Physical Performance of Nontransplanted Childhood ALL Survivors is Comparable to Healthy Controls

Abstract

Physical fitness is an essential feature of overall health. Our objective was to compare the physical performance between nontransplanted acute lymphoblastic leukemia (ALL) patients (study patients), healthy controls, and ALL patients after stem cell transplantation (SCT). Forty-five ALL patients (median age, 13.3 y) treated without cranial irradiation were compared with 34 ALL patients (12.0 y) treated with SCT and total body irradiation and 522 age-matched and sex-matched controls. Their physical performance was assessed by 6 muscle tests measuring speed and dynamic endurance, flexibility, acceleration, maximal speed, and speed differentiation. The patients were tested at a minimum of 3 years after treatment. The muscle test results of the study patients did not differ from that of the healthy controls. The study patients had normal body mass indexes (BMI). Only 42% of them exercised at least once a week. Those who exercised >3 times a week and those with a BMI below median had better results. SCT patients had inferior results in 4 out of 6 tests. The physical performance of nontransplanted ALL patients did not differ from that of healthy controls. A higher physical exercise activity and a BMI below median positively correlated with better muscle performance, supporting the importance of encouraging ALL survivors to exercise and avoid obesity.

Energy balance and fitness in adult survivors of childhood acute lymphoblastic leukemia

“…Jarvela et al 5 reported deficits in muscle performance and a 14% deficit in peak VO 2 when comparing 21 ALL survivors 16 to 30 years of age to age-and sex-matched controls, and Hartman et al 37 reported that mean performance on the 6-minute walk test was 2 SD below predicted, 5 years after therapy among 34 ALL survivors aged 9 to 18 years. In contrast, Taskinen et al 38 reported no differences in performance on 6 timed measures of physical fitness when comparing 45 ALL survivors aged 9 to 20 years to established reference values. 38 In our multivariable analysis among those not exposed to CRT, we found no specific chemotherapy agents or doses associated with proximal muscle weakness or exercise capacity.…”

“…In contrast, Taskinen et al 38 reported no differences in performance on 6 timed measures of physical fitness when comparing 45 ALL survivors aged 9 to 20 years to established reference values. 38 In our multivariable analysis among those not exposed to CRT, we found no specific chemotherapy agents or doses associated with proximal muscle weakness or exercise capacity. This suggests that exposure to cellular toxic therapies may confer nonspecific general damage to underlying cellular structures that persists years after exposure.…”

“…This finding is in contrast to a study in a small group (N 5 45) of younger (median age, 13.3; range, 9.2-20.1 years) ALL survivors treated without CRT, in which deficits in flexibility were not detected. 38 In our cohort, impaired dorsiflexion and low-back/hamstring flexibility were associated with higher cumulative dose of asparaginase. Hovi et al previously described a similar association, but between L-asparaginase exposure and muscular endurance (performance on sit-up and push-up tests), in a group of 43 female ALL survivors 14 to 30 (mean, 19) years of age.…”

Associating Physical Activity Levels with Motor Performance and Physical Function in Childhood Survivors of Acute Lymphoblastic Leukemia

“…19 Furthermore, results from these studies have been mixed, with one study 5 reporting no significant association between 6MWD and sports participation in childhood ALL survivors, and two studies reporting that more active childhood cancer survivors had better overall physical function, as measured with the 6MWT 6 and individual muscle performance tests. 19 Another study found that less physically active childhood cancer survivors felt more fatigued and had less physical strength and endurance. 18 The lack of observed association among PA, motor performance, and physical function in our study could be a result of several factors.…”

“…Anthracycline treatment has well-documented, potentially long-term cardiotoxic side effects, and it potentially limits physical function. 16,17 Few studies have investigated whether motor performance or physical function impairments are related to PA levels in children who have completed treatment for ALL, 5,6,18,19 and to date, these studies have included childhood cancer survivors with a wide range in age and time since completing treatment. Given how important it is that children participate in PA for their normal growth and development, and recognizing that a suitable time to reintroduce habitual PA is once treatment for ALL is completed, 20 a better understanding of the factors associated with higher or lower PA levels in children shortly after completing treatment for ALL is needed.…”