A Randomized Trial of Physical Activity in Children and Adolescents with Cancer

Abstract

Background: to evaluate the safety and efficacy of a physical activity program (PAP) in children and adolescents with cancer. Methods: children and adolescents with cancer were randomly assigned in a 1:1 ratio to the six-month PAP (intervention group) or to the control group. The first evaluation was performed at the end of the PAP (T0 + 6 mo). At T0 + 6 mo, both groups received the six-month PAP with a second evaluation at T0 + 12 mo. The primary outcome was the evolution of exercise capacity measured using the six-minute walk test (6 MWT) at T0 + 6 mo. Secondary outcomes included PAP safety and changes in other physical functions, self-esteem, and quality-of-life parameters. Results: The trial involved 80 children and adolescents (age range 5.0–18.4 years), of whom 41 were assigned to the interventional group and 39 to the control group. Underlying malignancies were leukemia (39%) and a broad range of solid tumors (61%). No adverse events occurred. At T0 + 6 mo, the evolution of the 6 MWT distance (±SEM) was improved in the intervention group vs. the control group (86 ± 12 m vs. 32 ± 6 m, p < 0.001). Several other physical parameters were significantly improved in the intervention group. Global self-esteem and parent-reported quality-of-life were significantly increased in the intervention group. Analysis at T0 + 12 mo showed persistence of the benefits in the intervention group on exercise capacity evolution (115 ± 18 m vs. 49 ± 11 m, p = 0.004) and on most physical and QoL parameters. Conclusion: In children and adolescents with cancer, a physical activity program is safe, improves exercise capacity, and may have physical and psychological benefits.

Adverse Events During Supervised Exercise Interventions in Pediatric Oncology—A Nationwide Survey

“…Although feasibility and safety have been described in the current literature ( 11 ), a concise evaluation of adverse events (AEs) occurring during exercise programs for children and adolescents with cancer is lacking. Interventional studies evaluating exercise interventions in childhood cancer patients and survivors mostly acknowledge no adverse events (AEs) ( 12 , 13 ). However, information about the evaluation of such AEs during interventional exercise studies is sparse, not recorded, or not published and no information is available about AEs occurring outside studies during exercise care programs.…”

Exercise and Childhood Cancer—A Historical Review

“…Finally, three trials have been published in the last two years (2020 and 2021), evaluating the effects of a combined (muscle strength and aerobic exercise) training intervention in children and adolescents undergoing treatment for different types of cancer [ 44 , 45 , 46 ]. Nielsen et al applied a supervised in-hospital exercise intervention that included for the first time two healthy classmates chosen as ‘ambassadors’, with the aim of improving patients’ motivation for engaging in the exercise intervention [ 44 ].…”

“…The authors found a significant beneficial effect of exercise on leg (but not on arm) muscle strength, walking performance, fatigue, self-esteem, and self-reported physical function, although no benefits were found for anthropometric outcomes or for the remainder of the HRQoL domains [ 45 ]. In 2021, Saultier et al implemented a six-month exercise intervention including both in-hospital and outdoor activities [ 46 ]. The intervention induced improvements in CRF and HRQoL and these benefits remained six months later [ 46 ].…”

“…In 2021, Saultier et al implemented a six-month exercise intervention including both in-hospital and outdoor activities [ 46 ]. The intervention induced improvements in CRF and HRQoL and these benefits remained six months later [ 46 ].…”

“…Notably, physical exercise interventions (with the vast majority combining aerobic and resistance training) during and/or after treatment have been shown to attenuate several of the harmful effects associated with medical therapies for a wide variety of pediatric tumors. Notably, there can be: a decrease in the number of infections after allogenic hematopoietic stem cell transplantation (HSCT) for the treatment of blood cancer [ 33 ]; the preservation of LV function in children receiving neoadjuvant treatment for solid tumors or intensive chemotherapy treatment for leukemias [ 34 ], as well as in children with acute lymphoblastic leukemia (ALL) [ 35 , 36 ]; increases in CRF levels in children with ALL [ 37 , 38 , 39 , 40 ] or with different types of blood cancers [ 41 , 42 ] or malignancies [ 43 , 44 , 45 , 46 , 47 ], as well as in survivors of brain tumors [ 48 ]; improvements in lean mass in children with all types of cancers [ 49 ] and in muscle strength in children with solid tumors undergoing neoadjuvant therapy [ 17 ], as well as in children with ALL [ 37 , 39 , 50 ] or with different types of cancer [ 45 , 46 , 47 , 49 , 51 ]; mild improvements in immune function in the context of HSCT [ 52 , 53 ]; improvements in cognitive function in survivors of brain tumors [ 48 ] and rises in PA levels in children with ALL [ 38 ] or with different types of cancer [ 45 ] as well as with bone tumors [ 54 ]; improvements in the health-related quality of life (HRQoL) in children with blood cancer [ 41 ]; decreases in waist circumference, waist-to-hip ratio, and percentage of fat mass in long-term survivors of childhood ALL [ 35 ]; and decreased pain [ 55 ] and fatigue in children with different types of cancer [ 45 ].…”