High impact physical activity and bone health of lower extremities in childhood cancer survivors: A cross‐sectional study of SURfit

Zürcher, Simeon Joel; Jung, Ruedi; Monnerat, Sophie; Schindera, Christina; Eser, Prisca; Meier, Christian; Rueegg, Corina S.; Weid, Nicolas von der; Kriemler, Susi

doi:10.1002/ijc.32963

Cited by 9 publications

(7 citation statements)

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“…This paper's null results may be due to the exercise program of SURfit that mainly included aerobic exercise aimed and powered to improve predominantly its primary endpoint of cardiovascular disease risk, and only secondarily affecting bone health 20 . Although a considerable number of CCS showed low BMD, 27 the majority of CCS in our study were in the normal range comparable to healthy adults 28 . Nevertheless, bone health of CCS can benefit from PA when being exposed already to a relatively low number of high mechanical impact peaks (roughly 300 impact repetitions/day for example, from jumping, running) 27 rather than through low impact training (eg, walking, cycling, swimming) 27,29‐33 .…”

Section: Discussionmentioning

confidence: 91%

“…Although a considerable number of CCS showed low BMD, 27 the majority of CCS in our study were in the normal range comparable to healthy adults 28 . Nevertheless, bone health of CCS can benefit from PA when being exposed already to a relatively low number of high mechanical impact peaks (roughly 300 impact repetitions/day for example, from jumping, running) 27 rather than through low impact training (eg, walking, cycling, swimming) 27,29‐33 . Most CCS probably failed reaching this threshold within our individual PA program and thus, the program was not optimal to boosting bone remodeling.…”

Section: Discussionmentioning

confidence: 99%

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Effect of a physical activity intervention on lower body bone health in childhood cancer survivors: A randomized controlled trial (SURfit)

Jung

Zürcher

Schindera

et al. 2022

Intl Journal of Cancer

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It remains controversial whether physical activity promotes bone health in childhood cancer survivors (CCS). We aimed to assess the effect of a one-year general exercise intervention on lower body bone parameters of CCS. CCS ≥16 years at enrollment, <16 years at diagnosis and ≥5 years in remission were identified from the national Childhood Cancer Registry. Participants randomized to the intervention group were asked to perform an additional ≥2.5 hours of intense physical activity/week, controls continued exercise as usual. Bone health was assessed as a secondary trial endpoint at baseline and after 12-months. We measured tibia bone mineral density (BMD) and morphology by peripheral quantitative computed tomography and lumbar spine, hip and femoral neck BMD by dual-energy x-ray absorptiometry. We performed intention-to-treat, per protocol, and an explorative subgroup analyses looking at low Abbreviations: BMD, bone mineral density (mg/cm 3 or g/cm 2 ); CCS, childhood cancer survivor(s); CPET, cardiopulmonary exercise test; DXA, dual-energy x-ray absorptiometry; ITT, intention-totreat analysis; PA, physical activity; pQCT, peripheral quantitative computed tomography; RCT, randomized controlled trial.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Effect of a physical activity intervention on lower body bone health in childhood cancer survivors: A randomized controlled trial (SURfit)

Jung

Zürcher

Schindera

et al. 2022

Intl Journal of Cancer

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“…Promoting regular moderate to vigorous levels of PA in survivors of childhood cancer is likely to reduce cardiovascular morbidity [ 86 ] and mortality [ 14 , 87 - 89 ], osteoporosis, and fatigue and increase psychological well-being. Moreover, as PA is an important determinant of PF, both PA and PF are essential for gaining developmental skills in children and adolescents.…”

Section: Discussionmentioning

confidence: 99%

The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an International Mixed Methods Study

