The effect of an online exercise programme on bone health in paediatric cancer survivors (iBoneFIT): study protocol of a multi-centre randomized controlled trial

Abstract

Background New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health. Methods A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health. Discussion Whether a simple, feasible and short in duration exercise programme can improve bone health has not been examined in paediatric cancer survivors. This article describes the design, rationale and methods of a study intended to test the effect of a rigorous online exercise programme on bone health in paediatric cancer survivors. If successful, the iBoneFIT study will contribute to decrease chronic health conditions in this population and will have a positive impact in the society. Trial registration Prospectively registered in isrctn.com: isrctn61195625. Registered 2 April 2020.

Telehealth multicomponent exercise and health education in breast cancer patients undergoing primary treatment: rationale and methodological protocol for a randomized clinical trial (ABRACE: Telehealth)

“…Ongoing trials have contributed to exploring the positive effects of online exercise programs in the oncology population. Currently, a randomized controlled trial employing jumping training delivered by recorded videos and including behavioral and diet counseling has been implemented to improve bone health and clinical outcomes in pediatric cancer survivors [17]. Furthermore, an innovative single-arm study assesses the feasibility and acceptability of a group-based exercise intervention using teleconferencing in older patients who have received or are undergoing liver cancer treatment [40].…”

Telehealth: A Useful Tool for the Management of Nutrition and Exercise Programs in Pediatric Obesity in the COVID-19 Era

“…During the last two decades, thanks to the improvement of electronic devices and the spread of online technologies, training and exercise practice was implemented through applications, web channels, and online platforms and specific active videogames (called exergames) were also developed to bring exercise training closer to online technologies [140,141]. Before the COVID-19 pandemic, the use of tele-exercise and exergames as home training was high, especially among children with diseases, such as cerebral palsy, bone cancer, and cystic fibrosis, and aimed to limit public exposure, risk of infections, and transport barriers [142][143][144]. In a study conducted among children with cerebral palsy, during an online individualized training program, specialists deduced that virtual reality was effective in cognitive function improvement through levels of attention and increased concentration [142].…”

“…In addition, other studies in patients with spastic hemiplegic cerebral palsy showed an improvement in upper limb motor function and an increase in manual strength [145]. Chen et al [143] proposed an interactive tele-exercise program with wearable devices in children with cystic fibrosis, suggesting that the streaming of sessions is a viable and convenient method to encourage PA practice without cross-infection risks associated with in-person group activity. Finally, Cosano et al [144] reported benefits on bone health in pediatric cancer survivors through a supervised online training program.…”

Combatting Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with Obesity in the COVID-19 Era: A Narrative Review

“…The using of tele-exercise and exergames spread ahead the COVID-19 outbreak, especially among children with pathologies such as cerebral palsy, bone cancer, and cystic fibrosis. This practice aimed to limit public exposure, risks of infections, and transport barriers [131][132][133]. In research conducted in children with cerebral palsy, based on an online individualized exercise program, specialists concluded that the virtual environment was effective in ameliorating the cognitive function thanks to increased levels of attention and concentration [131].…”

“…Moreover, other studies in children with spastic hemiplegic cerebral palsy found gains of motor function in the upper limbs and an improvement of manual strength [131]. Chen et al [132] equipped an interactive online exercise training with wearable devices in children with cystic fibrosis, finding that the streaming of the sessions is a practicable and suitable way to encourage PA practice without cross-infection risks related to in-person group activity. Finally, Cosano et al [133] showed improvements on bone health in pediatric cancer survivors after an adapted and supervised online exercise program.…”