Exercise Interventions in Children with Cancer: A Review

The purpose of this review is to summarize literature that describes the impact of exercise on health and physical function among children during and after treatment for cancer. Relevant studies were identified by entering the following search terms into Pubmed: aerobic training; resistance training; stretching; pediatric; children; AND cancer. Reference lists in retrieved manuscripts were also reviewed to identify additional trials. We include fifteen intervention trials published between 1993 and 2011 that included children younger than age 21 years with cancer diagnoses. Nine included children with an acute lymphoblastic leukemia (ALL) diagnosis, and six children with mixed cancer diagnoses. Generally, interventions tested were either in-hospital supervised exercise training or home based programs designed to promote physical activity. Early evidence from small studies indicates that the effects of exercise include increased cardiopulmonary fitness, improved muscle strength and flexibility, reduced fatigue and improved physical function. Generalizations to the entire childhood cancer and childhood cancer survivor populations are difficult as most of the work has been done in children during treatment for and among survivors of ALL. Additional randomized studies are needed to confirm these benefits in larger populations of children with ALL, and in populations with cancer diagnoses other than ALL.

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Home-Based Resistance and Plyometric Training Program using Telehealth in Early Survivors of Childhood Acute Lymphoblastic leukemia: a Feasibility Study (Preprint)

10.2196/preprints.25569 ◽

2020 ◽

Author(s):

Genevieve Lambert ◽

Nathalie Alos ◽

Pascal Bernier ◽

Caroline Laverdière ◽

Dahlia Kairy ◽

...

Keyword(s):

Physical Activity ◽

Acute Lymphoblastic Leukemia ◽

Bone Health ◽

Lymphoblastic Leukemia ◽

Functional Health ◽

Exercise Interventions ◽

Technical Requirements ◽

Home Based ◽

Intervention Protocol ◽

The Impact

BACKGROUND Acute Lymphoblastic Leukemia (ALL) is the most common type of pediatric cancer. ALL causes altered bone-mineral homeostasis state, which can contribute to osteopenia, and bone fractures, most commonly vertebral fractures. With the increasing number of childhood cancer survivors, late adverse effects (LAEs) such as musculoskeletal comorbidities are often reported, and are further influenced by inactive lifestyle habits. Physical activity has been shown to increase mechanical workload to the bone, mitigating the bone impairment in other cancer-specific populations. OBJECTIVE This interventional study proposes to investigate (1) the use of telehealth to deliver home-based exercise program for early-on survivors of bone marrow-related hematological malignancies, further (2) assessing its impact on survivors’ musculoskeletal and functional health. METHODS Survivors of ALL (n=12); 75% girls; 7.9 to 14.7 years old) within 6 months to 5 years off treatment were recruited to participate in the proposed study with a parent. The 16-week program included 40 potential home-based physical activity interventions supervised by a kinesiologist through a telehealth internet platform, with monthly progression. Patients could be recruited for the cohort if they were able to join the program during the first month (minimum 12 weeks of intervention). Evaluation before and after the intervention protocol highlighted differences in functional capacities and musculoskeletal health of patients using Mechanography, pQCT, six-minute walk test (6MWT), and grip force test. RESULTS Of the 12 patients recruited, 3 were excluded (1=relapse; 1=failure to meet technical requirements, and 1 abandoned). The 9 patients that completed the program (6 girls; 10.93±2.83 years; BMI: 21.58±6.55; CR: 36.67±16.37months) had a mean adherence of 89%, representing a completion rate of 75%. Additionally, these patients showed functional improvements in absolute and relative lower-limbs muscle power, relative muscle force, and 6MWT. Participants also showed improved bone health post-intervention on the following parameters: BMC, SSI, total and cortical CSA at the 14% and 38% sites of the tibia. CONCLUSIONS Telehealth might be a feasible way of delivering exercise interventions to ALL early-on survivors, with high adherence, and might bring benefits to patients’ functional performance in addition to bone health parameters. A longer intervention is needed to truly assess the impact of such program on bone health.

