Inhospital exercise benefits in childhood cancer: A prospective cohort study

Abstract

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.

Tailored Exercise during Hematopoietic Stem Cell Transplantation Hospitalization in Children with Cancer: A Prospective Cohort Study

“…In addition, an interesting finding was the lower number of infections after allo-HSCT in the exercise group, which remained quasi-significant after statistical adjustment ( p = 0.023 and 0.083 for total and viral infections, respectively). Further, in concordance with a recent study of our group in which fewer hospitalization days were observed for children and adolescents with cancer undergoing an exercise training program compared with a control group [ 11 ], we observed a trend ( p = 0.052) in unadjusted analysis towards a lower number of days between allo-HSCT and hospital discharge in the exercise group (17 days) compared to the control group (21 days).…”

“…The training load was gradually increased depending on the patients’ age, physical capacity, and health status. Exercise intensity was recorded continuously with heart rate (HR) monitors (Xtrainer Plus; Polar Electro OY, Kempele, Finland) and progressively increased from 65% to 80% of HR reserve (i.e., age-predicted maximum HR (220 minus age, in years) minus supine resting HR) [ 11 ]. Thereafter, participants performed strength exercises engaging major muscle groups (leg extension, half squat, plank on knees, supine bridge, arm curl, elbow extension, push-ups, and rowing) for a total duration of ~15 min ( Videos S2 and S3 ).…”

Untitled

“…Therefore, although LV function did not improve in the present meta-analysis, the fact that exercise interventions attenuated its decline is also worth noting because CCS frequently experience impaired LV function (i. e., LVEF and FS) even after treatment has ended [6]. It should be noted that in the study by Morales et al [8], exercise-associated benefits on LV function were not maintained at 1 year of follow-up or thereafter, suggesting that exercise should be ideally maintained after treatment has ended.…”

“…Flow chart of literature search. ▶table Studies analyzing the effects of exercise interventions on CCS during treatment Study Study design Sample size by group (sex), age (mean ± SD; range)Beulertz et al[19] Non-randomized controlled trial -EXP: n = 20 (9 female), 9 ± 5 years (5-13)-CT: n = 13 (8 female), 10 ± 4 years (6-14)-Healthy group: n = 20 (9 female), 9 ± 4 years(5)(6)(7)(8)(9)(10)(11)(12)(13)…”

Effects of a physical activity program from diagnosis on cardiorespiratory fitness in children with cancer: a national non-randomized controlled trial

“…The effects of the intervention might reduce the children's risk of developing cardiorespiratory fitness-related medical conditions years after their treatment has ended. This is supported by a recent study that showed that exercise during treatment maintained INT the intervention group, CON the control group *The interaction effect in TUG is presented in percentages left ventricular function compared with a non-exercising control group after ended treatment [44]. A key challenge in designing physical activity programs for children with cancer is to accommodate the varying and common treatmentrelated side effects (e.g., nausea, pain, and dizziness).…”