Cardiorespiratory fitness and physical function in children with cancer from diagnosis throughout treatment

Abstract

BackgroundChildren with cancer experience severe reductions in physical fitness and functionality during and following intensive treatment. This may negatively impact their quality of life.PurposeTo describe the physical capacity and functionality of children with cancer during and after treatment as well as the feasibility of physical activity intervention in the Rehabilitation including Social and Physical activity and Education in Children and Teenagers with Cancer study.Patients and methodsThe study included children diagnosed from January 2013 to April 2016 with paediatric cancer or Langerhans cell histiocytosis, all treated with chemotherapy. Seventy-five of 78 consecutively eligible children (96.2%) were included. Median age was 11 years (range 6‒18). The physical capacity and function were assessed based on testing of physical strength, balance and cardiorespiratory fitness. Children were tested at diagnosis, 3 and 6 months after diagnosis and 1 year after cessation of treatment. The feasibility evaluation was inspired by the criteria for reporting the development and evaluation of complex interventions in healthcare.ResultsAll children participated in the physical intervention programme with no dropouts. Strenuous physical exercise and physiological testing during paediatric cancer treatment was safe and feasible, with only five minor adverse events during the intervention. Cardiorespiratory fitness was significantly lower in children with cancer than norms for healthy age-matched children at diagnosis (difference 19.1 mL/kg/min, 95% CI 15.4 to 22.7; p <0.0001), during treatment 3 and 6 months from diagnosis (difference 21.0 mL/kg/min, 95% CI 17.4 to 24.6; p <0.0001 and difference 21.6 mL/kg/min, 95% CI 17.3 to 25.8; p <0.0001, respectively) and 1 year after cessation of treatment (difference 6.9 mL/kg/min, 95% CI 1.1 to 12.7; p <0.0072). Furthermore, children with cancer experienced a pronounced decline in physical function.ConclusionThis study shows that it is safe and feasible to perform strenuous physical exercise and testing during paediatric cancer treatment and that children with cancer have significantly lower physical capacity and functionality than healthy age-matched norms.Trial registration numberClinicalTrials.gov: NCT01772862.

Classmates motivate childhood cancer patients to participate in physical activity during treatment: A qualitative study

“…Most of those studies have small sample sizes and describe various exercise interventions, outcome measurements and duration of interventions (Braam et al, ; Grimshaw, Taylor, & Shields, ; Huang & Ness, ; Winter, Muller, Hoffmann, Boos, & Rosenbaum, ). Overall, the studies indicate that children with cancer are less physically active and have decreased muscle strength, balance and cardiorespiratory fitness during and after treatment compared with their peers (Braam et al, ; Grimshaw et al, ; Huang & Ness, ; Thorsteinsson et al, ; Winter et al, ). Decreased and impaired physical capacity and function lead to problems with balance and dynamic movements such as walking, running and jumping, which could be considered as everyday activities in children.…”

Testing physical function in children undergoing intense cancer treatment—a RESPECT feasibility study

“…A 39% reduction in cardiopulmonary function within 2 weeks of diagnosis has been reported in childhood cancer . Ness et al.…”

“…A 39% reduction in cardiopulmonary function within 2 weeks of diagnosis has been reported in childhood cancer. 1 Ness et al similarly reported that children with acute lymphoblastic leukemia (ALL) show 15% reduced lower extremity muscle strength 7-10 days after diagnosis. 4 These impairments may persist years after treatment [10][11][12] and result in an increased risk of chronic medical conditions, including metabolic syndrome and cardiovascular disease.…”

“…Physical function testing in children with cancer is gaining increasing interest as reports of physical function impairment during and after treatment become more prevalent. Function disabilities include reductions in cardiopulmonary function, muscle strength, balance, and general physical weakness, that impact quality of life . The existing topic‐related studies include limited numbers of children (n = 15–128) as well as restricted diagnostic groups and inclusion criteria.…”

Physical activity for children undergoing acute cancer treatment: A qualitative study of parental perspectives

“…Children with cancer have reduced physical activity levels during treatment compared with their peers 1‐3 . Children can also experience a range of adverse treatment effects that compromise their physical function 2,4‐7 . These adverse effects, in addition to reduced levels of physical activity, have implications for their development and their health and well‐being.…”