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Physical Activity: Physical Activity in the Management of Osteoarthritis of the Knee and Hip

American Journal of Lifestyle Medicine ◽

10.1177/1559827607302142 ◽

2007 ◽

Vol 1 (4) ◽

pp. 264-266 ◽

Cited By ~ 1

Author(s):

Robert F. Zoeller

Keyword(s):

Physical Activity ◽

Strength Training ◽

Physical Function ◽

Functional Decline ◽

Exercise Program ◽

Osteoarthritis Of The Knee ◽

Exercise Programs ◽

Exercise Interventions ◽

Supervised Exercise ◽

Home Based

Symptomatic osteoarthritis (OA) affects more than 4 million adults in this country and is associated with joint degeneration, chronic pain, muscle atrophy, decreased mobility, poor balance, and physical disability. The prevalence of comorbid conditions such as heart disease, hypertension, and obesity is greater in those with symptomatic OA. Obesity is a risk factor for OA, and weight loss has been shown to reduce pain and improve physical function. The role of physical activity/inactivity in the development of OA is not clear. Limited evidence suggests that a sedentary lifestyle may increase the risk for OA, while high levels of physical activity have also been suggested to contribute to the development of OA. Regular aerobic exercise may moderate the functional decline associated with OA. Both aerobic and strength training have been reported to reduce pain and improve physical function in persons with knee and hip OA, although very few studies have specifically examined the effects of regular physical activity on the OA hip. While it is generally recommended that exercise programs for OA incorporate both aerobic and strength-training activities, no studies have been performed to evaluate the efficacy of combining these 2 modes of exercise compared with either alone. Little work has been done to determine the optimal exercise program for individuals with OA. One study suggests that exercise interventions should be performed a minimum of 3 days per week for a duration of at least 35 minutes. Exercise programs should be individualized based on the patient's preferences, abilities, limitations, and comorbidities. It is recommended that exercise programs for OA incorporate strategies designed to promote adherence. Home-based exercise appears to be as effective as supervised exercise programs.

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Outcomes for Children and Adolescents With Cancer: Challenges for the Twenty-First Century

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.0421 ◽

2010 ◽

Vol 28 (15) ◽

pp. 2625-2634 ◽

Cited By ~ 593

Author(s):

Malcolm A. Smith ◽

Nita L. Seibel ◽

Sean F. Altekruse ◽

Lynn A.G. Ries ◽

Danielle L. Melbert ◽

...

Keyword(s):

United States ◽

Childhood Cancer ◽

Cancer Mortality ◽

Lymphoblastic Leukemia ◽

The United States ◽

Mortality Rates ◽

Mortality Data ◽

Childhood Cancers ◽

Essential Information ◽

The Impact

Purpose This report provides an overview of current childhood cancer statistics to facilitate analysis of the impact of past research discoveries on outcome and provide essential information for prioritizing future research directions. Methods Incidence and survival data for childhood cancers came from the Surveillance, Epidemiology, and End Results 9 (SEER 9) registries, and mortality data were based on deaths in the United States that were reported by states to the Centers for Disease Control and Prevention by underlying cause. Results Childhood cancer incidence rates increased significantly from 1975 through 2006, with increasing rates for acute lymphoblastic leukemia being most notable. Childhood cancer mortality rates declined by more than 50% between 1975 and 2006. For leukemias and lymphomas, significantly decreasing mortality rates were observed throughout the 32-year period, though the rate of decline slowed somewhat after 1998. For remaining childhood cancers, significantly decreasing mortality rates were observed from 1975 to 1996, with stable rates from 1996 through 2006. Increased survival rates were observed for all categories of childhood cancers studied, with the extent and temporal pace of the increases varying by diagnosis. Conclusion When 1975 age-specific death rates for children are used as a baseline, approximately 38,000 childhood malignant cancer deaths were averted in the United States from 1975 through 2006 as a result of more effective treatments identified and applied during this period. Continued success in reducing childhood cancer mortality will require new treatment paradigms building on an increased understanding of the molecular processes that promote growth and survival of specific childhood cancers.

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THE IMPACT OF 3 MONTHS OF SUPERVISED EXERCISE ON CHANGE IN FUNCTION: COMPARISONS BY ARTHRITIS STATUS

Innovation in Aging ◽

10.1093/geroni/igz038.136 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S34-S35

Author(s):

Lauren M Abbate ◽

Katherine Hall ◽

Megan Pearson ◽

Richard Sloane ◽

Kelli D Allen ◽

...

