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Efficacy of physical exercise intervention on children with acute lymphoblastic leukemia during treatment and rehabilitation: a systematic review and meta-analysis

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Abstract

Objective

To systematically evaluate the impact of physical exercise intervention on children with acute lymphoblastic leukemia (ALL) during the treatment and rehabilitation consolidation periods.

Method

Randomized controlled trials (RCTs) were retrieved from PubMed, Scopus, Web of Science, CNKI, and Cochrane databases, with a search time range from database establishment to September 1, 2023. The quality of the included RCTs was evaluated using the Cochrane risk assessment tool, and a systematic evaluation was conducted using RevMan 5.4. The study has been registered with INPLASY (registration number: 202390100).

Result

A total of 12 RCTs including 423 subjects was included. The meta-analysis results showed that long-term exercise intervention can effectively improve the endurance performance (SMD = 1.37, 95% CI 0.45 to 2.29, p = 0.004), functional mobility (MD =  − 1.17, 95% CI − 1.85 to − 0.49, p = 0.0008), cancer-related fatigue (CRF) (MD =  − 1.25, 95% CI − 1.69 to − 0.80, p < 0.00001), and quality of life (QOL) (MD = 4.93, 95% CI 1.80 to 8.05, p = 0.002) of ALL children during the treatment and rehabilitation consolidation periods. Its promoting effect on the muscle strength (SMD = 0.53, 95% CI − 0.33 to 1.39, p = 0.23) and bone mineral density (BMD) (SMD = 0.48, 95% CI 0.20 to 0.77, p = 0.05) of the subjects was not significant. Further meta-analysis showed that exercise intervention with a duration of less than 1 year (SMD = 0.91, 95% CI 0.55 to 1.28, p < 0.00001) rather than more than 1 year (SMD =  − 0.16, 95% CI − 0.61 to 0.29, p = 0.49) can effectively reduce subject BMD, while in terms of strength, exercise intervention can effectively improve strength during the treatment period (SMD = 0.97, 95% CI 0.40 to 1.54, p = 0.0008) rather than the consolidation period (SMD =  − 0.27, 95% CI − 1.08 to 0.53, p = 0.51).

Conclusion

Long-term regular exercise can effectively improve the endurance, functional mobility, CRF, and QOL of children with ALL in the rehabilitation and treatment consolidation stages. Their strength and BMD may be influenced by the timing of treatment and the intervention cycle, respectively. Considering the limited number of included literature and the instability of some outcome indicators, it is necessary to design more comprehensive and rigorous high-quality RCTs in the future to test the exercise efficacy of ALL children.

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References

  1. DeAngelo DJ, Jabbour E, Advani A (2020) Recent advances in managing acute lymphoblastic leukemia. Am Soc Clin Oncol Educ Book 40:330–342

    Article  PubMed  Google Scholar 

  2. Dandan Xu, Yang L (2019) Expression levels of miR377- and SMYD3 in patients with acute lymphoblastic leukemia and their clinical prognostic significance. Int J Lab Med 44(17):2129–2133

    Google Scholar 

  3. Davis KL (2022) Understanding the hematopoietic factory during acute lymphoblastic leukemia. Pediatric Res 91(5):1023–1024

    Article  Google Scholar 

  4. Malard F, Mohty M (2020) Acute lymphoblastic leukaemia. Lancet 395(10230):1146–1162

    Article  CAS  PubMed  Google Scholar 

  5. Zhu W, Liu S, Shi Y et al (2023) The epidemic of acute lymphoid leukemia in China: current trends and future prediction. Front Oncol 13:1195065

    Article  PubMed  PubMed Central  Google Scholar 

  6. Naomi S, Charles S, Kayo N et al (2022) Worldwide trends in population- based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3): analysis of individual data from 258 cancer registries in 61 countries. The Lancet. Child Adolescent Health 6(6):409–431

    Article  Google Scholar 

  7. Katz AJ, Chia VM, Schoonen WM et al (2015) Acute lymphoblastic leukemia: an assessment of international incidence, survival, and disease burden. Cancer Causes Control 26(11):1627–1642

    Article  PubMed  Google Scholar 

  8. Siegel RL, Miller KD, Wagle NS et al (2023) Cancer statistics 2023. CA Cancer J Clin 73(1):17–48

    Article  PubMed  Google Scholar 

  9. Bonaventure A, Harewood R, Stiller CA et al (2017) Worldwide comparison of survival from childhood leukaemia for 1995–2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries. Lancet Haematol 4(5):e202–e217

