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Beller R, Gauß G, Basu O, Schönberger S, Höfs M, Reinhardt D, Götte M. Severely reduced physical performance is already present at the time of admission for stem cell transplantation. BMJ Open Sport Exerc Med 2024; 10:e001907. [PMID: 38882207 PMCID: PMC11177700 DOI: 10.1136/bmjsem-2024-001907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives Paediatric patients with cancer undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) face a high risk for life-threatening infections and transplant-related complications. Therefore, these children should be in the best possible physical condition beforehand. The study aims to evaluate the fitness status before allo-HSCT and identify correlations between fitness, quality of life and fatigue, clinical data, and previous exercise sessions. Methods Paediatric patients with cancer ≥4 years old, treated with allo-HSCT, were recruited for the ANIMAL trial ("Effects of a low vs. moderate intense exercise program on immune recovery during paediatric allo-HSCT.", DRKS ID:DRKS00019865). Assessed at admission for HSCT were (1) clinical and anthropometric data, (2) motor performance (strength, endurance and balance) and (3) psychological parameters. Values were compared with published reference values (normative data from the literature) of healthy children, and correlation analyses were conducted. Results 22 paediatric patients undergoing pre-allo-HSCT (23% female, 9.4±4.5 years, 73% leukaemia) exhibited substantial reduced differences in all motor performance parameters, with up to -106%±98 (mean difference to reference value) in static stance, -37%±45 in sit-to-stand, -52%±16 in leg extension and -48%±22 in hand grip strength compared with reference values. Correlations were observed among age and fitness parameters, the number of inpatient days and fatigue, and many previous exercise sessions correlated with better hand grip strength. Conclusion These results indicate a poorer fitness status in children before HSCT compared with healthy children, recommending the need for structured exercise programmes for children undergoing HSCT. Differently directed correlations between age/body mass index and endurance/strength and between exercise sessions and strength show the importance of individualised training recommendations and the effect of training.
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Affiliation(s)
- Ronja Beller
- Clinics for Paediatrics III, Department of Paediatric Haematology/Oncology, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Gabriele Gauß
- Clinics for Paediatrics III, Department of Paediatric Haematology/Oncology, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Oliver Basu
- Clinics for Paediatrics III, Department of Paediatric Haematology/Oncology, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Stefan Schönberger
- Clinics for Paediatrics III, Department of Paediatric Haematology/Oncology, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Michaela Höfs
- Clinics for Paediatrics III, Department of Paediatric Haematology/Oncology, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Dirk Reinhardt
- Clinics for Paediatrics III, Department of Paediatric Haematology/Oncology, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Miriam Götte
- West German Cancer Centre, University Hospital Essen, Essen, Germany
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Kappelmann L, Götte M, Krombholz A, Hüter J, Fischer B. Factors That Influence Physical Activity Behavior in Children and Adolescents During and After Cancer Treatment: A Qualitative Systematic Review of the Literature. Pediatr Exerc Sci 2024; 36:106-114. [PMID: 37890837 DOI: 10.1123/pes.2022-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 07/31/2023] [Accepted: 08/23/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE The aim of this systematic review is to reveal the social, personal, and contextual factors that influence physical activity (PA) in children and adolescents during and after cancer treatment. METHOD SPORTDiscus, Cochrane, Web of Science, PubMed, and FIS Education electronic database were systematically searched. RESULTS The 13 included studies show that social support (parents, siblings, and friends) in particular is rated as important by cancer survivors; for example, doing PA together. Depending on the treatment status and state of health, particularities arise. During the acute treatment phase, parents issued more prohibitions regarding PA than after treatment. The state of health and concern about infections are described as inhibiting factors. Not all hospitals generally offer special exercise programs for cancer patients, and in some cases, only sporadic exercise sessions were conducted by specialized staff. In addition, the hospital atmosphere, such as cramped rooms, tends to be associated with demotivating effects. CONCLUSIONS Both inhibiting and promoting factors in the area of social, personal, and contextual factors could be identified. The most fundamental factor for PA is the physical condition. Social factors, such as parents or friends, often have a motivating effect and can promote PA. Inhibiting factors are mainly context-related, such as an environment unsuitable for PA. Although the review highlights interesting aspects, further treatment-related and longitudinal studies could provide deeper insights.
