Health-Related Physical Fitness and Arterial Stiffness in Childhood Cancer Survivors

Abstract

Introduction: Despite decreasing mortality in pediatric oncology as a result of standardized treatment protocols, the high number of functional and cardiovascular late sequelae due to anticarcinogenic therapy remains unchanged. The aim of this study was to further assess functional limitations in Health-related Physical Fitness (HRPF) and cardiovascular risk by means of markers of arterial stiffness in Childhood Cancer Survivors (CCS). Materials and Methods: Between March 2016 and August 2017 a total of 92 CCS (Age 12.5 ± 4.2 years, 43 girls) were recruited from their routine follow-up outpatient visit. HRPF was assessed using five Fitnessgram® tasks. Pulse Wave Velocity (PWV) along with peripheral and central blood pressure were assessed using oscillometric measurements performed by Mobil-O-Graph. Z-scores were used to compare the test results either to German reference values or to a recent healthy reference cohort. Results: In CCS, the HRPF was significantly reduced (z-score: −0.28 ± 1.01, p = 0.011) as compared to healthy peers. The peripheral Systolic Blood Pressure (pSBP) was significantly increased (z-score: 0.31 ± 1.11, p = 0.017) and the peripheral Diastolic Blood Pressure (pDBP) was decreased (z-score: −0.30 ± 1.25, p = 0.040), resulting in an increased pulse pressure. The PWV ( p = 0.649) and cSBP ( p = 0.408), were neither increased nor showed any association to HRPF. Discussion: CCS showed functional limitations in HRPF and an increased pulse pressure, which acts as an early onset parameter of arterial stiffness. Both a low HRPF and impaired hemodynamics are independent cardiovascular risk factors and needs to be taken into consideration in tertiary prevention of CCS.

Short-Term Consequences of Pediatric Anti-cancer Treatment Regarding Blood Pressure, Motor Performance, Physical Activity and Reintegration Into Sports Structures

“…Nevertheless, one recent study using the Mobil-O-Graph R as well, described results similar to our findings (12): The study examined n = 92 children and adolescents treated for cancer, aged 12.5 ± 4.2 years and 3.6 ± 2.8 post-diagnosis. Results show an increase in pSBP, but no significant changes in cSBP or PWV were found, independent of receiving anthracyclines.…”

“…The measurement using the Mobil-O-Graph R was previously used several times in pediatric patients (28)(29)(30)(31) and was also successfully applied in childhood cancer survivors (12).…”

“…Their results show reduced motor performance of childhood cancer survivors compared to reference values of healthy children. However, no correlation could be drawn regarding cardiovascular parameters and motor performance (12).…”

“…Moreover, elevated PWV reflecting subclinical vascular damage was shown in pediatric patients after hematopoietic stem cell transplantation (11). On the contrary, another study investigated elevated blood pressure levels, but no statistically significant variation for PWV in pediatric cancer survivors compared to healthy children and adolescents (12).…”

“…Von Korn et al ( 12 ) examined motor performance using the Fitnessgram® as well as peripheral blood pressure, central blood pressure and PWV using the Mobil-O-Graph® in children after treatment for childhood cancer ( n = 92, aged 12.5 ± 4.2 years, 3.6 ± 2.8 years post-diagnosis). Their results show reduced motor performance of childhood cancer survivors compared to reference values of healthy children.…”