Keyword(s):

Physical Function ◽

Upper Body ◽

Lower Body ◽

Time Points ◽

Supervised Exercise ◽

Mean Differences ◽

The Impact ◽

Usual Gait Speed ◽

Minute Walk

Abstract Physical activity is an established intervention for the management of arthritis. This study evaluated the effect of 3 months of participation in Gerofit on physical function by arthritis status. Participants, 519 Veterans aged ≥ 65 years self-reported either no arthritis (NA) (49%), upper body arthritis (UB) (8.2%), lower body arthritis (LB) (12.7%), or both upper and lower body arthritis (UB&LB) (30.4%) upon enrollment. Physical function measures [10-meter usual gait speed (m/s) (GS), arm curls (AC), chair stands (CS), and 6-minute walk (yards) (SMW)] were assessed at baseline and follow-up. Mean differences between time points were calculated. At baseline, compared to NA, LB and UB&LB had slower GS (1.10 and 1.06 vs 1.13) and shorter SMW distance (468.8 and 448.8 vs 490.7). All groups tended to increase physical function, with greatest improvement among LB (GS=0.27, AC=2.06, CS=2.52, SMW=42.53). Participation in Gerofit is associated with functional gains, regardless of burden of disease.

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Promoting Health and Physical Function Among Cancer Survivors: Potential for Prevention and Questions That Remain

Journal of Clinical Oncology ◽

10.1200/jco.2006.06.6175 ◽

2006 ◽

Vol 24 (32) ◽

pp. 5125-5131 ◽

Cited By ~ 167

Author(s):

Wendy Demark-Wahnefried ◽

Bernardine M. Pinto ◽

Ellen R. Gritz

Keyword(s):

Physical Activity ◽

Smoking Cessation ◽

Cancer Survivors ◽

Physical Function ◽

Behavioral Change ◽

Exercise Interventions ◽

Increased Risk ◽

Health Related ◽

The Impact

Cancer survivors are at increased risk, not only for progressive and recurrent disease, but also other cancers, cardiovascular disease, diabetes, osteoporosis, and functional decline. Lifestyle interventions to improve dietary and physical activity behaviors, and smoking cessation, have the potential to improve the overall health and quality of life of this vulnerable population. Studies on overall health and physical function from 1966 and beyond regarding the impact of behavioral interventions that used randomized and controlled designs were identified through MEDLINE and PubMed searches. Published reports currently exist for 22 exercise interventions, 11 diet-related interventions (excluding those limited to dietary supplements or single nutrients), two diet and exercise interventions, and 10 behavioral-based smoking cessation interventions. Although many interventions have been successful in promoting behavioral change and have resulted in improvements in various health-related outcomes, more research is needed to determine the key components of interventions that are able to produce the greatest behavioral change and the most favorable health-related benefits. The oncology care provider can play a pivotal role in improving the long-term health of cancer survivors by (1) being aware of opportunities to encourage healthful behaviors (ie, smoking cessation, weight control, and increased physical activity); (2) vigilantly tracking long-term effects among cancer survivors and exploring whether they are amenable to intervention; (3) staying abreast of current health behavior guidelines for cancer survivors and existing resources for professional and patient education; and (4) supporting and contributing to efforts aimed at primary and tertiary prevention research.

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Osteoarthritis, Exercise, and Tissue Engineering: A Stimulating Triad for Health Professionals

Journal of Aging Research ◽

10.1155/2019/1935806 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Pedro Morouço ◽

Cristiana Fernandes ◽

Rita Santos-Rocha

Keyword(s):

Tissue Engineering ◽

Mechanical Load ◽

Cartilage Regeneration ◽

Future Research ◽

The Novel ◽

Exercise Interventions ◽

Supervised Exercise ◽

Repetitive Loading ◽

Intensity Of Exercise ◽

The Impact

Osteoarthritis (OA) is a degenerative disease, promoted by abnormal chronic mechanical loading over the joint, for instance, due to excessive body mass. Patients frequently report pain, fatigue, and limitations in specific functional daily activities. Regarding the treatment of OA, two nonpharmacological options are available. However, it is not clear which type and intensity of exercise have better outcomes in treatment and how tissue engineering can be a promising field due to the mechanical load implants will suffer. The aims of this work were to investigate (1) the main characteristics, prevalence, and consequences of OA; (2) the exercise prescription guidelines and whether exercise interventions have a positive effect on OA treatment; and (3) the novel improvements on tissue engineering for OA treatment. Both patients and practitioners should be aware that benefits may come from prescribed and supervised exercise. Recent studies have highlighted that an optimal balance between exercise and nutritional income should be widely recommended. Regarding tissue engineering, significant steps towards the development of implants that mimic the native tissue have been taken. Thus, further studies should focus on the impact that exercise (repetitive loading) might have on cartilage regeneration. Finally, suggestions for future research were proposed.