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Affiliation(s)
- Laura Kappelmann
- Department of Sport Science, Christian-Albrechts-University of Kiel, Kiel,Germany
| | - Miriam Götte
- West German Cancer Center, University Hospital Essen, Essen,Germany
| | - Arno Krombholz
- Faculty of Sport Science, Ruhr-University Bochum, Bochum,Germany
| | - Jan Hüter
- Faculty of Sport Science, Ruhr-University Bochum, Bochum,Germany
| | - Britta Fischer
- Department of Sport Science, Christian-Albrechts-University of Kiel, Kiel,Germany
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Kesting S, Gaser D, Queisser J, Götte M, von Luettichau I, Peters C, Oberhoffer-Fritz R, Gauß G. Availability and adaption of exercise programs in pediatric oncology during the COVID-19 pandemic and beyond: a nationwide follow-up survey of providers in Germany. Front Pediatr 2024; 12:1372261. [PMID: 38586153 PMCID: PMC10995395 DOI: 10.3389/fped.2024.1372261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background The COVID-19 pandemic has presented major challenges to clinical practice and delivery of care programs throughout all health care systems. Exercise programs, that are implemented in most centers for pediatric oncology in Germany, are a relatively new care program however with high clinical impact and health benefits. Objective The impact and consequences of the pandemic on the delivery and availability of exercise programs in Germany for pediatric cancer patients and survivors are unknown. A national survey analyzed restrictions, challenges and novel approaches of exercise program delivery and scientific research. Method A two-stage online survey was distributed to providers of exercise programs (acute clinics, non-clinical institutions, rehabilitation facilities) via the established Network ActiveOncoKids. Data was collected during the pandemic in 2022 and 2023 using a combination of open and closed questions. Results In total, n = 27 (response rate: 82%) and n = 17 (response rate: 63%) providers participated in the first and second survey, respectively. Findings pointed out restrictions in 85% of all exercise programs in 2020 and 2021, with slight reductions in 2022. During pandemic, restrictions with major impact arose within exercise offers during follow-up and declined gradually. Whereas restrictions within the setting of acute therapy had medium or minor impact but persisted beyond. Delivery of provided exercise programs necessitated adaptions, including digital methods, supervised interventions from a distance and change of locations. Discussion The findings highlight the adaptability, the demand and the potential of exercise programs in pediatric oncology. We assume that exercise professionals have used the pandemic-related challenges to review and modify existing concepts and made adaptations according to local conditions and novel tools for the provision of exercise programs. Nevertheless, a conspicuous lack of exercise-related care has become evident in certain patients and survivors. Further expansion of programs is imperative to address and accommodate all pertinent needs.
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Affiliation(s)
- Sabine Kesting
- Department of Pediatrics and Children's Cancer Research Centre, Kinderklinik München Schwabing, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department Health and Sport Sciences, Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Children’s Oncology Network Bavaria, KioNet, Erlangen, Germany
| | - Dominik Gaser
- Department of Pediatrics and Children's Cancer Research Centre, Kinderklinik München Schwabing, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department Health and Sport Sciences, Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Children’s Oncology Network Bavaria, KioNet, Erlangen, Germany
| | - Jennifer Queisser
- Department of Pediatrics and Children's Cancer Research Centre, Kinderklinik München Schwabing, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department Health and Sport Sciences, Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Miriam Götte
- Clinic of Pediatrics III, Hematology and Oncology, University Hospital Essen, Essen, Germany
- West German Cancer Center Essen, University Hospital Essen, Essen, Germany
| | - Irene von Luettichau
- Department of Pediatrics and Children's Cancer Research Centre, Kinderklinik München Schwabing, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Children’s Oncology Network Bavaria, KioNet, Erlangen, Germany
| | - Christiane Peters
- Department Health and Sport Sciences, Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Renate Oberhoffer-Fritz
- Department Health and Sport Sciences, Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Gabriele Gauß
- Clinic of Pediatrics III, Hematology and Oncology, University Hospital Essen, Essen, Germany
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Mizrahi D, Lai JKL, Wareing H, Ren Y, Li T, Swain CTV, Smith DP, Adams D, Martiniuk A, David M. Effect of exercise interventions on hospital length of stay and admissions during cancer treatment: a systematic review and meta-analysis. Br J Sports Med 2024; 58:97-109. [PMID: 37989539 DOI: 10.1136/bjsports-2023-107372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To assess the effect of participating in an exercise intervention compared with no exercise during cancer treatment on the duration and frequency of hospital admissions. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, PEDro and Cochrane Central Registry of Randomized Controlled Trials. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised studies published until August 2023 evaluating exercise interventions during chemotherapy, radiotherapy or stem cell transplant regimens, compared with usual care, and which assessed hospital admissions (length of stay and/or frequency of admissions). STUDY APPRAISAL AND SYNTHESIS Study quality was assessed using the Cochrane Risk-of-Bias tool and Grading of Recommendations Assessment, Development and Evaluation assessment. Meta-analyses were conducted by pooling the data using random-effects models. RESULTS Of 3918 screened abstracts, 20 studies met inclusion criteria, including 2635 participants (1383 intervention and 1252 control). Twelve studies were conducted during haematopoietic stem cell transplantation regimens. There was a small effect size in a pooled analysis that found exercise during treatment reduced hospital length of stay by 1.40 days (95% CI: -2.26 to -0.54 days; low-quality evidence) and lowered the rate of hospital admission by 8% (difference in proportions=-0.08, 95% CI: -0.13 to -0.03, low-quality evidence) compared with usual care. CONCLUSION Exercise during cancer treatment can decrease hospital length of stay and admissions, although a small effect size and high heterogeneity limits the certainty. While exercise is factored into some multidisciplinary care plans, it could be included as standard practice for patients as cancer care pathways evolve.