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bhakta N, Liu Q, Ness KK et al (2017) The cumulative burden of surviving childhood cancer:an initial report from the St Jude Lifetime Cohort Study (SJLIFE). Lancet 390(10112):2569–2582

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chen Fuyi Wu, Jieling ML (2019) Long-term Rehabilitation management of childhood acute lymphoblastic leukemia survivors. Cancer Res Prev Treat 49(09):893–898

    Google Scholar 

  12. Xiaowen S, Honghua Z, Xiaofen Z et al (2022) Effect of exercise intervention on cancer-related fatigue in children with acute leukemia during chemotherapy. J Nursing Sci 37(12):72–74

    Google Scholar 

  13. Millan NC, Pastrana A, Guitter MR et al (2018) Acute and sub-acute neurological toxicity in children treated for acute lymphoblastic leukemia. Leuk Res 65:86–93

    Article  PubMed  Google Scholar 

  14. Shuang H, Zhenling L, Fang C (2019) Research progress of exercise rehabilitation in children with acute lymphoblastic leukemia. Chin J New Clin Med 14(02):143–148

    Google Scholar 

  15. Koelwyn GJ, Zhuang X, Tammela T et al (2020) Exercise and immunometabolic regulation in cancer. Nat Metab 2(9):849–857

    Article  PubMed  PubMed Central  Google Scholar 

  16. Galunas L (2022) The impact of a nurse-led exercise activity for cancer-related fatigue in patients with leukemia. Clin J Oncol Nurs 26(3):257–260

    Article  PubMed  Google Scholar 

  17. Gheyasi F, Baraz S, Malehi A et al (2019) Effect of the walking exercise program on cancer-related fatigue in patients with acute myeloid leukemia undergoing chemotherapy. Asian Pac J Cancer Prev 20(6):1661–1666

    Article  PubMed  PubMed Central  Google Scholar 

  18. Zhou Y, Zhu J, Gu Z et al (2017) Efficacy of exercise interventions in patients with acute leukemia: a meta-analysis. PLoS ONE 11(7):e0159966

    Article  Google Scholar 

  19. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol 134:178–189

    Article  PubMed  Google Scholar 

  20. Elnaggar RK, Mohamed RR (2021) Aqua-plyometric exercises: potential implications for bone mineral density, functional capacity, and quality of life in survivors of childhood acute lymphoblastic leukemia. Semin Oncol Nurs 37(6):151225

    Article  PubMed  Google Scholar 

  21. Essam AM, Mohamed AAS, Fahad MA et al (2023) Effectiveness of exergaming in reducing cancer-related fatigue among children with acute lymphoblastic leukemia: a randomized controlled trial. Ann Med 55(1):2224048

    Article  Google Scholar 

  22. Cox CL, Zhu L, Kaste SC, et al. (2018) Modifying bone mineral density, physical function, and quality of life in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 65(4). https://doi.org/10.1002/pbc.26929

  23. Marchese VG, Chiarello LA, Lange BJ (2004) Effects of physical therapy intervention for children with acute lymphoblastic leukemia. Pediatr Blood Cancer 42(2):127–133

    Article  PubMed  Google Scholar 

  24. Waked IS, Albenasy KS (2018) Bone mineral density, lean body mass and bone biomarkers following physical exercise in children with acute lymphoblastic leukemia undergoing chemotherapy. IJBC 10(3):69–75

    Google Scholar 

  25. Baky AM, Elhakk SM (2017) Impact of aerobic exercise on physical fitness and fatigue in children with acute lymphoblastic leukemia. Int J Therapies Rehab Res 6(2):137–145

    Google Scholar 

  26. Manchola-González JD, Bagur-Calafat C, Girabent-Farrés M et al (2020) 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(7):3171–3178

    Article  PubMed  Google Scholar 

  27. Khodashenas E, Badiee Z, Sohrabi M et al (2017) The effect of an aerobic exercise program on the quality of life in children with cancer. Turk J Pediatr 59(6):678–683

    Article  PubMed  Google Scholar 

  28. Tanir MK, Kuguoglu S (2013) Impact of exercise on lower activity levels in children with acute lymphoblastic leukemia: a randomized controlled trial from Turkey. Rehabil Nurs 38(1):48–59

