Vigorous physical activity and mental health—Associations suggest a link among childhood cancer survivors

Abstract

Cancer and its treatment often negatively influence the psychological well-being of survivors of childhood cancers for years or even decades after diagnosis. Commonly occurring cancer-related symptoms include depression, anxiety, pain, fatigue, and cognitive impairment; these symptoms tend to cluster and culminate in poorer overall health-related quality of life (HRQOL). Exercise is an effective nonpharmacologic approach to mitigate cancer-related symptoms. 1 The American Cancer Society nutrition and physical activity guidelines recommend at least 150 minutes of moderate physical activity per week. 2 Yet the majority of survivors of childhood cancers fail to meet these guidelines. 3 Much of the evidence on exercise comes from studies among adult female breast cancer survivors. Recently, Dieli-Conwright and collegues 4 conducted a randomized controlled trial (RCT) of a progressive exercise intervention, consisting of aerobic exercise and resistance training 3 times per week over a period of 16 weeks, among 100 adult female breast cancer survivors. At postintervention, compared with the control group, the exercise group reported significant improvements in HRQOL (between-group difference, 14.7; 95% CI, 18.2-9.7; P < .001), fatigue (P < .001), and depression (P < .001), which were maintained at 3-month follow-up. To evaluate the impact of the LIVESTRONG at the YMCA exercise program among adult cancer survivors of various cancer types, Irwin and colleagues 5 enrolled 186 male and female survivors. The intervention consisted of a twice-weekly, 90-minute exercise program of aerobic exercise and resistance training led by a YMCA trainer over the period of 12 weeks. The exercise program improved HRQOL (between group difference, 4.1; 95% CI, 0.5-7.7; P < .03). However, among childhood cancer survivors, exercise intervention studies are sparse.An ongoing RCT among 150 childhood cancer survivors (aged ≥16 years and diagnosed at least 5 years before the study; the SURfit study 6 ) is currently testing whether a 12-month partially supervised exercise intervention can improve cardiovascular disease risk factors, bone health, body composition, physical activity, fitness, fatigue, mental health, and overall HRQOL. The intervention consists of at least 2.5 hours per week of vigorous physical activity, including 30 minutes of strength training and 2 hours of aerobic exercise. In addition, participants are requested to reduce screen time by 25%. Motivational tools include individual "personal coach" phone calls (conducted by a physiotherapist), a web-based daily activity diary, and a pedometer. Data are collected a baseline and at 3, 6, and 12 months. Proposed study completion for this RCT (clinicaltrials.gov identifier NCT02730767) is March 2019.In this issue of Cancer, Tonorezos and colleagues 7 focus on the relationship between vigorous exercise and psychological well-being among 6199 adult survivors of childhood cancer within the Childhood Cancer Survivor Study (CCSS) who currently have a median age of 34.3 years. They report t...

Effects of Exercise Intervention on Quality of Life in Adolescent and Young Adult Cancer Patients and Survivors: A Meta-Analysis

“…While there is growing recognition that exercise is effective as a nonpharmacological intervention in diminishing cancer-related sequelae for AYA cancer survivors, 5 more than half of AYA cancer survivors nevertheless remain sedentary. 6 According to the physical activity guidelines of Centers for Disease Control and Prevention, AYAs are advised to engage in at least 150 minutes of moderate physical activity per week.…”