Implementation of Structured Physical Activity in the Pediatric Stem Cell Transplantation

Rosenhagen, Andreas; Bernhörster, Marcus; Vogt, Lutz; Weiss, Brendan M.; Senn, A; Arndt, Sherry W.; Siegler, Klaus; Jung, Michael; Bader, Peter; Banzer, Winfried

doi:10.1055/s-0031-1271782

Cited by 67 publications

(136 citation statements)

References 25 publications

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“…San Juan et al 30 demonstrated positive effects on VO 2peak , muscle strength and quality of life during an 8-week intrahospital training programme in children 2-12 months post-HSCT. Rosenhagen et al 31 trained endurance and strength in children from day 1 to day 14 post HSCT and reported a decreased loss of muscular power, a trend toward better quality of life and reduced fatigue compared with matched controls.…”

Section: Discussionmentioning

confidence: 99%

Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Mathiesen

Uhlving

Buchvald

et al. 2014

Bone Marrow Transplant

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Peak oxygen uptake (VO 2peak ), a measure of aerobic exercise capacity, predicts mortality and morbidity in healthy and diseased individuals. Our aim was to determine VO 2peak years after paediatric allogeneic haematopoietic SCT (HSCT) and to identify associations with baseline patient and donor characteristics, transplantation factors, pulmonary function and self-reported sports activity. In this cross-sectional, population-based study, we measured VO 2peak , spirometry and diffusion capacity of the lung (D LCO ) 3-10 years post HSCT. Z-scores were calculated by reference values from healthy subjects. Self-reported hours of sports activity were obtained by interview. We included 63 patients (mean age (range) 14.4 (7-24) years). HSCT patients exhibited lower mean VO 2peak (−1.42 z-score, 95% confidential interval (−1.7; − 1.1)) compared with healthy subjects (Po 0.001). Sixteen patients (25%) had VO 2peak values o − 1.96 z-score. Low VO 2peak was associated with reduced forced expiratory volume in 1 s (R 2 = 0.11, P = 0.009), reduced D LCO /V A (R 2 = 0.09, P = 0.01) and low physical activity (mean VO 2peak z-score inactive group: − 2.1 vs most active group: − 1.1, P = 0.02). No associations between VO 2peak and diagnosis, donor type or GvHD were found. Although causes for reduced VO 2peak may be multiple, our findings stress the need to focus on physical activity post HSCT to prevent lifestyle diseases and improve quality of life. INTRODUCTIONThe population of long-term survivors after allogeneic haematopoietic SCT (HSCT) has increased owing to advances in donor selection and improvements in conditioning regimens and supportive care. Improved survival has increased the focus on late effects and quality of life. 1 HSCT may affect multiple organ systems as a result of the toxicity from chemotherapy, TBI and complications including GvHD and infections. 1 In a recent retrospective study, we documented reduced spirometric values in 34% of paediatric patients more than 18 months from HSCT. 2 However, little is known about the potential consequences of reduced pulmonary function for daily life activities and aerobic exercise capacity.Peak oxygen uptake (VO 2peak ) is a measure of physical capacity, which integrates the responses of the cardiovascular, pulmonary and musculoskeletal systems when faced with physical requirements; 3 thus, VO 2peak allows evaluation of abnormalities, which may not be apparent during rest. 4 As a measure of cardiorespiratory fitness, VO 2peak is a powerful predictor of morbidity and mortality in both healthy and diseased individuals. 5,6 In cancer patients, reduced VO 2peak has been associated with fatigue, which is known to reduce the quality of life, especially in children and young adults for whom physical activities are an essential part of the daily routine. 7 A recent systematic review revealed slightly reduced VO 2peak in survivors of childhood leukaemia compared with healthy controls. 8 Although HSCT has been described as the treatmentvariable most consistently associated with redu...