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Affiliation(s)
- David Mizrahi
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan King Lam Lai
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Sciences Division, The University of Oxford, Oxford, UK
| | - Hayley Wareing
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Yi Ren
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tong Li
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher T V Swain
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - David P Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Diana Adams
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Alexandra Martiniuk
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Office of the Chief Scientist, The George Institute for Global Health, Sydney, New South Wales, Australia
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Michael David
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Rueegg CS, Zürcher SJ, Schindera C, Jung R, Deng WH, Bänteli I, Schaeff J, Hebestreit H, von der Weid NX, Kriemler S. Effect of a 1-year physical activity intervention on cardiovascular health in long-term childhood cancer survivors-a randomised controlled trial (SURfit). Br J Cancer 2023; 129:1284-1297. [PMID: 37653075 PMCID: PMC10575964 DOI: 10.1038/s41416-023-02410-y] [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: 04/05/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND This randomised controlled trial (RCT) assessed the effect of a 1-year, partially supervised, physical activity (PA) intervention on a cardiovascular disease (CVD) risk score in adult survivors of childhood cancer. METHODS We included childhood cancer survivors ≥16 y at enrolment, <16 y at diagnosis and ≥5 y in remission. The intervention group was asked to perform an additional ≥2.5 h of intense physical activity/week, controls continued exercise as usual; assessments were performed at baseline, 6 months (T6) and 12 months (T12). The primary endpoint was change in a CVD risk score (average z-score of waist circumference, blood pressure, fasting glucose, inverted high-density lipoprotein cholesterol, triglycerides, and inverted cardiorespiratory fitness) from baseline to T12. We performed intention-to-treat (ITT, primary) and 3 per protocol analyses. RESULTS We randomised 151 survivors (44% females, 30.4 ± 8.6 years). We found a significant and robust reduction of the CVD risk score in the intervention compared to the control group at T6 and T12 across all analyses; with a difference in the reduction of the CVD risk z-score of -0.18 (95% confidence interval -0.29 to -0.06, P = 0.003) at T12 in favour of the intervention group (ITT analysis). CONCLUSIONS This RCT showed that a long-term PA intervention can reduce CVD risk in long-term survivors of childhood cancer. TRIAL REGISTRATION Clinicaltrials.gov: NCT02730767.
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Grants
- Swiss Cancer League (KLS-3175-02-2013), the “Stiftung für krebskranke Kinder, Regio Basiliensis”, “Gedächtnis-Stiftung Susy Rückert zur Krebsbekämpfung”, “Taecker-Stiftung für Krebsforschung”, “Stiftung Henriette & Hans-Rudolf Dubach-Bucher”, “Stiftung zur Krebsbekämpfung”, “Stiftung Krebs-Hilfe Zürich”, “Fondation Recherche sur le Cancer de l'Enfant (FORCE)”, and Fond’Action contre le Cancer. CSR has received funding from the European Union Seventh Framework Programme (FP7-PEOPLE-2013-COFUND) under grant agreement n°609020-Scientia Fellows. WHD is paid by a research grant from the South-Eastern Norway Regional Health Authority (grant number 2019039, to CSR).
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Affiliation(s)
- Corina S Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
| | - Simeon J Zürcher
- Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD) and University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christina Schindera
- Department of Pediatric Hematology and Oncology, University Children's Hospital Basel (UKBB) and University of Basel, Basel, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ruedi Jung
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Wei H Deng
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Iris Bänteli
- Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Jonathan Schaeff
- Pediatric Department, University Hospital Augsburg, Augsburg, Germany
| | - Helge Hebestreit
- Pediatric Department, University Hospital, Julius-Maximilians University, Würzburg, Germany
| | - Nicolas X von der Weid
- Department of Pediatric Hematology and Oncology, University Children's Hospital Basel (UKBB) and University of Basel, Basel, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Is an Exercise Program for Pediatric Cancer Patients in Palliative Care Feasible and Supportive?-A Case Series. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020318. [PMID: 36832447 PMCID: PMC9955029 DOI: 10.3390/children10020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
(1) Background: Growing evidence indicates benefits through exercise programs in pediatric oncology throughout the whole cancer trajectory. This should include palliative care, too. This project analyzes the feasibility of a supervised exercise program offered during hospital and home-based care for children with advanced cancer diagnoses. (2) Methods: Four children (7-13 years old) with advanced cancer diagnoses participated in this project. It consisted of supervised exercise sessions offered once a week (30-90 min), mainly home-based, but also on an in- and outpatient basis. Regular data assessments included psychological and physical capacity-related endpoints and body composition. Details and contents of exercise sessions and adverse events were recorded. (3) Results: Exercise was feasible with 73 ± 9% adherence to the minimum number of planned sessions. The exercise offer was accepted until shortly before death. Effects on fatigue, quality of life and muscular endurance were noted. Participants showed major deviations from age-specific reference values. No exercise-related adverse events occurred. (4) Conclusions: The exercise program was safe, feasible, and might have served as a supportive tool to reduce overall burden. Evaluation of exercise as usual palliative care should be assessed by further studies.
