Reply: Letter to the Editor: Exercise Interventions and
                    Cardiovascular Health in Childhood Cancer: A Meta-Analysis

Dear EditorWe sincerely appreciate the nice comments by Drs. P.V. da Costa Ghignatti and R. Pereira de Lima 1 concerning our recent meta-analysis assessing the effects of physical exercise interventions on cardiovascular endpoints in childhood cancer survivors 2. They are quite right to remain that even non-significant improvements in cardiorespiratory fitness (CRF) might be clinically relevant. Indeed, we still do not know if CRF increments of a theoretically low magnitude (i. e., <1 metabolic equivalent) might have a prognostic value in the context of pediatric cancer and treatment-associated cardiotoxicity. We also agree that unsupervised exercise interventions are unlikely to be as effective as tailored programs, especially because the latter allow for intensity to being adequately controlled and thus gradually increased. It is indeed our opinion, after long years of experience working with children with cancer as well as with other debilitated clinical populations, that there is always room for physiological improvement and ideally loads should be gradually improved instead of remaining stable.

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Letter to the Editor: Exercise Interventions and Cardiovascular Health in Childhood Cancer: A Meta-Analysis

International Journal of Sports Medicine ◽

10.1055/a-1195-6425 ◽

2020 ◽

Vol 41 (09) ◽

pp. 628-629 ◽

Cited By ~ 1

Author(s):

Paola Victória da Costa Ghignatti ◽

Ricardo Pereira de Lima

Keyword(s):

Childhood Cancer ◽

Sports Medicine ◽

Cardiovascular Health ◽

Meta Analysis ◽

Childhood Cancer Survivors ◽

Structure And Function ◽

Training Intervention ◽

Exercise Interventions ◽

Cardiac Structure And Function ◽

And Function

Dear Editor,International Journal of Sports MedicineThe analysis of the study entitled “Exercise Interventions and Cardiovascular Health in Childhood Cancer: a Meta-Analysis” 1 was very interesting. The authors of this meta-analysis aimed to summarize the evidence on the effects of physical training intervention over three weeks on cardiovascular and cardiorespiratory outcomes in childhood cancer survivors (CCS). In addition, they addressed endpoints related not only to cardiac structure and function, but also to cardiorespiratory fitness.

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Exercise Interventions and Cardiovascular Health in Childhood Cancer: A Meta-analysis

International Journal of Sports Medicine ◽

10.1055/a-1073-8104 ◽

2020 ◽

Vol 41 (03) ◽

pp. 141-153 ◽

Cited By ~ 3

Author(s):

Javier S. Morales ◽

Pedro L. Valenzuela ◽

Alba M. Herrera-Olivares ◽

Antonio Baño-Rodrigo ◽

Adrián Castillo-García ◽

...

Keyword(s):

Confidence Interval ◽

Cancer Survivors ◽

Childhood Cancer ◽

Meta Analysis ◽

Childhood Cancer Survivors ◽

Left Ventricular ◽

Mean Difference ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Exercise Interventions

AbstractThis study analyzed the effects of physical exercise interventions on cardiovascular endpoints in childhood cancer survivors. Relevant articles were systematically searched in PubMed, CINAHL, and Web of Science databases (since inception to 11th September 2019). We performed a meta-analysis (random effects) to determine the mean difference (expressed together with 95% confidence intervals) between pre- and post-intervention values for those cardiovascular endpoints reported in more than three studies. Twenty-seven studies (of which 16 were controlled studies) comprising 697 participants were included. Only three studies reported adverse events related to exercise interventions. Exercise resulted in an increased performance on the 6-minute walk distance test (mean difference=111 m, 95% confidence interval=39–183, p=0.003) and a non-significant trend (mean difference=1.97 ml∙kg−1∙min−1, 95% confidence interval=−0.12–4.06, p=0.065) for improvement in peak oxygen uptake. Furthermore, left ventricular ejection fraction was preserved after exercise interventions (mean difference=0.29%, 95% confidence interval=−1.41–1.99, p=0.738). In summary, exercise interventions might exert a cardioprotective effect in childhood cancer survivors by improving – or attenuating the decline of – physical capacity and cardiovascular function. Further studies, particularly randomized controlled trials, are needed to confirm these benefits.

