Journal of Cancer Survivorship

, Volume 4, Issue 4, pp 339–345 | Cite as

Physical activity and fitness in adolescent and young adult long-term survivors of childhood acute lymphoblastic leukaemia

  • Liisa S. Järvelä
  • Harri Niinikoski
  • Päivi M. Lähteenmäki
  • Olli J. Heinonen
  • Jukka Kapanen
  • Mikko Arola
  • Jukka Kemppainen
Article

Abstract

Introduction

There is a lack of data on physical activity (PA) and fitness of adolescent and young adult very long-term survivors of childhood acute lymphoblastic leukemia (ALL).

Methods

We studied 21 childhood ALL long-term survivors (aged 16–30 years, median time since diagnosis 15.9y), diagnosed in 1986–1996, with age- and sex-matched controls. Peak oxygen uptake (VO2peak) and muscle strength were measured and physical activity index (PAI; MET h/week) calculated.

Results

Mean VO2peak of the ALL survivors was 34.8 ± 9.3 ml/kg/min. This was 14% lower than that of the controls (−5.7 ml/kg/min, 95% CI −9.4 to −1.9, p = 0.01), and all the 11 female survivors performed below the age-adjusted reference values. The survivors also performed poorer in the sit-up and maximal jump tests (p = 0.02 and p = 0.004). Body mass index and PAI were similar in survivors and controls (p = 0.34 and p = 0.52). Nonetheless, as much as 30% of the male survivors and 36% of the female survivors had PAI ≤ 5 indicating very low levels of physical activity (PA).

Conclusions

Insufficient PA and poor physical fitness are clinically important issues in childhood ALL long-term survivors treated with modern protocols. Girls seem to be especially at risk. PA and better physical fitness decrease cardiovascular mortality irrespective of weight. Thus, PA should be promoted throughout and after the treatment for ALL.

Implications for cancer survivors

Since insufficient PA and poor physical fitness are an issue in very long-term ALL survivors, they should be informed on the benefits of physical activity, and be strongly encouraged to adopt a physically active lifestyle.

Keywords

Acute lymphoblastic leukemia Fitness Late effect Obesity Physical activity 

Notes

Acknowledgements

This study was financially supported by the Nona and Kullervo Väre Foundation, the Foundation for Paediatric Research, the Finnish Cancer Society, the Turku University Foundation, and grants from South-West Finland and Pirkanmaa Hospital Districts. Part of the results was presented at the Nordic Society of Pediatric Hematology and Oncology (NOPHO) annual meeting 2008, and at the European symposium on late complications after childhood cancer (ESLCCC) 2009. Saija Hurme, MSc, is acknowledged for statistical consultation.