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Physical activity and exercise for cancer-related cognitive impairment among individuals affected by childhood cancer: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:47-58. [PMID: 36309037 DOI: 10.1016/s2352-4642(22)00286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals affected by childhood cancer can have cognitive dysfunction that persists into adulthood and negatively affects quality of life. In this study, we aimed to evaluate the effects of physical activity and exercise on cognitive function among individuals affected by childhood cancer. METHODS In this systematic review and meta-analysis, we searched seven databases (CINAHL Plus, Cochrane Library, Embase, MEDLINE, PsycINFO, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and the International Clinical Trials Registry Platform) for randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) published (or registered) from database inception to Jan 30, 2022, with no language restrictions. We included studies that compared the effects of physical activity or exercise interventions with controls (no intervention or usual care) on cognitive function among individuals diagnosed with any type of cancer at age 0-19 years. Two reviewers (JDKB and FR) independently screened records for eligibility and searched references of the selected studies; extracted study-level data from published reports; and assessed study risk of bias of RCTs and NRSIs using the Cochrane risk of bias tool for randomised trials (RoB 2) and Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) tools, certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, and any adverse events. We used intention-to-treat data and unpublished data if available. Cognitive function was assessed by standardised cognitive performance measures (primary outcome) and by validated patient-reported measures (secondary outcome). A random-effects meta-analysis model using the inverse-variance and Hartung-Knapp methods was used to calculate pooled estimates (Hedges' g) and 95% CI values. We estimated the heterogeneity variance by the restricted maximum likelihood method and calculated I2 values to measure heterogeneity. We examined funnel plots and used Egger's regression test to assess for publication bias. This study is registered with PROSPERO, CRD42021261061. FINDINGS We screened 12 425 titles and abstracts, which resulted in full-text assessment of 131 potentially relevant reports. We evaluated 22 unique studies (16 RCTs and six NRSIs) with data on 1277 individuals affected by childhood cancer and low-to-moderate risk of bias. Of the 1277 individuals, 674 [52·8%] were male and 603 [47·2%] were female; median age at study start was 12 (IQR 11-14) years, median time since the end of cancer treatment was 2·5 (IQR -1·1 to 3·0) years, and median intervention period was 12 [IQR 10-24] weeks. There was moderate-quality evidence that, compared with control, physical activity and exercise improved cognitive performance measures (five RCTs; Hedges' g 0·40 [95% CI 0·07-0·73], p=0·027; I2=18%) and patient-reported measures of cognitive function (13 RCTs; Hedges' g 0·26 [0·09-0·43], p=0·0070; I2=40%). No evidence of publication bias was found. Nine mild adverse events were reported. INTERPRETATION There is moderate-certainty evidence that physical activity and exercise improves cognitive function among individuals affected by childhood cancer, which supports the use of physical activity for managing cancer-related cognitive impairment. FUNDING Research Impact Fund of Research Grants Council of the Hong Kong University Grants Committee (R7024-20) and Seed Fund for Basic Research of the University of Hong Kong. COPYRIGHT © 2022 Published by Elsevier Ltd. All rights reserved.
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8
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Xu F, Jin X, Chen Y, Guan Z, Zhou R, Xu X, Mao J, Shen Z, Jin L, Liu Y, Chen H, Gu R, Wang J, Wang H. Associated factors on physical activity among childhood cancer survivors in Mainland China: a qualitative exploration applied health belief model. Support Care Cancer 2022; 30:9221-9232. [PMID: 36056273 DOI: 10.1007/s00520-022-07324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/09/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Regular physical activity (PA) is essential for childhood cancer survivors (CCS), yet most CCS have difficulty participating in it. The level of PA participation among CCS in China is lower than those of western countries, leading to a worse long-term survival of CCS in China. Here, the study aims to explore the associated factors on the PA performance among CCS. METHODS From September to December 2020, the study used purposive sampling to recruit 35 families (88.9%) as sampling units among two hospitals in Hangzhou City, China. The data collection conducted two designs on semi-structured interviews with different roles under family structure - children (n = 35) and parents (n = 35) - respectively. The design of predetermined questions relied on the health belief model (HBM) as a thematic framework. The qualitative analysis applied codebook thematic analysis and used the deductive approach to finalize the main findings. RESULTS The study only presented preliminary conclusions from interviews with CCS, which resulted in four themes (changes in PA performance; perceptions on participating PA; cognitions of PA; impacts from others) with eight sub-themes. In particular, CCS replied diversity changes in PA, but most of them mentioned the inactive PA after diagnosis, especially the decline of moderate-to-vigorous PA (MVPA). As for the "perceptions of PA," almost all CCS had substantial perceived benefits about PA, specifically on their physical well-being. All children also expressed perceived barriers to PA, including the side effects of disease and treatment, fatigue, academic burden, changes in psychological status, and lack of companions. On the cognitions of PA, the CCS had limited realizations of regular PA and low self-efficacy on MVPA. Furthermore, CCS expressed their need for support from their parents, school teachers, and healthcare providers. But in reality, they recieved less support on PA from these important people. CONCLUSION The changes in PA after illness among CCS are apparent and unavoidable because of the interaction impacts from internal factors (e.g., personal characters, cognization, perceptions of PA) and external factors (e.g., disease effects, interpersonal supports). The findings explained the main elements under HBM but also provided explored views as the evidence on developing theories and guiding motivations and practices on PA among CCS. IMPLICATIONS FOR CANCER SURVIVORS In this exploratory study of 35 CCS, we identified the current situation of PA among CCS in China and explored the associated factors. As the first qualitative study on the CCS in mainland China, the study considered particular effects on social culture and living environment.
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Affiliation(s)
- Fengjiao Xu
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Xiaoyuan Jin
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Ying Chen
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Zhonghai Guan
- Department of Oncology Surgery, the Children's Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Rui Zhou
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Xiaojun Xu
- Department of Hematology &Oncology, the Children's Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Junqing Mao
- Department of Oncology Surgery, the Children's Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Zhipeng Shen
- Department of Neurosurgery, the Children's Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Libin Jin
- Department of Department of Orthopedic, the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Yunxia Liu
- Department of Oncology, Hangzhou Third People's Hospital, Zhejiang Province, Hangzhou, People's Republic of China
| | - Hao Chen
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Renjun Gu
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China
| | - Jinhu Wang
- Department of Oncology Surgery, the Children's Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China.
| | - Hongmei Wang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, People's Republic of China.