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Correction: Reply: Letter to the Editor: Exercise Interventions and Cardiovascular Health in Childhood Cancer: A Meta-Analysis

International Journal of Sports Medicine ◽

10.1055/a-1240-2907 ◽

2020 ◽

Author(s):

Javier S. Morales ◽

Pedro L. Valenzuela ◽

Alba M. Herrera-Olivares ◽

Antonio Baño-Rodrigo ◽

Adrián Castillo-García ◽

...

Keyword(s):

Childhood Cancer ◽

Cardiovascular Health ◽

Meta Analysis ◽

Exercise Interventions ◽

Letter To The Editor

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Abstract P270: Effects of Exercise Training on Cardiorespiratory Fitness and Biomarkers of Cardio-metabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Circulation ◽

10.1161/circ.131.suppl_1.p270 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Xiaochen Lin ◽

Xi Zhang ◽

Jianjun Guo ◽

Christian K Roberts ◽

Steve McKenzie ◽

...

Keyword(s):

Health Status ◽

Exercise Training ◽

Randomized Controlled Trials ◽

Cardiorespiratory Fitness ◽

Cardiovascular Health ◽

Meta Analysis ◽

Metabolic Health ◽

Controlled Trials ◽

Exercise Interventions ◽

Randomized Controlled

Context: Current guidelines recommend exercise for optimal cardiovascular health, although evidence from intervention trials linking exercise to cardiovascular health through intermediate biomarkers remains inconsistent. Objective: To perform a meta-analysis of randomized controlled trials (RCTs) to quantify the impact of exercise training on cardiorespiratory fitness (CRF) and a variety of standard and novel biomarkers for cardio-metabolic health in adults without cardiovascular disease (CVD). Data Sources: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 1965 to March 2014. Study Selection: Two investigators (X. Lin and X. Zhang) selected 159 RCTs (7,282 participants) that evaluated the effects of exercise interventions on CRF and circulating CVD biomarkers. Data Extraction: Data were extracted by two researchers using a standardized protocol. Data Synthesis: In the primary analysis, DerSimonian and Laird random-effect models were used to compute weighted mean differences (WMDs) and 95% confidence intervals (95% CIs) comparing exercise groups to control groups. In addition, effect modifications were examined using meta-regression and subgroup analyses stratified by pre-specified potential modifiers, including age, sex, body mass index, lifestyle, health status, and trial duration. Exercise training significantly improved CRF, lipid and lipoprotein metabolism, glucose intolerance and insulin resistance, systematic inflammation, and hemostasis. ( Table ) We also found that exercise effects were modified by age, sex, and health status such that people under 50 years, men, and people with type 2 diabetes, hypertension, hyperlipidemia, or metabolic syndrome appeared to benefit more from exercise interventions. Conclusion: This meta-analysis indicates that exercise training significantly improved CRF and some biomarkers of cardio-metabolic health. Significant effect modifications were also identified by age, sex, and health status.

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Effects of Physical Exercise Interventions on Stereotyped Motor Behaviours in Children with ASD: A Meta-Analysis

Journal of Autism and Developmental Disorders ◽

10.1007/s10803-021-05152-z ◽

2021 ◽

Author(s):

Elizabeth J. Teh ◽

Ranjith Vijayakumar ◽

Timothy Xing Jun Tan ◽

Melvin J. Yap

Keyword(s):

Physical Exercise ◽

Meta Analysis ◽

Exercise Interventions ◽

Children With Asd

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Greater cardiorespiratory fitness reduces incidence of atrial fibrillation: a meta-analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.200 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