Lie¹,

Anderssen²,

Rueegg³

et al. 2022

JMIR Res Protoc

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Background Survivors of childhood cancer represent a growing population with a long life expectancy but high risks of treatment-induced morbidity and premature mortality. Regular physical activity (PA) may improve their long-term health; however, high-quality empirical knowledge is sparse. Objective The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) study comprises 4 work packages (WPs) aiming for the objective determination of PA and self-reported health behavior, fatigue, and quality of life (WP 1); physical fitness determination (WP 2); the evaluation of barriers to and facilitators of PA (WP 1 and 3); and the feasibility testing of an intervention to increase PA and physical fitness (WP 4). Methods The PACCS study will use a mixed methods design, combining patient-reported outcome measures and objective clinical and physiological assessments with qualitative data gathering methods. A total of 500 survivors of childhood cancer aged 9 to 18 years with ≥1 year after treatment completion will be recruited in follow-up care clinics in Norway, Denmark, Finland, Germany, and Switzerland. All participants will participate in WP 1, of which approximately 150, 40, and 30 will be recruited to WP 2, WP3, and WP 4, respectively. The reference material for WP 1 is available from existing studies, whereas WP 2 will recruit healthy controls. PA levels will be measured using ActiGraph accelerometers and self-reports. Validated questionnaires will be used to assess health behaviors, fatigue, and quality of life. Physical fitness will be measured by a cardiopulmonary exercise test, isometric muscle strength tests, and muscle power and endurance tests. Limiting factors will be identified via neurological, pulmonary, and cardiac evaluations and the assessment of body composition and muscle size. Semistructured, qualitative interviews, analyzed using systematic text condensation, will identify the perceived barriers to and facilitators of PA for survivors of childhood cancer. In WP 4, we will evaluate the feasibility of a 6-month personalized PA intervention with the involvement of local structures. Results Ethical approvals have been secured at all participating sites (Norwegian Regional Committee for Medical Research Ethics [2016/953 and 2018/739]; the Oslo University Hospital Data Protection Officer; equivalent institutions in Finland, Denmark [file H-19032270], Germany, and Switzerland [Ethics Committee of Northwestern and Central Switzerland, project ID: 2019-00410]). Data collection for WP 1 to 3 is complete. This will be completed by July 2022 for WP 4. Several publications are already in preparation, and 2 have been published. Conclusions The PACCS study will generate high-quality knowledge that will contribute to the development of an evidence-based PA intervention for young survivors of childhood cancer to improve their long-term care and health. We will identify physiological, psychological, and social barriers to PA that can be targeted in interventions with immediate benefits for young survivors of childhood cancer in need of rehabilitation. International Registered Report Identifier (IRRID) DERR1-10.2196/35838

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“…Only a few studies investigated the effects of physical exercise on CCS. In 2020 Zürcher and collaborators confirmed the efficacy and safety of high-impact exercise, for example jumping and fast running, in 161 CCS [ 174 ]. This study is in contrast with the previous evidence in the literature.…”

Section: Therapy and Preventionmentioning

confidence: 99%

Osteoporosis in Childhood Cancer Survivors: Physiopathology, Prevention, Therapy and Future Perspectives

Tortora

Paoletta

Marrapodi

et al. 2022

Cancers

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The improvement of chemotherapy, radiotherapy, and surgical interventions, together with hematopoietic stem cell transplantation, increased childhood cancer survival rate in the last decades, reaching 80% in Europe. Nevertheless, anti-cancer treatments are mainly responsible for the onset of long-term side effects in childhood cancer survivors (CCS), including alterations of the endocrine system function and activity. In particular, the most frequent dysfunction in CCS is a metabolic bone disorder characterized by low bone mineral density (BMD) with increased skeletal fragility. BMD loss is also a consequence of a sedentary lifestyle, malnutrition, and cancer itself could affect BMD, thus inducing osteopenia and osteoporosis. In this paper, we provide an overview of possible causes of bone impairment in CCS in order to propose management strategies for early identification and treatment of skeletal fragility in this population.

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High impact physical activity and bone health of lower extremities in childhood cancer survivors: A cross‐sectional study of SURfit

Cited by 9 publications

References 39 publications

Effect of a physical activity intervention on lower body bone health in childhood cancer survivors: A randomized controlled trial (SURfit)

Effect of a physical activity intervention on lower body bone health in childhood cancer survivors: A randomized controlled trial (SURfit)

The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an International Mixed Methods Study

Osteoporosis in Childhood Cancer Survivors: Physiopathology, Prevention, Therapy and Future Perspectives

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