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A National Implementation Approach for Exercise as Usual Care in Pediatric and Adolescent Oncology: Network ActiveOncoKids. Pediatr Exerc Sci 2022; 34:219–226. [PMID: 35700978 DOI: 10.1123/pes.2021-0218] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 01/19/2023]
Abstract
The diagnosis of cancer as well as accompanying acute and late effects of treatment are influencing physical activity behavior of patients with childhood cancer and survivors. Research has shown that a pediatric cancer diagnosis is associated with impairments of physical performance, and function, as well as reduced physical, and psychosocial, health conditions. From an ethical perspective, lack of knowledge of health care providers, lack of physical activity promotion, and environmental, and structural barriers to physical activity restrict children's right to move and actively engage in physical activities. Network ActiveOncoKids is a German-wide initiative with the main goal of enabling children, adolescents, and young adults with exercise opportunities during and after cancer treatment. Since the network's foundation in 2012, Network ActiveOncoKids focuses on: (1) physical activity support for patients and families, (2) policy change to establish structures and guidelines, and (3) generating evidence through scientific projects. The purpose of this paper is to present an overview of Network ActiveOncoKids structure, aims, and projects. This topical review will highlight the network's structural development, research work, and implementation progress of exercise programs for patients with pediatric cancer and survivors, link international collaborations, and discuss future directions.
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Götte M, Gauß G, Dirksen U, Driever PH, Basu O, Baumann FT, Wiskemann J, Boos J, Kesting SV. Multidisciplinary Network ActiveOncoKids guidelines for providing movement and exercise in pediatric oncology: Consensus-based recommendations. Pediatr Blood Cancer 2022; 69:e29953. [PMID: 36073842 DOI: 10.1002/pbc.29953] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pediatric cancer leads to reduced participation in exercise and only few patients comply with national physical activity recommendations. Physically inactive behavior hinders motor development and increases physical and psychological adverse effects of therapy and incidence of sequelae. Currently, there is neither nationwide coverage nor uniform level of knowledge regarding exercise promotion. The objective of the guideline is to facilitate qualified exercise interventions through standardized procedures in addition to regular physiotherapy and overall avoid physical inactivity in pediatric cancer patients. METHODS This guideline addresses the multidisciplinary treatment team and informs physiotherapists and decision-makers in tertiary care hospitals and health insurance companies. The requirements of the Association of the Scientific Medical Societies in Germany were followed. Contents were based on best practice experience of experts, patient advocates, as well as on scientific evidence. RESULTS The guideline includes 11 recommendations. Recommendations 1-4 declare the relevance of implementing exercise interventions and address general framework conditions. Recommendations 5-11 focus on the design of exercise programs, prevention and safety issues, relative contraindications for specific training loads, and options to overcome barriers to exercise. CONCLUSION This guideline summarizes existing and established structures and evidence in the context of movement and exercise in pediatric oncology. It takes into consideration the rights, varying needs, and characteristics of children and adolescents as well as national and international experience in this field. In the future, relevant research gaps need to be addressed by high-quality intervention studies to provide the scientific background for a stronger evidence-based guideline.
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Affiliation(s)
- Miriam Götte
- Department of Pediatric Hematology/Oncology, Clinic for Pediatrics III, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Gabriele Gauß
- Department of Pediatric Hematology/Oncology, Clinic for Pediatrics III, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Uta Dirksen
- Department of Pediatric Hematology/Oncology, Clinic for Pediatrics III, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Basu
- Department of Pediatric Hematology/Oncology, Clinic for Pediatrics III, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Freerk T Baumann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital of Cologne, Cologne, Germany
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Department of Medical Oncology, University Clinic Heidelberg and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Joachim Boos
- Faculty of Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Sabine Verena Kesting
- Department of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany.,Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, TUM School of Medicine, Technical University of Munich, Munich, Germany
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11
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Götte M, Basteck S, Beller R, Gauß G, Schmidt S, Burchartz A, Kolb S, Grydeland M, Reinhardt D. Physical activity in 9-15 year-old pediatric cancer survivors compared to a nationwide sample. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04392-5. [PMID: 36224439 DOI: 10.1007/s00432-022-04392-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Sufficient physical activity (PA) has the potential to mitigate late effects of cancer, but objective data of PA levels in adolescents are scarce. The aim of this study was to investigate differences in PA behavior between childhood cancer survivors (CCS) and healthy peers. METHODS PA levels of n = 74 CCS and n = 1304 healthy peers from the MoMo study aged 9-15 years were assessed with validated objective accelerometry and group means were compared. A binary multiple logistic regression was performed to investigate the potential predictors of PA. RESULTS CCS spent significantly more time sedentary (p < 0.001) and less time in moderate-to-vigorous physical activity (p = 0.002) compared to the healthy cohort. Subgroup analysis revealed the largest deviations of PA levels for CCS aged 9-11 years who fulfilled international PA recommendations on significantly fewer days than MoMo (p < 0.01). Health conditions seem to be a predictor concerning the fulfillment of international PA recommendations by the WHO (p = 0.015). CONCLUSIONS Our study identified vulnerable groups which seem to require targeted exercise and health behavior change programs to increase physical activity and reduce sedentary time. The presence of treatment sequelae as a significant predictor of insufficient physical activity underlines the need of multidisciplinary supportive care approaches.
