data. REHABILITATION ONCOLOGY 2013. [DOI: 10.1097/01893697-201331030-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Winter CC. The assessment of physical activity in children undergoing cancer treatment. Leuk Res 2012; 37:243-4. [PMID: 23259990 DOI: 10.1016/j.leukres.2012.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 11/26/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
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Tan SY, Poh BK, Chong HX, Ismail MN, Rahman J, Zarina AL, Juraida ARE, Tahir A, Ruzita AT, Roslee R, Shanita SN, Hamidah A, Shah MIH, Norimah AK. Physical activity of pediatric patients with acute leukemia undergoing induction or consolidation chemotherapy. Leuk Res 2012; 37:14-20. [PMID: 23099236 DOI: 10.1016/j.leukres.2012.09.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 09/03/2012] [Accepted: 09/05/2012] [Indexed: 11/18/2022]
Abstract
This study aimed to assess the physical activity levels of pediatric patients with acute leukemia undergoing chemotherapy. Thirty-eight pediatric patients and matched controls, aged 3-12 years old, were measured for weight, height, and other anthropometric parameters. Physical activity was assessed using actical accelerometer and activity log book. Patients recorded significantly lower mean total activity counts (26.2±30.2 cpm vs. 192.2±68.8 cpm; p<0.01) and spent more time in sedentary activities (1301±121 min vs. 1020±101 min; p<0.001) compared to controls. They also achieved fewer 1-5-min bouts of moderate-vigorous physical activity (MVPA) compared to controls (1.50±5.95 vs. 37.38±40.36; p<0.001). In conclusion, patients had lower physical activity level and intensity; and simple exercise intervention programs may be needed to minimize the detrimental effects of prolonged sedentary behaviors.
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Affiliation(s)
- Sue Yee Tan
- Physical Activity and Energy Metabolism Research Group, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Chamorro-Viña C, Guilcher GMT, Khan FM, Mazil K, Schulte F, Wurz A, Williamson T, Reimer RA, Culos-Reed SN. EXERCISE in pediatric autologous stem cell transplant patients: a randomized controlled trial protocol. BMC Cancer 2012; 12:401. [PMID: 22963378 PMCID: PMC3503655 DOI: 10.1186/1471-2407-12-401] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 12/18/2022] Open
Abstract
Background Hematopoietic stem cell transplantation is an intensive therapy used to improve survivorship and cure various oncologic diseases. However, this therapy is associated with high mortality rates and numerous negative side-effects. The recovery of the immune system is a special concern and plays a key role in the success of this treatment. In healthy populations it is known that exercise plays an important role in immune system regulation, but little is known about the role of exercise in the hematological and immunological recovery of children undergoing hematopoietic stem cell transplant. The primary objective of this randomized-controlled trial (RCT) is to study the effect of an exercise program (in- and outpatient) on immune cell recovery in patients undergoing an autologous stem cell transplantation. The secondary objective is to determine if an exercise intervention diminishes the usual deterioration in quality of life, physical fitness, and the acquisition of a sedentary lifestyle. Methods This RCT has received approval from The Conjoint Health Research Ethics Board (CHREB) of the University of Calgary (Ethics ID # E-24476). Twenty-four participants treated for a malignancy with autologous stem cell transplant (5 to 18 years) in the Alberta Children’s Hospital will be randomly assigned to an exercise or control group. The exercise group will participate in a two-phase exercise intervention (in- and outpatient) from hospitalization until 10 weeks after discharge. The exercise program includes strength, flexibility and aerobic exercise. During the inpatient phase this program will be performed 5 times/week and will be supervised. The outpatient phase will combine a supervised session with two home-based exercise sessions with the use of the Wii device. The control group will follow the standard protocol without any specific exercise program. A range of outcomes, including quantitative and functional recovery of immune system, cytokine levels in serum, natural killer (NK) cells and their subset recovery and function, and gene expression of activating and inhibitory NK cell receptors, body composition, nutrition, quality of life, fatigue, health-related fitness assessment and physical activity levels will be examined, providing the most comprehensive assessment to date. Discussion We expect to find improvements in immunological recovery and quality of life, and decreased acquisition of sedentary behavior and fitness deconditioning. The comprehensive outcomes generated in this RCT will provide preliminary data to conduct a multisite study that will generate stronger outcomes. Trial registration Gov identification # NCT01666015
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Brinksma A, Huizinga G, Sulkers E, Kamps W, Roodbol P, Tissing W. Malnutrition in childhood cancer patients: A review on its prevalence and possible causes. Crit Rev Oncol Hematol 2012; 83:249-75. [DOI: 10.1016/j.critrevonc.2011.12.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 12/22/2022] Open
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Exercise interventions in children with cancer: a review. Int J Pediatr 2011; 2011:461512. [PMID: 22121378 PMCID: PMC3205744 DOI: 10.1155/2011/461512] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/03/2011] [Accepted: 09/03/2011] [Indexed: 11/17/2022] Open
Abstract
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.
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Abstract
Owing to improved treatment pro-tocols in the last 25 years there have been dramatic improvements in the 5-year relative survival rate of the most prevalent childhood cancers. For instance, the 5-year relative survival rate among children for all cancer sites combined, improved from 58% to 80% in patients diagnosed in 1975-1977 and in 1996-2004 respectively. However, as survival rates have improved, there has been an increasing recognition of adverse short and longer term effects associated with treatment and cancer itself, which we describe in detail in this chapter. There is growing interest in those interventions that can counteract the adverse effects of treatment and cancer. Because such adverse effects are further aggravated by physical inactivity, a special emphasis is being placed on physical activity (PA) interventions. Results are promising: there is increasing evidence that regular PA can improve the overall health status, functional capacity, and quality of life (QOL) of children with cancer as well as of older survivors of childhood cancer.
