Device-measured physical activity and cardiovascular disease risk in adolescent childhood cancer survivors. A physical activity in childhood cancer survivors (PACCS) study

Abstract

ObjectivesWe aimed to compare cardiovascular disease (CVD) risk factors in childhood cancer survivors (CCS) with age- and sex-stratified reference material and examine the association between physical activity (PA) intensities and CVD risk factors in CCS.Materials and methodsWithin the cross-sectional, multicenter Physical Activity in Childhood Cancer Survivors (PACCS) study, we collected data on CVD risk factors [VO2–peak (mL⋅kg–1⋅min–1), body mass index (BMI, kg/m2), systolic blood pressure (SBP, mmHg), and total-cholesterol/HDL-cholesterol (Total/HDL)] among CCS aged 9–18 years. CVD risk factors were compared to references with immediate t-tests. We transformed CVD risk factors into z-scores based on international references and generated an individual CVD risk score: [inverse ZVO2–peak + ZBMI + ZSBP + ZTotal/HDL)/4]. Multivariable mixed linear regression models were used to analyze the associations between device-measured PA intensities and CVD risk factors.ResultsWe included 157 CCS aged on average 13.4 years at inclusion and 8.2 years from diagnosis. Male CCS had lower VO2–peak compared to references (45.4 vs. 49.4 mL⋅kg–1⋅min–1, P = 0.001), higher diastolic BP (67 vs. 63 mmHg, P < 0.001), lower HDL (1.35 vs. 1.44 mmol/L, P = 0.012), as well as a tendency to higher CVD risk score (z-score=0.14 vs. 0.00, P = .075). Female CCS’ CVD risk factors were comparable to references. Vigorous-intensity PA (VPA) was associated with CVD risk factors. A 10-min increase in VPA was associated with higher VO2–peak (β = 4.9, 95% CI, 2.1–7.7), lower Total/HDL (β = −0.3, 95% CI, −0.6 to −0.1) and a lower CVD risk score (β = −0.4, 95% CI, −0.6 to −0.2).ConclusionMale adolescent CCS had less favorable values of CVD risk factors compared to references. VPA in adolescent CCS is associated with clinically meaningful favorable values of CVD risk factors.

Systolic myocardial function measured by echocardiographic speckle-tracking and peak oxygen consumption in pediatric childhood cancer survivors—a PACCS study

“…Other studies have reported reduced peak VO 2 in pediatric CCSs with reduced cardiac function revealed by myocardial imaging during exercise ( 4 , 45 ), but also in CCSs with preserved myocardial stress response ( 4 ). Our study population is part of a larger study population included in the PACCS study where 157 pediatric CCSs have participated in cardiopulmonary exercise testing ( 46 ). Bratteteig et al reported a positive association between physical activity levels and peak VO 2 in these participants ( 46 ).…”

“…Our study population is part of a larger study population included in the PACCS study where 157 pediatric CCSs have participated in cardiopulmonary exercise testing ( 46 ). Bratteteig et al reported a positive association between physical activity levels and peak VO 2 in these participants ( 46 ). In our sub-study, we found that lower LV myocardial function measured by EF Simpson and LV-GLS was associated with lower peak VO 2 .…”

Physical Activity Among Adolescent Cancer Survivors: The PACCS Study

“…[7][8][9] PA is defined as any bodily movement produced by skeletal muscles that requires energy expenditure, whereas ST is defined as time spent sitting, reclining, or lying. 10 In adolescent CCS, observational studies have shown that higher PA and/or lower ST is associated with improved cardiorespiratory and muscular fitness, 11,12 bone health, 13 body composition, 14 and quality of life. 15,16 During and immediately after cancer treatment, children and adolescents often have significant impairments in motor performance, potentially affecting their ability to re-engage in PA. [17][18][19] Exercise training interventions in children with any type of cancer during treatment and/or shortly after treatment have shown to improve functional mobility without increasing the risk of mortality, recurrence, or associated adverse effects.…”