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A Personalized Patient-Centered Intervention to Empower through Physical Activity the Patient in the Dialysis Center: Study Protocol for a Pragmatic Nonrandomized Clinical Trial

Methods and Protocols ◽

10.3390/mps3040083 ◽

2020 ◽

Vol 3 (4) ◽

pp. 83

Author(s):

Fabio Manfredini ◽

Nicola Lamberti ◽

Yuri Battaglia ◽

Sofia Straudi ◽

Martino Belvederi Murri ◽

...

Keyword(s):

Physical Activity ◽

Clinical Outcomes ◽

Second Phase ◽

Patient Centered ◽

Activity Increase ◽

Dialysis Center ◽

Supervised Exercise ◽

Home Based ◽

The Impact

Sedentariness of patients affected by end-stage kidney disease (ESKD) expose them to high risk of unfavorable clinical outcomes. Exercise training is effective in improving physical function, quality of life (QoL) and long-term outcomes. However, the existing barriers related to patients, programs and dialysis staff limit patient participation and call for new strategies. This pragmatic nonrandomized trial will test the impact on ESKD population of an intervention proposed by an exercise facilitator regularly present in a dialysis center. The patient will be free to choose among three-month walking and/or resistance low-intensity training programs: (a) guided physical activity increase; (b) home-based exercise; (c) in-hospital (pre/post dialysis) supervised exercise; (d) performance assessment only. The first phase will define feasibility and the characteristics and preference of responders. The second phase will evaluate safety and patients’ adherence. Outcome measures will be collected at baseline, after three-month and at six-month follow-up. They will include: aerobic capacity, QoL, gait speed, strength, depression and long-term clinical outcomes (hospitalization and mortality). The trial was approved by the Area-Vasta Emilia-Romagna Centro Ethics Committee with approval number 48/2019. Written informed consent will be obtained from all participants. The results of the study will be presented in international congresses, published in peer-reviewed journals and communicated to the patient community. Registration details: Clinicaltrials.gov NCT04282616 [Registered:24/02/2020].

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The Impact of Home-Based Exercise Program on Physical Function of Chronic Kidney Disease Patients: A Meta-Analysis of Randomized Controlled Trials

Physikalische Medizin Rehabilitationsmedizin Kurortmedizin ◽

10.1055/a-1079-3714 ◽

2020 ◽

Vol 30 (02) ◽

pp. 108-114

Author(s):

Hongbo Ju ◽

Haojun Chen ◽

Caixia Mi ◽

Yifei Chen ◽

Caijiao Zuang

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Physical Function ◽

Meta Analysis ◽

Exercise Program ◽

Walk Test ◽

Randomized Controlled ◽

Home Based ◽

The Impact

Abstract Background Home-based exercise program showed the potential in improving physical function of chronic kidney disease patients, and it might need low associated costs. We conducted a systematic review and meta-analysis to explore the impact of home-based exercise program on physical function of chronic kidney disease patients. Methods PubMed, EMBASE, Web of science, EBSCO, and Cochrane library databases were systematically searched. This meta-analysis included randomized controlled trials (RCTs) assessing the effect of home-based exercise program on physical function of chronic kidney disease patients. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were 6-min walk test and grip strength change. Results Seven RCTs were included in the meta-analysis. Overall, compared with control intervention in chronic kidney disease patients, home-based exercise program could significantly improve 6-min walk test (MD=79.01; 95% CI=22.39–135.62; P=0.006) and grip strength (SMD=0.52; 95% CI=0.14–0.89; P=0.007), but showed no impact on pain scores (SMD=−1.43; 95% CI=−3.75 to 0.88; P=0.22), Kidney Disease Quality of life including symptom/problem list (SMD=1.92; 95% CI=−1.06 to 4.90; P=0.21), effects of kidney disease (SMD=−3.69; 95% CI=−8.56 to 1.19; P=0.14), or burden of kidney disease (SMD=1.04; 95% CI=−0.75 to 2.82; P=0.26). Conclusions Home-based exercise program might improve physical function for chronic kidney disease, and more RCTs should be conducted to confirm this issue.