    Article  PubMed  Google Scholar 

  29. Yeh CH, Man WJP, Lin US et al (2011) A pilot study to examine the feasibility and effects of a home-based aerobic program on reducing fatigue in children with acute lymphoblastic leukemia. Cancer Nurs 34(1):3–12

    Article  PubMed  Google Scholar 

  30. De Macedo TMF, Oliveira KMC, Melo JBDC et al (2010) Inspiratory muscle training in patients with acute leukemia: preliminary results. Revista Paulista de Pediatria 28:352–358

    Article  Google Scholar 

  31. Hartman A, te Winkel ML, van Beek RD et al (2009) A randomized trial investigating an exercise program to prevent reduction of bone mineral density and impairment of motor performance during treatment for childhood acute lymphoblastic leukemia. Pediatric Blood Cancer 53(1):64–71

    Article  CAS  PubMed  Google Scholar 

  32. Zhao WR, Ma ZL, Cheng TY et al (2019) Application of cardiopulmonary exercise test in patients with lung cancer. Chin J Cancer Prev 30(15):941–947

    Google Scholar 

  33. Cowdery SP, Stuart AL, Pasco JA et al (2021) Mood disorder and cancer onset: evidence from a population-based sample of Australian women. Braz J Psychiatry 43(4):355–361

    Article  PubMed  Google Scholar 

  34. Braam KI, van Dijk-Lokkart EM, Kaspers GJL et al (2016) Cardiorespiratory fitness and physical activity in children with cancer. Support Care Cancer 24(5):2259–2268

    Article  PubMed  Google Scholar 

  35. Ahn KY, Lee MK, Kim DI et al (2016) Cardiopulmonary fitness, adiponectin, chemerin associated fasting insulin level in colorectal cancer patients. Support Care Cancer 24(7):2927–2935

    PubMed  Google Scholar 

  36. Parry-Williams G, Sharma S (2020) The effects of endurance exercise on the heart: panacea or poison? Nat Rev Cardiol 17(7):402–412

    Article  CAS  PubMed  Google Scholar 

  37. van der Schoot GGF, Ormel HL et al (2022) Optimal timing of a physical exercise intervention to improve cardiorespiratory fitness: during or after chemotherapy. JACC CardioOncol 18,4(4):491–503

    Article  Google Scholar 

  38. Moran JM, Puerto-Parejo LM, Leal-Hernandezo (2019) Acupuncture for cancer-related fatigue in lung cancer patients: methodological and statistical issues. Supportive Care in Cancer 27(1):1–2

    Article  PubMed  Google Scholar 

  39. Zhou X, Li X, Wang Z (2022) Impact of individualized intervention on the psychological status of patients with localized small cell lung cancer complicated with pleural effusion. Psychol Health Med 27(6):1326–1333

    Article  PubMed  Google Scholar 

  40. Zhao J, Qi Q, Xu S et al (2020) Combined aerobic resistance exercise improves dialysis adequacy and quality of life in patients on maintenance hemodialysis. Clin Nephrol 93(6):275–282

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

I would like to thank and the leaders and colleagues of the School of Physical Education of Southwest University for their selfless contributions and help to this research.

Funding

This project is supported by the Humanities and Social Science Foundation of the Ministry of education (Project No: 20YJA890018).

Author information

Author notes

  1. Hengxu Liu and Jingqi Yin are co first authors.

Authors and Affiliations

  1. Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China

    Hengxu Liu, Kun Wang, Shiqi Liu, Yi Yang, Tingran Zhang & Jiong Luo

  2. Department of Sociology, Shanghai Normal University, Shanghai, 200233, China

    Jingqi Yin

  3. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, 100032, China

    Ziyi Song

  4. Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100032, China

    Ziyi Song

  5. Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China

    Caiyun Dong

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Contributions

Hengxu Liu and Jingqi Yin was in charge of proposing topics and writing articles;Kun Wang,Shiqi Liu,Yi Yang,Ziyi Song,Caiyun Dong,Tingran Zhang,Jiong Luo was primarily responsible for retrieving, collecting data,drawing graphs and revising articles.All authors have read and agreed to the published version of the manuscript.

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Correspondence to Tingran Zhang or Jiong Luo.

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Tingran Zhang and Jiong Luo are co corresponding authors.

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Liu, H., Yin, J., Wang, K. et al. Efficacy of physical exercise intervention on children with acute lymphoblastic leukemia during treatment and rehabilitation: a systematic review and meta-analysis. Support Care Cancer 32, 177 (2024). https://doi.org/10.1007/s00520-024-08355-z

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