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Affiliation(s)
- Miriam Götte
- Clinic for Pediatrics III, Department of Pediatric Hematology/Oncology, West German Cancer Centre, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
| | - Simon Basteck
- Clinic for Pediatrics III, Department of Pediatric Hematology/Oncology, West German Cancer Centre, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Ronja Beller
- Clinic for Pediatrics III, Department of Pediatric Hematology/Oncology, West German Cancer Centre, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Gabriele Gauß
- Clinic for Pediatrics III, Department of Pediatric Hematology/Oncology, West German Cancer Centre, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Steffen Schmidt
- Institute for Sports and Sports Science, Karlsruhe Institute of Technology, 76131, Karlsruhe, Germany
| | - Alexander Burchartz
- Institute for Sports and Sports Science, Karlsruhe Institute of Technology, 76131, Karlsruhe, Germany
| | - Simon Kolb
- Institute for Sports and Sports Science, Karlsruhe Institute of Technology, 76131, Karlsruhe, Germany
| | - May Grydeland
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - Dirk Reinhardt
- Clinic for Pediatrics III, Department of Pediatric Hematology/Oncology, West German Cancer Centre, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
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Beller R, Gauß G, Reinhardt D, Götte M. Ein individualisiertes Bewegungsprogramm für
kinderonkologische Patienten in palliativen Situationen mithilfe von
Hausbesuchen. B&G BEWEGUNGSTHERAPIE UND GESUNDHEITSSPORT 2022. [DOI: 10.1055/a-1909-5939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ZusammenfassungKinder und Jugendliche sollten während ihrer gesamten Krebstherapie
einschließlich der palliativ-medizinischen Versorgung Zugang zu
Bewegungsprogrammen haben. Für die Phase am Lebensende gibt es nur sehr
wenige Erfahrungen und Daten. Am Universitätsklinikum Essen wurde ein
Bewegungsprojekt für onkologische Patienten im fortgeschrittenen
Tumorstadium initiiert.Teilnehmende haben die Diagnose einer fortgeschrittenen Krebserkrankung, sind
mindestens 3 Jahre alt, haben zuvor schon an der Bewegungstherapie der
Akutklinik teilgenommen und dadurch eine Bindung zu ihren Bewegungstherapeuten
aufgebaut und wohnen in der Umgebung des Krankenhauses (<60 Minuten
Autofahrt/Strecke). Die Aufnahme wird mit dem Team der Spezialisierten
Ambulanten Palliativversorgung (SAPV) der Klinik abgestimmt, um den
Gesundheitszustand sowie familiäre Besonderheiten
berücksichtigen zu können. Nach der Entscheidung über
die Durchführ-barkeit und die Einwilligung der Familien bieten die
Bewegungstherapeuten einmal pro Woche eine 30–90-minütige
Bewegungseinheit an. Die Einheiten finden in der Regel bei den Patienten zu
Hau-se statt, aber auch ambulant oder stationär, wenn die Patienten
Termine oder Komplikationen haben. Inhaltlich bestehen die Einheiten aus einer
Kombination von Kraft-, Ausdauer-, Koordinations-, Körperwahrnehmungs-
und Mobilitätstraining, welche ressourcenorientiert,
interessensorientiert und an die jeweilige Tagesform angepasst sind. Eine
freiwillige Datenerfassung zu motorischen und psychologischen Parametern erfolgt
alle vier bis sechs Wochen.Das Bewegungskonzept für palliative pädiatrische Patienten
berücksichtigt die individuellen Möglichkeiten, Ziele und
Interessen der Betroffenen. Da das Projekt aktuell noch nicht Teil der
Regel-versorgung ist, sollte es evaluiert und ausgebaut werden.
Pädiatrische onkologische Patienten im fortgeschrittenen Stadium sollten
die Möglichkeit haben, an Bewegungsprogrammen teilzunehmen und von der
Bewegungsförderung zu profitieren.
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Affiliation(s)
- Ronja Beller
- Zentrum für Kinder- und Jugendmedizin, Kinderheilkunde III,
Westdeutsches Tumorzentrum Essen, Universitätsklinikum Essen,
Deutschland
| | - Gabriele Gauß
- Zentrum für Kinder- und Jugendmedizin, Kinderheilkunde III,
Westdeutsches Tumorzentrum Essen, Universitätsklinikum Essen,
Deutschland
| | - Dirk Reinhardt
- Zentrum für Kinder- und Jugendmedizin, Kinderheilkunde III,
Westdeutsches Tumorzentrum Essen, Universitätsklinikum Essen,
Deutschland
| | - Miriam Götte
- Zentrum für Kinder- und Jugendmedizin, Kinderheilkunde III,
Westdeutsches Tumorzentrum Essen, Universitätsklinikum Essen,
Deutschland
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Kesting S, Weeber P, Schönfelder M, Pfluger A, Wackerhage H, von Luettichau I. A Bout of High-Intensity Interval Training (HIIT) in Children and Adolescents during Acute Cancer Treatment-A Pilot Feasibility Study. Cancers (Basel) 2022; 14:cancers14061468. [PMID: 35326619 PMCID: PMC8945900 DOI: 10.3390/cancers14061468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
Low- and moderate-intensity exercise is safe and feasible during childhood cancer treatment. The feasibility of a bout of high-intensity interval training (HIIT) in this population has not been analyzed to date. Pediatric cancer patients aged between 6 and 18 years were selected based on clinical conditions to perform ten sets of 15 s HIIT (>90% of estimated maximal heart rate (HRmax)) and 1 min active recovery on a bicycle ergometer within the first three chemotherapy courses. We assessed safety and feasibility criteria and the following parameters: perceived exertion rate, heart rate, and lactate and adrenaline concentrations. Out of 212 eligible patients, 11 patients aged 13.9 ± 3.6 years (n = 7 ♂) with lymphoma, leukemia, rhabdomyosarcoma, nephroblastoma, and synovial sarcoma completed the bout of HIIT without serious adverse events. During exercise, patients reached a BORG value maxima of 16 ± 1.2, and their heart rates rose from 78 ± 17 beats per minute (bpm) at rest to 178 ± 12 bpm after exercise (90 ± 6% estimated HRmax). The power-to-weight ratio was 2 ± 0.5 W/kg (watt per kilogram). Blood lactate concentrations increased from 1.09 ± 0.50 mmol/L (millimole per liter) at rest to 5.05 ± 1.88 mmol/L post-exercise. Our preliminary data suggest that HIIT is applicable only in a small number of childhood cancer patients. Individually adapted exercise protocols for patients with multiple impairments are needed.
