Is an Exercise Program for Pediatric Cancer Patients in Palliative Care Feasible and Supportive?—A Case Series

Abstract

(1) Background: Growing evidence indicates benefits through exercise programs in pediatric oncology throughout the whole cancer trajectory. This should include palliative care, too. This project analyzes the feasibility of a supervised exercise program offered during hospital and home-based care for children with advanced cancer diagnoses. (2) Methods: Four children (7–13 years old) with advanced cancer diagnoses participated in this project. It consisted of supervised exercise sessions offered once a week (30–90 min), mainly home-based, but also on an in- and outpatient basis. Regular data assessments included psychological and physical capacity-related endpoints and body composition. Details and contents of exercise sessions and adverse events were recorded. (3) Results: Exercise was feasible with 73 ± 9% adherence to the minimum number of planned sessions. The exercise offer was accepted until shortly before death. Effects on fatigue, quality of life and muscular endurance were noted. Participants showed major deviations from age-specific reference values. No exercise-related adverse events occurred. (4) Conclusions: The exercise program was safe, feasible, and might have served as a supportive tool to reduce overall burden. Evaluation of exercise as usual palliative care should be assessed by further studies.

Effects of exercise on sleep in patients with epilepsy: A systematic review

“…Seizure frequency decreased in five studies after trials ranging from ten weeks to twelve months, two of which tested yoga [52] , [55] , two of which tested combined aerobic, strength, and stretch training [56] , [57] , and one of which combined aerobic exercise with a low glycemic diet [27] . Nine studies [28] , [29] , [30] , [31] , [58] , [59] , [60] , [61] , [62] specifically mentioned that the tested exercise intervention was feasible, and only one reported limited feasibility [63] . Although the exercise interventions were generally deemed safe, one study reported that half of participants (7 out of 14) experienced seizures during exercise [56] .…”

“…The two articles by Vooturi et al [30] , [63] reported average sleep duration at baseline but did not assess the effects of the exercise intervention on sleep as an outcome. Two studies [56] , [60] did not assess sleep directly but included sleep and rest-related fatigue outcomes in their studies. Of these, a case study of four children with brain tumor diagnoses, one of which with a diagnosis of epilepsy, reported that 30–90 min of home-based exercise per week improved general and cognitive fatigue, but worsened sleep and rest-related fatigue over time [60] .…”

“…Two studies [56] , [60] did not assess sleep directly but included sleep and rest-related fatigue outcomes in their studies. Of these, a case study of four children with brain tumor diagnoses, one of which with a diagnosis of epilepsy, reported that 30–90 min of home-based exercise per week improved general and cognitive fatigue, but worsened sleep and rest-related fatigue over time [60] . It is notable that these results occurred in the context of a progressive cancer diagnosis that is typically associated with increasing levels of fatigue over time.…”

“…Notably, one study reported marginal improvements in subjective sleep quality in children with epilepsy [50] , while another study reported no improvements in subjective sleep quality in adults with epilepsy, although different questionnaires were used to assess subjective sleep quality and this could explain the discrepant findings [57] . The lack of an effect of exercise on sleep could be due to a variety of factors, including being underpowered to determine an effect (studies would likely not have been powered for sleep as a mediator/moderator or outcome) [60] , heterogeneity of the sample to include epilepsy phenotypes where sleep disorders are less impactful, inclusion of participants without a sleep concern at baseline assessment producing a floor effect [50] , or lack of rigorous assessment of sleep examining multiple domains. In particular, participants in Do et al’s study were active at baseline and displayed normal sleeping patterns, which could have limited potential exercise-related impacts on their sleep [50] .…”

Análisis de la implementación de cuidados paliativos en pacientes pediátricos oncológicos en etapas terminales

“…Frente a las necesidades del niño oncológico y la familia Beller et al (2023) y Kazak & Noll. (2015) mencionan la importancia de que el psicólogo intervenga dentro de los CCP.…”