Exercise training in childhood cancer: A systematic review and meta-analysis of randomized controlled trials

Morales, Javier S.; Valenzuela, Pedro L.; Rincón‐Castanedo, Cecilia; Takken, Tim; Fiuza‐Luces, Carmen; Santos‐Lozano, Alejandro; Lucía, Alejandro

doi:10.1016/j.ctrv.2018.08.012

Cited by 78 publications

(100 citation statements)

References 33 publications

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“…3 Our own review (date: 18/7/17; search terms: (("exercise"[MeSH Terms] OR "exercise"[All Fields]) AND ("neoplasms"[MeSH Terms] OR "neoplasms"[All Fields])) AND ("2009"[PDAT] AND Review[ptyp])) identified more than 140 systematic reviews or meta-analyses and more than 90 nonsystematic reviews on new or emerging topics. There now exists evidence of varying strength on the safety, feasibility and/or efficacy of exercise throughout the cancer continuum in a range of cancers, including but not limited to, more common cancers such as breast, 4 prostate, 5 colorectal 6 and lung 7 cancer, as well as other cancers including haematological, 8 head and neck, 9 cancers of childhood and adolescence, 10 and gynaecological cancers, 11,12 and less common cancers such as brain, 13 testicular 14 and pancreatic. 15 Some studies have specifically targeted patient cohorts with more advanced disease, 16,17 providing initial evidence beyond patients with early-stage disease, generally considered 'well'.…”

Section: Evidence Of Exercise Benefit Following a Cancer Diagnosismentioning

confidence: 99%

The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management

Hayes

Newton

Spence

et al. 2019

Journal of Science and Medicine in Sport

344

366

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Objectives: Since Exercise and Sports Science Australia (ESSA) first published its position statement on exercise guidelines for people with cancer, there has been exponential growth in research evaluating the role of exercise pre-, during and post-cancer treatment. Design and Methods: The purpose of this report is to use the current scientific evidence, alongside clinical experience and exercise science principles to update ESSA's position statement on cancer-specific exercise prescription. Results: Reported in this position statement is a summary of the benefits accrued through exercise following a cancer diagnosis and the strengths and limitations of this evidence-base. An exercise prescription framework is then proposed to enable the application of cancer-specific considerations for individualisation, specificity, safety, feasibility and progression of exercise for all patients. Additional specific exercise prescription considerations are provided for the presence of haematological, musculoskeletal, systemic, cardiovascular, lymphatic, gastrointestinal, genitourinary and neurological disease-and treatment-related concerns, as well as presence of co-morbid chronic disease. Further, we also identify and discuss cancer-specific pragmatic issues and barriers requiring consideration for exercise prescription. Conclusions: While for the majority, multimodal, moderate to high intensity exercise will be appropriate, there is no set prescription and total weekly dosage that would be considered evidence-based for all cancer patients. Targeted exercise prescription, which includes the provision of behaviour change advice and support, is needed to ensure greatest benefit (as defined by the patient) in the short and longer term, with low risk of harm.

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Section: Evidence Of Exercise Benefit Following a Cancer Diagnosismentioning

confidence: 99%

The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management

Hayes

Newton

Spence

et al. 2019

Journal of Science and Medicine in Sport

344

366

View full text Add to dashboard Cite

show abstract

“…10 Meta-analytic evidence also shows that exercise interventions have positive effects on the functional mobility of this population. 11 Further, although data in juvenile rat models have demonstrated the cardioprotective effects of exercise against anthracycline-induced cardiotoxicity, 12,13 to the best of our knowledge; however, no study has specifically assessed the effects of exercise intervention during active treatment of pediatric tumors on major clinical endpoints (notably, risk of mortality or disease relapse, hospitalization days, or cardiovascular function). This study aimed to determine the effects of a supervised exercise training intervention (combining aerobic and resistance exercises) during neoadjuvant (in children with solid tumors) or intensive chemotherapy phase of treatment (in children with leukemias).…”

Section: Introductionmentioning

confidence: 99%

Inhospital exercise benefits in childhood cancer: A prospective cohort study

Morales

Santana‐Sosa

Santos‐Lozano

et al. 2019

Scandinavian Med Sci Sports

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Childhood cancer patients are at risk of developing important adverse effects, mortality and disease relapse after treatments, which has a substantial economic impact on healthcare systems. The objective of this study was to determine the effects of supervised inhospital exercise on clinical endpoints during childhood cancer treatment.169 children with a new diagnosis of cancer were divided into an exercise intervention (n = 68, 11 ± 4 years) or a control group (n = 101, 11 ± 3 years). The cohort was followed up from the start of treatment for up to five years. Supervised inhospital exercise intervention was performed during the neoadjuvant (for solid tumors) or intensive chemotherapy treatment period (for leukemias). The median duration of the intervention was 22 (interquartile range, 14-28) weeks. We assessed survival, risk of disease relapse or metastasis, and days of hospitalization (primary outcomes), and cardiovascular function, anthropometry and blood variables (secondary outcomes).No exercise-related adverse events were noted. The exercise group had significantly less days of hospitalization than the control group (P = .031), resulting in a lower (~−17%) mean total economic cost of hospitalization in the former. Moreover, echocardiography-determined left ventricular function (ejection fraction and fractional shortening) was significantly impaired in the control group after treatment compared with baseline, whereas it was maintained in the exercise group (P = .024 and .021 for the between-group differences, respectively). In conclusion, supervised inhospital exercise intervention is safe and plays a cardioprotective role, at least in the short term, in children with cancer, also reducing hospitalization time, and therefore alleviating the economic burden.

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“…In turn, whether the weakest children could still have shown further improvements with higher exercise loads is unknown. Much more work is thus still needed to maximize exercise adaptations in children with cancer, and we should not fear this type of interventions, notably because they are safe [4]. Children with cancer deserve our strongest efforts.…”

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confidence: 99%

Reply: Letter to the Editor: Exercise Interventions and Cardiovascular Health in Childhood Cancer: A Meta-Analysis

et al. 2020

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Dear EditorWe sincerely appreciate the nice comments by Drs. P.V. da Costa Ghignatti and R. Pereira de Lima 1 concerning our recent meta-analysis assessing the effects of physical exercise interventions on cardiovascular endpoints in childhood cancer survivors 2. They are quite right to remain that even non-significant improvements in cardiorespiratory fitness (CRF) might be clinically relevant. Indeed, we still do not know if CRF increments of a theoretically low magnitude (i. e., <1 metabolic equivalent) might have a prognostic value in the context of pediatric cancer and treatment-associated cardiotoxicity. We also agree that unsupervised exercise interventions are unlikely to be as effective as tailored programs, especially because the latter allow for intensity to being adequately controlled and thus gradually increased. It is indeed our opinion, after long years of experience working with children with cancer as well as with other debilitated clinical populations, that there is always room for physiological improvement and ideally loads should be gradually improved instead of remaining stable.

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Exercise training in childhood cancer: A systematic review and meta-analysis of randomized controlled trials

Cited by 78 publications

References 33 publications

The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management

The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management

Inhospital exercise benefits in childhood cancer: A prospective cohort study

Reply: Letter to the Editor: Exercise Interventions and Cardiovascular Health in Childhood Cancer: A Meta-Analysis

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