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Affiliation(s)
- Sabine Kesting
- Kinderklinik München Schwabing, Department of Pediatrics and Children’s Cancer Research Center, TUM School of Medicine, Technical University of Munich, 80804 Munich, Germany; (P.W.); (I.v.L.)
- Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
- Pediatric Oncology Network Bavaria, KIONET Bavaria, 91054 Erlangen, Germany;
- Correspondence: ; Tel.: +49-89-3068-7411
| | - Peter Weeber
- Kinderklinik München Schwabing, Department of Pediatrics and Children’s Cancer Research Center, TUM School of Medicine, Technical University of Munich, 80804 Munich, Germany; (P.W.); (I.v.L.)
- Exercise Biology, Department of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany; (M.S.); (A.P.)
| | - Martin Schönfelder
- Exercise Biology, Department of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany; (M.S.); (A.P.)
| | - Anja Pfluger
- Exercise Biology, Department of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany; (M.S.); (A.P.)
| | - Henning Wackerhage
- Pediatric Oncology Network Bavaria, KIONET Bavaria, 91054 Erlangen, Germany;
| | - Irene von Luettichau
- Kinderklinik München Schwabing, Department of Pediatrics and Children’s Cancer Research Center, TUM School of Medicine, Technical University of Munich, 80804 Munich, Germany; (P.W.); (I.v.L.)
- Pediatric Oncology Network Bavaria, KIONET Bavaria, 91054 Erlangen, Germany;
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Gaser D, Peters C, Götte M, Oberhoffer-Fritz R, Feuchtinger T, Schmid I, von Luettichau I, Kesting S. Analysis of self-reported activities of daily living, motor performance and physical activity among children and adolescents with cancer: Baseline data from a randomised controlled trial assessed shortly after diagnosis of leukaemia or non-Hodgkin lymphoma. Eur J Cancer Care (Engl) 2022; 31:e13559. [PMID: 35150025 DOI: 10.1111/ecc.13559] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/05/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cancer diagnosis, treatment side effects and physical inactivity can lead to reduced muscle strength. Patients undergoing acute treatment experience many burdens that can restrict their mobility and autonomy, leading to limited independence and loss of resources to cope with everyday tasks. In this work, we analyse the status quo and potential influencing factors for the accomplishment of activities of daily living (ADLs) shortly after cancer diagnosis. METHODS We recruited participants ages 4-18 years diagnosed with acute leukaemia or non-Hodgkin lymphoma. For the baseline analysis, we assessed (1) physical function limitations using the Activities Scale for Kids©, (2) exercise-related ADLs simulated with the Functional ADL Screen, (3) motor performance using the Motor Performance in Paediatric Oncology test and (4) physical activity (PA) level measured using an accelerometer. RESULTS We conducted the baseline assessment 19.2 ± 12.6 days post-diagnosis in 41 patients. All participants reported functional limitations in ADLs and PA. Motor performance was reduced for all abilities. Cumulative steroid dose was negatively correlated with hand grip strength (r = -0.50, p = 0.009). CONCLUSION Shortly after diagnosis of paediatric cancer, patients experience various physical impairments that can be counteracted with regular, instructed exercise interventions.
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Affiliation(s)
- Dominik Gaser
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany.,Department of Sport and Health Sciences, Chair of Preventive Pediatrics, Technical University of Munich, Munich, Germany.,Pediatric Oncology Network, KIONET BAVARIA, Bavaria, Germany
| | - Christiane Peters
- Department of Sport and Health Sciences, Chair of Preventive Pediatrics, Technical University of Munich, Munich, Germany
| | - Miriam Götte
- Department of Hematology and Oncology, Clinic of Pediatrics III, West German Cancer Center Essen, University Hospital, Essen, Germany
| | - Renate Oberhoffer-Fritz
- Department of Sport and Health Sciences, Chair of Preventive Pediatrics, Technical University of Munich, Munich, Germany
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.,Pediatric Oncology Network, KIONET BAVARIA, Bavaria, Germany
| | - Irene Schmid
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.,Pediatric Oncology Network, KIONET BAVARIA, Bavaria, Germany
| | - Irene von Luettichau
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany.,Pediatric Oncology Network, KIONET BAVARIA, Bavaria, Germany
| | - Sabine Kesting
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany.,Department of Sport and Health Sciences, Chair of Preventive Pediatrics, Technical University of Munich, Munich, Germany.,Pediatric Oncology Network, KIONET BAVARIA, Bavaria, Germany
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15
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Gaser D, Peters C, Oberhoffer-Fritz R, Götte M, Feuchtinger T, Schmid I, Haller B, von Luettichau I, Kesting S. Effects of strength exercise interventions on activities of daily living, motor performance, and physical activity in children and adolescents with leukemia or non-Hodgkin lymphoma: Results from the randomized controlled ActiveADL Study. Front Pediatr 2022; 10:982996. [PMID: 36425395 PMCID: PMC9679409 DOI: 10.3389/fped.2022.982996] [Citation(s) in RCA: 4] [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: 06/30/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Pediatric patients with cancer experience impairments in muscle strength and physical activity (PA) that may reduce autonomy during hospitalization. To determine the effects of strength exercise interventions on the accomplishment of activities of daily living (ADLs), motor performance, and PA in children with leukemia or non-Hodgkin lymphoma, we randomly allocated patients (4-18 years) immediately after diagnosis into two exercise groups. METHODS The intervention group (IG; n = 21) received a specific strength training combined with a standard care exercise program, whereas the control group (CG; n = 20) was provided standard care exercise program without any targeted muscle strengthening. After the baseline visit, participants were followed-up three times until intensive treatment cessation. We assessed physical function limitations using the Activities Scale for Kids© (ASK) and Functional ADL Screen. Secondary outcomes were PA levels using accelerometer and motor performance as measured by MOON-test (motor performance in pediatric oncology-test). RESULTS In both groups, ADL accomplishment had significantly increased (p < 0.05). However, no significant between-group differences for ASK outcome were noted. Motor performance was reduced in all motor abilities. CONCLUSIONS Both exercise interventions were effective to maintain ADLs and motor performance during intensive treatment. In comparison, regular strength exercise interventions in the course of therapy tended to be more beneficial with regards to muscular explosive and endurance strength.