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Affiliation(s)
- Alejandro F San Juan
- Department of Education, International University of Rioja, Avenida de la Gran Vía Rey Juan Carlos I, 41, 26002, Logroño', Spain.
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Abstract
PURPOSE To summarize and discuss current evidence and understanding of clinical pediatric exercise physiology focusing on the work the research group at Utrecht and others have performed in the last decade in a variety of chronic childhood conditions as a continuation of the legacy of Dr Bar-Or. KEY POINTS The report discusses current research findings on the cardiopulmonary exercise performance of children (and adolescents) with juvenile idiopathic arthritis, osteogenesis imperfecta, achondroplasia, hemophilia, cerebral palsy, spina bifida, cystic fibrosis, and childhood cancer. Exercise recommendations and contraindications are provided for each condition. Implications for clinical practice and future research in this area are discussed for each of the chronic conditions presented. CLINICAL IMPLICATIONS The authors provide a basic framework for developing an individual and/or disease-specific training program, introduce the physical activity pyramid, and recommend a core set of clinical measures to be used in clinical research.
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Braam KI, van Dijk EM, Veening MA, Bierings MB, Merks JHM, Grootenhuis MA, Chinapaw MJM, Sinnema G, Takken T, Huisman J, Kaspers GJL, van Dulmen-den Broeder E. Design of the Quality of Life in Motion (QLIM) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of a combined physical exercise and psychosocial training program to improve physical fitness in children with cancer. BMC Cancer 2010; 10:624. [PMID: 21070639 PMCID: PMC2996394 DOI: 10.1186/1471-2407-10-624] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 11/11/2010] [Indexed: 11/14/2022] Open
Abstract
Background Childhood cancer and its treatment have considerable impact on a child's physical and mental wellbeing. Especially long-term administration of chemotherapy and/or radiotherapy impairs physical fitness both during and after therapy, when children often present with muscle weakness and/or low cardiorespiratory fitness. Physical exercise can improve these two elements of physical fitness, but the positive effects of physical exercise might be further increased when a child's wellbeing is simultaneously enhanced by psychosocial training. Feeling better may increase the willingness and motivation to engage in sports activities. Therefore, this multi-centre study evaluates the short and long-term changes in physical fitness of a child with a childhood malignancy, using a combined physical exercise and psychosocial intervention program, implemented during or shortly after treatment. Also examined is whether positive effects on physical fitness reduce inactivity-related adverse health problems, improve quality of life, and are cost-effective. Methods This multi-centre randomized controlled trial compares a combined physical and psychosocial intervention program for children with cancer, with care as usual (controls). Children with cancer (aged 8-18 years) treated with chemotherapy and/or radiotherapy, and who are no longer than 1 year post-treatment, are eligible for participation. A total of 100 children are being recruited from the paediatric oncology/haematology departments of three Dutch university medical centres. Patients are stratified according to pubertal stage (girls: age ≤10 or >10 years; boys: ≤11 or >11 years), type of malignancy (haematological or solid tumour), and moment of inclusion into the study (during or after treatment), and are randomly assigned to the intervention or control group. Discussion Childhood cancer patients undergoing long-term cancer therapy may benefit from a combined physical exercise and psychosocial intervention program since it may maintain or enhance their physical fitness and increase their quality of life. However, the feasibility, patient need, and effectiveness of such a program should be established before the program can be implemented as part of standard care. Trial registration number NTR1531 (The Netherlands National Trial Register)
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Affiliation(s)
- Katja I Braam
- Department of Paediatrics, Division of Oncology-Haematology, VU University Medical Center, Amsterdam, the Netherlands.
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Abstract
BACKGROUND Nutritional status, as represented by body composition, is an important consideration in the treatment of pediatric cancer patients because it is linked to poor outcomes. Little is known about how a child's body composition responds to cancer and treatment. OBJECTIVES We aimed to compare the body composition of children undergoing treatment of cancer with that of healthy controls and to compare body composition between children with hematologic malignancies and children with solid tumors. DESIGN This cross-sectional study measured height, weight, body cell mass, fat-free mass, and fat mass in 48 children undergoing treatment of cancer and blood-related disorders and in age-matched healthy controls. RESULTS Patients with cancer had a significantly lower body cell mass index z score (body cell mass/height raised to the power of 2.5 for females and 3 for males) than did controls (P = 0.0001), and 45% of the patients with cancer were considered malnourished according to body cell mass. Subjects with cancer had a significantly higher percentage of body fat (P = 0.0001) and fat mass (P = 0.0001) than did controls; however, there was no significant difference in fat-free mass (P = 0.09). On the basis of percentage fat, 77% of subjects with cancer were considered obese. No difference in body composition was observed between cancer types. CONCLUSIONS This study showed that children undergoing treatment of all types of cancer have a significantly lower body cell mass and a significantly higher fat mass than do healthy controls. Nutritional support is suggested for all children undergoing treatment of cancer.
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Affiliation(s)
- Alexia J Murphy
- Discipline of Paediatrics, The University of Queensland Royal Children's Hospital, Queensland, Australia.
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