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Feasibility and Acceptability of Home-Based Exercise Snacking and Tai Chi Snacking Delivered Remotely to Self-Isolating Older Adults During COVID-19

Journal of Aging and Physical Activity ◽

10.1123/japa.2020-0391 ◽

2021 ◽

pp. 1-11

Author(s):

Ian Ju Liang ◽

Oliver J. Perkin ◽

Polly M. McGuigan ◽

Dylan Thompson ◽

Max J. Western

Keyword(s):

Older Adults ◽

Physical Function ◽

Tai Chi ◽

Multilevel Models ◽

Controlled Trial ◽

Exercise Program ◽

Well Being ◽

Exercise Interventions ◽

Home Based

The purpose of this study was to examine the feasibility and acceptability of remotely delivered, home-based exercise programs on physical function and well-being in self-isolating older adults during the COVID-19 pandemic. In a four-arm randomized controlled trial, 63 participants (aged 65 years and older) were allocated to one of three home-based daily (2 × 10-min) exercise interventions (exercise snacking, tai chi snacking, and combination) or control (UK National Health Service Web pages). Functional assessments were conducted via video call at baseline and 4-week follow-up. A web-based survey assessed the acceptability of each exercise program and secondary psychological/well-being outcomes. Ecological momentary assessment data, collected in Weeks 1 and 4, explored feeling states as antecedents and consequences of exercise. All intervention groups saw increased physical function at follow-up and displayed good adherence with exercise snacking considered the most acceptable program. Multilevel models revealed reciprocal associations between feelings of energy and exercise engagement. Further studies are needed with larger, more diverse demographic samples.

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Maintaining Weight Loss in Obese Men with Prostate Cancer Following a Supervised Exercise and Nutrition Program—A Pilot Study

Cancers ◽

10.3390/cancers13143411 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3411

Author(s):

Rebekah L. Wilson ◽

Dennis R. Taaffe ◽

Robert U. Newton ◽

Nicolas H. Hart ◽

Philippa Lyons-Wall ◽

...

Keyword(s):

Prostate Cancer ◽

Weight Loss ◽

Body Composition ◽

Muscle Strength ◽

Physical Function ◽

Weight Maintenance ◽

Supervised Exercise ◽

Nutrition Programs ◽

Maintenance Program ◽

Home Based

Supervised exercise and nutrition programs can mitigate or reverse androgen deprivation therapy (ADT) induced fat mass (FM) gain, lean mass (LM) loss, and impaired physical function. It is unclear whether these benefits are retained following transition to self-management. This study examined the effect of a home-based weight maintenance program on body composition and physical function in obese men with prostate cancer (PCa) on ADT following a 12-week supervised weight loss intervention. Eleven obese PCa patients (74 ± 5 years, 40.0 ± 4.9% body fat) on ADT (>6 months) completed a 12-week self-managed home-based weight maintenance program consisting of 150 min/week of aerobic and resistance training while maintaining a healthy balanced diet. Body composition (DXA), muscle strength (1RM), and cardiorespiratory fitness (400 m walk) were assessed. Significant reductions in weight (−2.8 ± 3.2 kg) and FM (−2.8 ± 2.6 kg), preservation of LM (−0.05 ± 1.6 kg), and improvements in muscle strength and VO2max were achieved across the supervised intervention. Across the home-based program, no significant changes were observed in weight (−0.6 ± 2.8 kg, p = 0.508), FM (0.2 ± 1.4 kg, p = 0.619), LM (−0.8 ± 1.6 kg, p = 0.146), muscle strength (−0.2 to 4.1%, p = 0.086–0.745), or estimated VO2max (0.3 ± 2.1 mL/min/kg, p = 0.649). Self-managed, home-based exercise and nutrition programs are a viable strategy to promote maintenance of body composition and physical function following a supervised intervention in obese PCa patients on ADT.

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