Abstract
Purpose
The aim of this study was to evaluate the effects of a home-exercise programme on physical fitness indicators and physical functioning after completion of chemotherapy in children and adolescents diagnosed with acute lymphoblastic leukaemia (ALL).
Methods
Twenty-four survivors of ALL were assigned to usual care (control group, n = 12, 11.0 ± 3.7 years) or to a home-exercise programme (intervention group, n = 12, 11.8 ± 4.3 years). Peak oxygen uptake (VO2peak ml/kg/min), minute ventilation (VE L/min), output of carbon dioxide (VCO2 L/min), respiratory exchange ratio (RER), peak heart rate (beats/min), maximal load (W), VO2 at anaerobic threshold (VO2 at AT, ml/kg/min), pulse oxygen (PO2 ml/beat), heart rate at anaerobic threshold (beats/min), handgrip test (pounds), flexibility (cm), Timed Up & Go test TUG (s), and Timed Up and Down Stairs test (TUDS s) were measured at baseline and over 16 weeks of intervention.
Results
Adjusted mixed linear models revealed a significant group-time interaction + 6.7 (95% CI = 0.6–12.8 ml/kg/min; η2 partial = 0.046, P = 0.035) for VO2peak. Similarly, changes in mean values were observed after the home-exercise programme compared with baseline for VE (L/min) − 8.8 (3.0) (P = 0.035), VCO2 − 0.2 (0.08), (P = 0.041), maximal load (W) − 35.5 (12.8) (P = 0.024), TUDS (s) 0.8 (2.6) (P = 0.010), and TUG (s) 0.6 (0.1) (P = 0.001); however, the group-time interaction was not significant.
Conclusion
The home-exercise programme resulted in changes in measures of VO2peak, VE, VCO2, and functional capacity during daily life activities (TUDS and TUG test). This is an interesting and important study that surely adds to the current body of knowledge/literature on the safety of exercise interventions, especially in children with haematological cancer.
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References
Abbasi S, Maleha F, Shobaki M (2013) Acute lymphoblastic leukemia experience: epidemiology and outcome of two different regimens. Mediterr J Hematol Infect Dis 5(1):e2013024
Ward E, DeSantis C, Robbins A, Kohler B, Jemal A (2014) Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 64(2):83
Silverman LB (2014) Balancing cure and long-term risks in acute lymphoblastic leukemia. Hematol Am Soc Hematol Educ Program 2014(1):190–197
Söntgerath R, Eckert K (2015) Impairments of lower extremity muscle strength and balance in childhood cancer patients and survivors: a systematic review. Pediatr Hematol Oncol 32:585–612
van Brussel M, Takken T, Lucia A, van der Net J, Helders PJ (2005) Is physical fitness decreased in survivors of childhood leukemia? A systematic review. Leukemia 19:13–17
Simioni C, Zauli G, Martelli AM et al (2018) Physical training interventions for children and teenagers affected by acute lymphoblastic leukemia and related treatment impairments. Oncotarget. 9(24):17199–17209
Klika R, Tamburini A, Galanti G, Mascherini G, Stefani L (2018) The role of exercise in pediatric and adolescent cancers: a review of assessments and suggestions for clinical implementation. J Funct Morphol Kinesiol 3(1):7
Braam KI, van der Torre P, Takken T, Veening MA, van Dulmen-den Broeder E, Kaspers GJL (2016) Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev 3:CD008796
Morales JS, Valenzuela PL, Rincón-Castanedo C, Takken T, Fiuza-Luces C, Santos-Lozano A, Lucia A (2018) Exercise training in childhood cancer: a systematic review and meta-analysis of randomized controlled trials. Cancer Treat Rev 70:154–167
Esbenshade AJ, Friedman DL, Smith WA, Jeha S, Pui CH, Robison LL, Ness KK (2014) Feasibility and initial effectiveness of home exercise during maintenance therapy for childhood acute lymphoblastic leukemia. Pediatr Phys Ther 26(3):301–307
Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hróbjartsson A, Schulz KF, Parulekar WR, Krleza-Jeric K, Laupacis A, Moher D (2013) SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ 346:e7586
Beaver WL, Wasserman K, Whipp BJ (1986) A new method for detecting the anaerobic threshold by gas exchange. J Appl Physiol 60:2020–2027
Mathiowetz V (2002) Comparison of Rolyan and Jamar dynamometers for measuring grip strength. Occup Ther Int 9(3):201–209
Verbecque E (2015) Lobo Da Costa PH, Vereeck L, Hallemans A. Psychometric properties of functional balance tests in children: a literature review. Dev Med Child Neurol 57(6):521–529
Martinez-Gomez D, Martinez-de-Haro V, Pozo T, Welk GJ, Villagra A, Calle ME, Marcos A, Veiga OL (2009) Reliability and validity of the PAQ-A questionnaire to assess physical activity in Spanish adolescents. Rev Esp Salud Publica 83:427–439
Lakens D (2013) Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol 4:863
Ness KK, Baker KS, Dengel DR, Youngren N, Sibley S, Mertens AC, Gurney JG (2007) Body composition, muscle strength deficits and mobility limitations in adult survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 49(7):975–981
Warner JT, Bell W, Webb DK, Gregory JW (1997) Relationship between cardiopulmonary response to exercise and adiposity in survivors of childhood malignancy. Arch Dis Child 76:298–303
Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H (2009) Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 301(19):2024–2035
Fiuza-Luces C, Padilla JR, Soares-Miranda L, Santana-Sosa E, Quiroga JV, Santos-Lozano A, Pareja-Galeano H, Sanchis-Gomar F, Lorenzo-González R, Verde Z, López-Mojares LM, Lassaletta A, Fleck SJ, Pérez M, Pérez-Martínez A, Lucia A (2017) Exercise intervention in pediatric patients with solid tumors: the Physical Activity in Pediatric Cancer Trial. Med Sci Sports Exerc 49(2):223–230
Ness KK, Kaste SC, Zhu L, Pui CH, Jeha S, Nathan PC, Inaba H, Wasilewski-Masker K, Shah D, Wells RJ, Karlage RE, Robison LL, Cox CL (2015) Skeletal, neuromuscular and fitness impairments among children with newly diagnosed acute lymphoblastic leukemia. Leuk Lymphoma 56(4):1004–1011
Takken T, van der Torre P, Zwerink M, Hulzebos EH, Bierings M, Helders PJ, van der Net J (2009) Development, feasibility and efficacy of a community-based exercise training program in pediatric cancer survivors. Psychooncology 18:440–448
San Juan A, Fleck S, Chamorro-Vina C, Maté-Muñoz JL, Moral S, García-Castro J, Ramírez M, Madero L, Lucia A (2007) Early-phase adaptations to intrahospital training in strength and functional mobility of children with leukemia. J Strength Cond Res 21:173–177
San Juan AF, Fleck SJ, Chamorro-Viña C, Maté-Muñoz JL, Moral S, Pérez M, Cardona C, Del Valle MF, Hernández M, Ramírez M, Madero L, Lucia A (2007) Effects of an intrahospital exercise program intervention for children with leukemia. Med Sci Sports Exerc 39(1):13–21
Hauser M, Gibson BS, Wilson N (2001) Diagnosis of anthracyclineinduced late cardiomyopathy by exercise-spiroergometry and stress-echocardiography. Eur J Pediatr 160(10):607–610
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Patients and their families, the Hemato-Oncology Unit, Pediatrics and the Cardiology Service of the Santa Creu and Sant Pau Hospital in Barcelona.
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Manchola-González, J.D., Bagur-Calafat, C., Girabent-Farrés, M. et al. Effects of a home-exercise programme in childhood survivors of acute lymphoblastic leukaemia on physical fitness and physical functioning: results of a randomised clinical trial. Support Care Cancer 28, 3171–3178 (2020). https://doi.org/10.1007/s00520-019-05131-2
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DOI: https://doi.org/10.1007/s00520-019-05131-2