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Affiliation(s)
- Dominik Gaser
- Kinderklinik München Schwabing, Department of Pediatrics and Children's Cancer Research Centre, TUM School of Medicine, Technical University of Munich, Munich, Germany.,Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.,Pediatric Oncology Network, KIONET Bavaria, Erlangen, Germany
| | - Christiane Peters
- Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Renate Oberhoffer-Fritz
- Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Miriam Götte
- Clinic of Pediatrics III, Department of Hematology and Oncology, West German Cancer Centre Essen, University Hospital, Essen, Germany
| | - Tobias Feuchtinger
- Pediatric Oncology Network, KIONET Bavaria, Erlangen, Germany.,Dr. von Hauner Children's Hospital, Pediatric Hematology and Oncology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Irene Schmid
- Pediatric Oncology Network, KIONET Bavaria, Erlangen, Germany.,Dr. von Hauner Children's Hospital, Pediatric Hematology and Oncology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Irene von Luettichau
- Kinderklinik München Schwabing, Department of Pediatrics and Children's Cancer Research Centre, TUM School of Medicine, Technical University of Munich, Munich, Germany.,Pediatric Oncology Network, KIONET Bavaria, Erlangen, Germany
| | - Sabine Kesting
- Kinderklinik München Schwabing, Department of Pediatrics and Children's Cancer Research Centre, TUM School of Medicine, Technical University of Munich, Munich, Germany.,Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.,Pediatric Oncology Network, KIONET Bavaria, Erlangen, Germany
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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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17
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De Lazzari N, Niels T, Tewes M, Götte M. A Systematic Review of the Safety, Feasibility and Benefits of Exercise for Patients with Advanced Cancer. Cancers (Basel) 2021; 13:cancers13174478. [PMID: 34503288 PMCID: PMC8430671 DOI: 10.3390/cancers13174478] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Most advanced cancer patients suffer from severe symptoms due to cancer and medical treatment. Common symptoms are physical weakness, mental problems, and tiredness. Research has shown that exercise positively influences cancer-related side effects during and after treatment and longevity in cancer survivorship. However, exercise as a supportive therapy in advanced cancer patients is still not recommended in oncological guidelines. Therefore, the aim of this systematic review was to assess the safety, feasibility, and benefits of exercise for patients with advanced cancer. Based on the results of 14 included exercise intervention studies, we conclude that exercise is safe and feasible, seems to improve physical performance, and may lower symptoms like chronic tiredness. Early integration of exercise for advanced cancer patients should be considered as usual care as a supportive strategy. Abstract Exercise therapy is a common supportive strategy in curative cancer treatment with strong evidence regarding its positive effects on, for example, cancer-related fatigue, health- related quality of life, and physical function. In the field of advanced cancer patients, knowledge about exercise as a useful supportive strategy is missing. The aim of this systematic review was to evaluate the feasibility and safety of exercise interventions as well as its effects on lowering the symptom burden. We included randomized controlled trials and nonrandomized controlled trials with advanced cancer patients receiving any type of exercise intervention. After an extensive literature search (in accordance to PRIMSA guidelines) in PubMed, Cochrane Library, and SPORTDiscus, 14 studies including 940 participants with different cancer entities were eligible. The results indicated the safety of exercise. In total, 493 participants received exercise interventions, with nine adverse events and no severe adverse events. The median recruitment rate was 68.33%, and adherence to exercise intervention was 86%. Further research with a high-quality and larger sample size is needed to clarify the potential of exercise with advanced cancer patients. Different advanced cancer entities have distinguished symptoms, and future research should construct entities-specific trial populations to figure out the best supportive exercise interventions.
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Affiliation(s)
- Nico De Lazzari
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany;
- Correspondence:
| | - Timo Niels
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, 50937 Cologne, Germany;
| | - Mitra Tewes
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany;
| | - Miriam Götte
- Department of Pediatric Hematology/Oncology, Clinic for Pediatrics 3, Center for Child and Adolescent Medicine, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany;
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