C Verdicchio ◽

A Elliott ◽

R Mahajan ◽

D Linz ◽

D Lau ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Risk Factor ◽

Cardiorespiratory Fitness ◽

Meta Analysis ◽

Exercise Stress ◽

Inverse Association ◽

Exercise Interventions ◽

Increased Risk ◽

Statistical Heterogeneity

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the global population, with the prevalence of AF increasing dramatically over the past two decades. Although low levels of cardiorespiratory fitness (CRF) and physical activity are predictive of cardiovascular disease onset and mortality, only recently has this emerged as a potential risk factor for AF. Purpose The aim of this meta-analysis was therefore to quantify the relationship between CRF, measured by a symptom limited exercise stress test, and incident AF. We hypothesised that there would be an inverse relationship between CRF and the incidence of AF. Methods The systematic literature review was conducted using PUBMED, MEDLINE and EMBASE databases, with seven studies meeting the inclusion criteria. A random-effects meta-analysis was then used to compare the multivariate risk estimates of the lowest CRF group from each cohort with the group of the highest CRF. Results Data from 206,925 individuals (55.8% males) was used for analysis with a mean age of 55 ± 2.5 years and a mean follow-up period of 10.3 ± 5 years. The total number of AF events across the studies was 19,913. The overall pooled risk of AF in the high-CRF group versus the low-CRF group showed a significant lower risk of incident AF in those with high-CRF (OR: 0.52, 95% CI, 0.44-0.605, p < 0.001). There was evidence of statistical heterogeneity between the studies (I2 = 81%, p < 0.001). AF incidence rates demonstrated an overall decline in rates across the CRF quartiles from low to high. The mean incidence rate for low-CRF was 21 ± 13.4 compared to 6.9 ± 0.7 per 1000 person-years for the high CRF group (p = 0.03). Conclusion There is an inverse association between a lower CRF and an increased risk of AF, with a higher level of CRF protective against AF. This study highlights that low-CRF may be an additional risk factor for AF along with already other established lifestyle-based risk factors such as obesity and hypertension. Exercise interventions should be promoted as a primary prevention strategy in those at risk of developing AF with known risk factors. Future studies are warranted to identify the mechanism(s) through which improved CRF confers a reduction in AF incidence. Abstract Figure. AF risk between high and low-CRF

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Fear of progression in parents of childhood cancer survivors: prevalence and associated factors

Journal of Cancer Survivorship ◽

10.1007/s11764-021-01076-w ◽

2021 ◽

Author(s):

Mona L. Peikert ◽

Laura Inhestern ◽

Konstantin A. Krauth ◽

Gabriele Escherich ◽

Stefan Rutkowski ◽

...

Keyword(s):

Cancer Survivors ◽

Childhood Cancer ◽

Pediatric Cancer ◽

Coping Style ◽

Associated Factors ◽

Childhood Cancer Survivors ◽

Cns Tumor ◽

Mothers And Fathers ◽

Fear Of Progression ◽

Pediatric Cancer Survivors

Abstract Purpose Recent research demonstrated that fear of progression (FoP) is a major burden for adult cancer survivors. However, knowledge on FoP in parents of childhood cancer survivors is scarce. This study aimed to determine the proportion of parents who show dysfunctional levels of FoP, to investigate gender differences, and to examine factors associated with FoP in mothers and fathers. Methods Five hundred sixteen parents of pediatric cancer survivors (aged 0–17 years at diagnosis of leukemia or central nervous system (CNS) tumor) were consecutively recruited after the end of intensive cancer treatment. We conducted hierarchical multiple regression analyses for mothers and fathers and integrated parent-, patient-, and family-related factors in the models. Results Significantly more mothers (54%) than fathers (41%) suffered from dysfunctional levels of FoP. Maternal FoP was significantly associated with depression, a medical coping style, a child diagnosed with a CNS tumor in comparison to leukemia, and lower family functioning (adjusted R2 = .30, p < .001). Paternal FoP was significantly associated with a lower level of education, depression, a family coping style, a child diagnosed with a CNS tumor in comparison to leukemia, and fewer siblings (adjusted R2 = .48, p < .001). Conclusions FoP represents a great burden for parents of pediatric cancer survivors. We identified associated factors of parental FoP. Some of these factors can be targeted by health care professionals within psychosocial interventions and others can provide an indication for an increased risk for higher levels of FoP. Implications for Cancer Survivors Psychosocial support targeting FoP in parents of childhood cancer survivors is highly indicated.

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