References

  1. 1.
    Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N, et al. SEER Cancer Statistics Review, 1975–2006, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2006/, based on November 2008 SEER data submission, posted to the SEER web site, 2009.
  2. 2.
    Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355:1572–82.CrossRefPubMedGoogle Scholar
  3. 3.
    Oeffinger KC, Mertens AC, Sklar CA, Yasui Y, Fears T, Stovall M, et al. Obesity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. J Clin Oncol. 2003;21:1359–65.CrossRefPubMedGoogle Scholar
  4. 4.
    Florin TA, Fryer GE, Miyoshi T, Weitzman M, Mertens AC, Hudson MM, et al. Physical inactivity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev. 2007;16:1356–63.CrossRefPubMedGoogle Scholar
  5. 5.
    Ness KK, Baker KS, Dengel DR, Youngren N, Sibley S, Mertens AC, et al. Body composition, muscle strength deficits and mobility limitations in adult survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007;49:975–81.CrossRefPubMedGoogle Scholar
  6. 6.
    De Caro E, Fioredda F, Calevo MG, Smeraldi A, Saitta M, Hanau G, et al. Exercise capacity in apparently healthy survivors of cancer. Arch Dis Child. 2006;91:47–51.CrossRefPubMedGoogle Scholar
  7. 7.
    van Brussel M, Takken T, van der Net J, Engelbert RH, Bierings M, Schoenmakers MA, et al. Physical function and fitness in long-term survivors of childhood leukaemia. Pediatr Rehabil. 2006;9:267–74.PubMedGoogle Scholar
  8. 8.
    Hartman A, van den Bos C, Stijnen T, Pieters R. Decrease in peripheral muscle strength and ankle dorsiflexion as long-term side effects of treatment for childhood cancer. Pediatr Blood Cancer. 2008;50:833–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Gustafsson G, Schmiegelow K, Forestier E, Clausen N, Glomstein A, Jonmundsson G, et al. Improving outcome through two decades in childhood ALL in the nordic countries: The impact of high-dose methotrexate in the reduction of CNS irradiation. nordic society of pediatric haematology and oncology (NOPHO). Leukemia. 2000;14:2267–75.CrossRefPubMedGoogle Scholar
  10. 10.
    Durnin JV, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr. 1974;32:77–97.CrossRefPubMedGoogle Scholar
  11. 11.
    Lahti-Koski M, Taskinen O, Simila M, Männistö S, Laatikainen T, Knekt P, et al. Mapping geographical variation in obesity in Finland. Eur J Public Health. 2008;18:637–43.CrossRefPubMedGoogle Scholar
  12. 12.
    Raitakari OT, Taimela S, Porkka KV, Leino M, Telama R, Dahl M, et al. Patterns of intense physical activity among 15-to 30-year-old Finns: the cardiovascular risk in young Finns study. Scand J Med Sci Sports. 1996;6:36–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Viljanen T, Viitasalo JT, Kujala UM. Strength characteristics of a healthy urban adult population. Eur J Appl Physiol Occup Physiol. 1991;63:43–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Shvartz E, Reibold RC. Aerobic fitness norms for males and females aged 6 to 75 years: A review. Aviat Space Environ Med. 1990;61:3–11.PubMedGoogle Scholar
  15. 15.
    Blair SN, Kampert JB, Kohl 3rd HW, Barlow CE, Macera CA, Paffenbarger Jr RS, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA. 1996;276:205–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346:793–801.CrossRefPubMedGoogle Scholar
  17. 17.
    Wei M, Kampert JB, Barlow CE, Nichaman MZ, Gibbons LW, Paffenbarger Jr RS, et al. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA. 1999;282:1547–53.CrossRefPubMedGoogle Scholar
  18. 18.
    Laukkanen JA, Lakka TA, Rauramaa R, Kuhanen R, Venäläinen JM, Salonen R, et al. Cardiovascular fitness as a predictor of mortality in men. Arch Intern Med. 2001;161:825–31.CrossRefPubMedGoogle Scholar
  19. 19.
    Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301:2024–35.CrossRefPubMedGoogle Scholar
  20. 20.
    Hovi L, Era P, Rautonen J, Siimes MA. Impaired muscle strength in female adolescents and young adults surviving leukemia in childhood. Cancer. 1993;72:276–81.CrossRefPubMedGoogle Scholar
  21. 21.
    Warner JT, Bell W, Webb DK, Gregory JW. Relationship between cardiopulmonary response to exercise and adiposity in survivors of childhood malignancy. Arch Dis Child. 1997;76:298–303.CrossRefPubMedGoogle Scholar
  22. 22.
    Jarfelt M, Fors H, Lannering B, Bjarnason R. Bone mineral density and bone turnover in young adult survivors of childhood acute lymphoblastic leukaemia. Eur J Endocrinol. 2006;154:303–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Helakorpi S, Prättälä R, Uutela A. Health behaviour and health among the finnish adult population, spring 2007. Publications of the National Public Health Institute. 2008;6:1–198.Google Scholar
  24. 24.
    Jarfelt M, Lannering B, Bosaeus I, Johannsson G, Bjarnason R. Body composition in young adult survivors of childhood acute lymphoblastic leukaemia. Eur J Endocrinol. 2005;153:81–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Harila-Saari AH, Huuskonen UE, Tolonen U, Vainionpää LK, Lanning BM. Motor nervous pathway function is impaired after treatment of childhood acute lymphoblastic leukemia: a study with motor evoked potentials. Med Pediatr Oncol. 2001;36:345–51.CrossRefPubMedGoogle Scholar
  26. 26.
    Shankar SM, Marina N, Hudson MM, Hodgson DC, Adams MJ, Landier W, et al. Monitoring for cardiovascular disease in survivors of childhood cancer: report from the cardiovascular disease task force of the children’s oncology group. Pediatrics. 2008;121:e387–96.CrossRefPubMedGoogle Scholar
  27. 27.
    Jenney ME, Faragher EB, Jones PH, Woodcock A. Lung function and exercise capacity in survivors of childhood leukaemia. Med Pediatr Oncol. 1995;24:222–30.CrossRefPubMedGoogle Scholar
  28. 28.
    Ganame J, Claus P, Uyttebroeck A, Renard M, D’hooge J, Bijnens B, et al. Myocardial dysfunction late after low-dose anthracycline treatment in asymptomatic pediatric patients. J Am Soc Echocardiogr. 2007;20:1351–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Lucia A, Earnest C, Perez M. Cancer-related fatigue: can exercise physiology assist oncologists? Lancet Oncol. 2003;4:616–25.CrossRefPubMedGoogle Scholar
  30. 30.
    San Juan AF, Fleck SJ, Chamorro-Vina C, Mate-Munoz JL, Moral S, Perez M, et al. Effects of an intrahospital exercise program intervention for children with leukemia. Med Sci Sports Exerc. 2007;39:13–21.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Liisa S. Järvelä
    • 1
    • 2
  • Harri Niinikoski
    • 1
  • Päivi M. Lähteenmäki
    • 1
  • Olli J. Heinonen
    • 2
  • Jukka Kapanen
    • 2
  • Mikko Arola
    • 3
  • Jukka Kemppainen
    • 4
  1. 1.Department of PaediatricsTurku University HospitalTurkuFinland
  2. 2.Paavo Nurmi Centre, Department of Physiology, and Department of Health and Physical ActivityUniversity of TurkuTurkuFinland
  3. 3.Department of PaediatricsTampere University HospitalTampereFinland
  4. 4.Department of Clinical Physiology and Nuclear MedicineTurku University HospitalTurkuFinland

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