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

Abstract

Objectives: Exercise interventions during and after treatment for pediatric cancer are associated with beneficial physical, psychological, and social effects. However, valid data about adverse events (AEs) of such interventions have rarely been evaluated. This retrospective study evaluates AEs that occurred during supervised oncological exercise programs for pediatric cancer patients and survivors.Methods: This Germany-wide study used a self-administered online survey focusing on general program characteristics and AEs retrospectively for 2019. The questionnaire included (a) basic data on the offered exercise program, (b) AEs with consequences (Grade 2–5) that occurred in 2019 during an exercise intervention, (c) number of Grade 1 AEs, (d) safety procedures as part of the exercise programs, and (e) possibility to give feedback and describe experience with AEs in free text.Results: Out of 26 eligible exercise programs, response rate of program leaders was 92.3% (n = 24). Representatives working for Universities (n = 6), rehabilitation clinics (n = 3), acute cancer clinics (n = 12), and activity camps (n = 3) participated. In total, 35,110 exercise interventions with varying duration were recorded for 2019. Six AEs with consequences (Grade 2–3) occurred during exercise interventions after cancer treatment resulting in an incidence of 17 per 100,000 exercise interventions (0.017%). No life-threatening consequences or death were reported and no serious AE occurred during acute cancer treatment. Grade 1 AE occurred with a frequency of 983, corresponding to an incidence of 2,800 per 100,000 interventions (2.8%). Most frequent Grade 1 AE were muscle soreness, circulatory problems, and abdominal pain. The most frequent preventive safety procedures at the institutions were regular breaks, consultations with the medical treatment team, and material selection with low injury potential.Conclusions: Supervised exercise interventions for pediatric cancer patients and survivors seem to be safe and AEs with consequences comparatively rare when compared to general childhood population data. Occurrence of grade 1 AEs was common, however, causality was probably not evident between AEs and the exercise intervention. Future research should standardize assessment of AEs in clinical practice and research, and prospectively register and evaluate AEs that occur in the context of exercise interventions in pediatric cancer patients and survivors.

Effect of exercise interventions on hospital length of stay and admissions during cancer treatment: a systematic review and meta-analysis

“…Exercise during cancer treatment has been shown to be safe. For instance, in children with cancer, an evaluation of 35 110 exercise sessions found severe adverse events occurred at a rate of 0.02% 75. Half the studies in our review reported on safety, in which most reported no adverse events from exercise.…”

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

“…Three Grade 1 adverse events among our participants represent a 0.002% relative frequency. In Germany, fewer adverse events occurred in our cohort than those with other acute cancer clinics with an exercise program ( 34 ). After consultation with physicians and based on published literature, one participant continued to exercise after stem cell transplantation and successfully completed the intervention ( 56 , 57 ).…”

“…The exercise physiologists documented participants' adherence to the exercise sessions. Adverse events concerning exercise interventions or assessments were recorded with regard to the study of Gauß et al ( 34 ). For a detailed description of the measurement methods, we refer to the publication of the baseline data ( 27 ).…”

A National Implementation Approach for Exercise as Usual Care in Pediatric and Adolescent Oncology: Network ActiveOncoKids

“…Future steps include quality standards and financial sustainability for exercise programs. A current retrospective analysis of adverse events during exercise programs underlines the safety of structured and supervised exercise interventions with only 6 adverse events grades 2-3 according to the CTCAE criteria in 35,110 exercise interventions (12). For a standardized assessment of adverse events in the clinical setting, a registry will be established to prospectively file and evaluate adverse events occurring during exercise programs in acute pediatric cancer centers and aftercare offers nationwide.…”