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Section: Discussionmentioning

confidence: 99%

Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Mathiesen

Uhlving

Buchvald

et al. 2014

Bone Marrow Transplant

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“…Review more patients (21,25,(27)(28)(29)(30)(31)(32)(33)(34). Five randomized, controlled trials have been identified (28)(29)(30)(31)33) and were ranked with evidence level "2b. "…”

Section: Exercise In Pediatric Oncologymentioning

confidence: 99%

“…Five randomized, controlled trials have been identified (28)(29)(30)(31)33) and were ranked with evidence level "2b. " Six studies reached level "3b" as they included a control group but were not randomized (8,27,32,(34)(35)(36)). Six studies were classified level "4" (19-26) because they did not enroll a control group.…”

Section: Exercise In Pediatric Oncologymentioning

confidence: 99%

“…Although eight studies were conducted with acute lymphoblastic leukemia (ALL) patients (20,(22)(23)(24)26,28,30,31,34,35), study cohorts including mixed cancer types have also been examined (19,21,25,29,33,36). The settings differ from supervised exercise intervention (8,19,(21)(22)(23)(24)27,29,32,33,35) to home-based exercise programs (31,34). Six studies included a combination of a supervised and an additional home-based exercise intervention (20,25,26,28,30,36).…”

Section: Exercise In Pediatric Oncologymentioning

confidence: 99%

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Clinical exercise interventions in pediatric oncology: a systematic review

2013

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Studies in pediatric oncology have shown a positive effect of physical activity on disease-and treatment-related side effects. Although several reviews have approved the benefits of therapeutic exercise for adult cancer patients, no systematic review exists summarizing the evidence of physical activity in pediatric oncology. We identified a total of 17 studies using the PubMed database and Cochrane library. To evaluate the evidence, we used the evaluation system of the Oxford Center for Evidence-Based Medicine 2001. The findings confirm that clinical exercise interventions are feasible and safe, especially with acute lymphoblastic leukemia (ALL) patients and during medical treatment. No adverse effects have been reported. Positive effects were found on fatigue, strength, and quality of life. Single studies present positive effects on the immune system, body composition, sleep, activity levels, and various aspects of physical functioning. Child-specific aspects such as cognitive abilities, growth, adolescence, and reintegration into peer-groups, school, and sports have barely been taken into consideration. The evidence for exercise interventions in pediatric oncology is rated level "3. " Although the results are very promising, future research of high methodological quality and focusing on child-specific aspects is needed to establish evidence-based exercise recommendations, particularly for childhood cancer patients.A s a result of improved treatment regimes in pediatric oncology, the survival rates of children with cancer have risen to ~80% for 5-y survival (1-4). Therefore, the population of childhood cancer survivors is constantly growing. Despite these positive developments, childhood cancer is associated with a wide spectrum of various disease-and treatment-related side effects that may develop into chronic diseases and therefore result in long-term consequences. A negative impact on social, psychological, and physiological levels can be observed. Inactivity (5-7), impaired cardiopulmonary and musculoskeletal function, as well as reduced motor performance levels (8,9) and cognitive abilities (10) have been detected. Current studies also examined a negative impact on psychological well-being, satisfaction, and social functioning (11). Taken together, an impaired quality of life can thus be determined (8,12).During the past few years, several studies have generated first hints describing holistic, positive effects of clinical exercise interventions in pediatric oncology. First results present an association between increased physical activity levels in childhood cancer patients and an improvement in quality of life (13). In particular, physical functioning is increased, anxiety is reduced, and social integration is encouraged (14). Considering the fact that physical activity plays a vital role in the physiological and psychosocial development of children, therapeutic exercise in pediatric oncology is particularly important. However, there is still a lack of comprehensive and evidence-based data in the field o...

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“…The fact that initial literature research and studies revealed that there a very few German publications on CRF [6] and that it occurs also in children [14], led to initial steps being taken. Subsequently, the department for stem cell transplantation initiated a study on the subject of sports therapy funded by the José Carreras Leukemia Foundation [12], which is already well advanced. First results are expected for 2013.…”

Section: Prospectsmentioning

confidence: 99%

„ …when you’re tired before you even start“ –Fatigue in paediatric oncology seen from different perspectives

Jung¹

2014

apgr

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Implementation of Structured Physical Activity in the Pediatric Stem Cell Transplantation

Cited by 67 publications

References 25 publications

Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Clinical exercise interventions in pediatric oncology: a systematic review

„ …when you’re tired before you even start“ –Fatigue in paediatric oncology seen from different perspectives

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