A randomized controlled trial of a structured exercise intervention after the completion of acute cancer treatment in adolescents and young adults

Abstract

Background: Cancer treatments are frequently associated with impaired physical fitness, quality of life (QOL), and fatigue, often persisting into survivorship. Studies in older adults with cancer have demonstrated benefits from exercise; however, this has not been rigorously investigated in adolescents and young adults (AYA). The aim of this study was to determine whether a structured 10-week exercise intervention was associated with improved cardiorespiratory fitness (VO 2peak), fatigue, and QOL in AYA who have recently completed cancer treatment. Method: Forty-three AYA (median age 21 ± 6 years) were randomly assigned to an exercise group (n = 22) or a control group (n = 21). The exercise group received a structured 10-week exercise program comprising progressive aerobic and resistance exercise; the control arm received routine care. VO 2peak was measured at baseline, 10 weeks, and six months. Fatigue and QOL were assessed by the FACIT fatigue scale and the PEDS QL, respectively. Results: Mean VO 2peak at baseline was 26.5 ± 7.2 mL.kg −1 .min −1 , which is substantially lower than population norms. The exercise group demonstrated significant improvement in VO 2peak at 10 weeks compared with controls (33.8 ± 8.1 vs 29.6 ± 7.6 mL.kg −1 .min −1 , P = 0.0002), but by six months, the difference was no longer significant (32.9 ± 7.0 vs 30.9 ± 11.0 mL.kg −1 .min −1 , P = 0.21). There were no significant differences in fatigue or total QOL scores between groups. Conclusion: Cancer treatment is associated with reduced VO 2peak in AYA. Improvement in VO 2peak was accelerated by a 10-week exercise program; however, no significant benefit was observed in QOL or fatigue. The plateau in VO 2peak at six months suggests that a maintenance exercise program may be beneficial.

Feasibility and acceptability of a home‐based resistance training intervention in adolescent and young adult hematopoietic cell transplant survivors

“…Recruitment rates in other non‐AYA exercise intervention studies of HCT survivors report enrollment rates ranging from 22% to 71%, with completion of follow‐up evaluations ranging from 58% to 79% 29–33 . In a recent AYA oncology exercise study in patients who completed cancer treatment (not including HCT), a recruitment rates of 68% was reported, which is similar to 65% reported in our study 34 …”

A randomised controlled trial investigating the ability for supervised exercise to reduce treatment-related decline in adolescent and young adult cancer patients

“…High-quality randomised controlled trials (RCTs) involving exercise during cancer therapy in AYA are lacking [ 13 ]. Limited research has demonstrated cardiorespiratory fitness (CRF) [ 14 ] and walk distance [ 15 ] benefits in AYA as a result of exercise following treatment. These studies report clear evidence of patient deconditioning including reduced CRF and strength, suggesting a need for earlier intervention to prevent such decline [ 14 , 15 ].…”

“…Limited research has demonstrated cardiorespiratory fitness (CRF) [ 14 ] and walk distance [ 15 ] benefits in AYA as a result of exercise following treatment. These studies report clear evidence of patient deconditioning including reduced CRF and strength, suggesting a need for earlier intervention to prevent such decline [ 14 , 15 ]. While not specific to AYA, research has reported a 5–26% decline in CRF during exposure to various chemotherapeutic regimens that may not recover following treatment [ 16 , 17 ].…”

Physical Activity Promotion Programmes in Childhood Cancer Patients and Their Impact on Fatigue and Pain: A Systematic Review

“…It is undeniable that greater cancer survival rate is a positive fact, but it also means that more people suffer severe adverse effects due to the treatment, which are even more severe in young patients [ 9 , 10 ]. However, these adverse effects do not occur exclusively during the disease, but also in cancer survivors as cardiotoxicity is one of the main morbidity causes due to chemotherapy treatments with anthracyclines and radiation [ 11 , 12 ].…”

“…However, these adverse effects do not occur exclusively during the disease, but also in cancer survivors as cardiotoxicity is one of the main morbidity causes due to chemotherapy treatments with anthracyclines and radiation [ 11 , 12 ]. Furthermore, the tendency to a sedentary lifestyle increases other risk factors such as risk of overweight or obesity, arterial hypertension, muscular atrophy, etc., which can drastically reduce the patient’s quality of life (QOL) [ 10 ]. Apart from other reasons, this is why the risk of early mortality is eight times higher in these patients compared to the general population [ 11 , 13 ].…”