Physical Activity, Fitness, and Cardiometabolic Risk Factors in Adult Survivors of Childhood Cancer with a History of Hematopoietic Cell Transplantation

Abstract

Purpose Along with other childhood cancer survivors (CCS), hematopoietic cell transplantation (HCT) survivors are at high risk of treatment-related late effects, including cardiovascular disease and diabetes. Cardiometabolic risk factor abnormalities may be exacerbated by inadequate physical activity (PA). Relationships between PA and cardiometabolic risk factors have not been well described in CCS with HCT. Methods PA (self-report), mobility (Timed Up and Go test), endurance (six-minute walk test), handgrip strength, and cardiometabolic risk factors were measured in 119 HCT survivors and 66 sibling controls aged ≥18 years. Adjusted comparisons between HCT survivors and controls and between categories of low and high PA, mobility, endurance, and strength were performed with linear regression. Results Among HCT survivors, the high PA group had lower waist circumference (WC) (81.9±2.5 v 88.6±3.1 cm±standard error (SE), P=.009) than the low PA group, while the high endurance group had lower WC (77.8±2.6 v 87.8±2.5 cm±SE, P=.0001) and percent fat mass (33.6±1.8 v 39.4±1.7 %±SE, P=.0008) and greater insulin sensitivity (IS) (10.9±1.0 v 7.42±1.14 mg/kg/min±SE via euglycemic insulin clamp, P=.001) than the low endurance group. Differences were greater in HCT survivors than in controls for WC between low and high PA groups, triglycerides between low and high mobility groups, and WC, systolic blood pressure, and IS between low and high endurance groups (all Pinteraction <.05). Conclusions Higher endurance was associated with a more favorable cardiometabolic profile in HCT survivors, suggesting that interventions directed to increase endurance in survivors may reduce the risk of future cardiovascular disease.

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Cardiovascular Disease and Associated Risk Factors Working Group Report

“…72–74 A variety of oral glucose lowering medications (for e.g., metformin, insulin and acarbose) have been tested to delay or reduce the progression from PDS to DM and/or decrease CVD risk in the general population; however, metformin has been the only agent recommended by the ADA. 58 No studies have tested pharmacologic interventions in HCT survivors, thus, it remains unknown whether diagnosing PDS early and treating these aggressively may improve CVD risk in this population.…”

Diabetes and Metabolic Syndrome in Survivors of Childhood Cancer

“…In a cross-sectional study of 117 adult survivors of childhood ALL, our group found that the odds of having metabolic syndrome fell by 31% for each unit increase in adherence to a Mediterranean diet [74]. Others have similarly demonstrated that increased physical activity is associated with improved cardiometabolic risk factor status in childhood cancer survivors [85, 86] and in HCT survivors specifically [87]. These studies provide important foundational data for future intervention studies assessing the impact of lifestyle change on metabolic risk in childhood cancer survivors.…”

Health Behavior Change Interventions for Teenage and Young Adult Cancer Survivors: A Systematic Review

“…Combined, these findings suggest that physical activity and healthy lifestyle among young cancer survivors may reduce cardiovascular risk and improve long-term health by the same mechanisms observed in older adult cancer survivors and age-matched healthy population controls. 12,13 However, although evidence is limited, surveys suggest that a significant proportion of TYA-aged cancer survivors fail to meet diet and physical activity recommendations [14][15][16][17] and engage in multiple risky health behaviors such as smoking and drinking. 18,19 A cross-sectional survey of 74 young adult cancer survivors (M age = 22.9 years) found that only 48.7% of the sample met physical activity guidelines and that more than half retrospectively rated their current fitness as ''much worse'' or ''not quite as good'' compared with pre-diagnosis.…”