Rehabilitation and development after childhood cancer: can the need for physical exercise be met?

Abstract

Clinical and experimental evidence attests to the neurological and psychological benefits of physical exercise. Prescribing exercise for children after cancer has the potential to facilitate recovery, performance and development, with consequent improvement in quality of life and long-term outcome. However, could a school take up the prescription for a child's individual exercise programme? As a preliminary to an intervention study, all primary and secondary schools in two Scottish regions were surveyed. The aim was to evaluate the utility of prescribing exercise as part of a child's individual rehabilitation plan and to investigate awareness in schools of the potential benefits of exercise for cognition and behaviour. Approximately half the respondents indicated that extra physical exercise sessions could be incorporated into the school day. The main difficulties preventing such inclusion were identified as a lack of staff for supervision and timetabling problems. However, there was also a high level (>70%) of lack of information about what a child could be expected to do after cancer. Further, more respondents (approximately 60%) anticipated benefits of exercise for social development than for academic progress (approximately 35%). These results emphasize the necessity of clear and specific liaison with a school when planning and implementing a child's long-term rehabilitation programme.

Influences and Barriers on Physical Activity in Pediatric Oncology Patients

“…Siblings rated their HRQL lower than parents, while survivors rated social functioning higher than their parents did. Physical, psychosocial health, social health, and school functioning were in agreement with survivor–motherRobertson and Johnson (15)Cross-sectional survey N  = 308 primary schools N  = 93 secondary schoolPrimary and secondary school in ScotlandIdentify knowledge/willingness of school to assist with cancer patients in exerciseMajority of schools did not know what to expect of cancer patients in regards to exercise, some thought exercise would be beneficial, half believed more exercise could be incorporated…”

“…Robertson and Johnson (15) mailed a questionnaire to all Local Education Authority regions (LEAs) in Scotland. Example questions include: “For a pupil who has returned to school during/after treatment for cancer how much would you expect that pupil to participate in PA (PE)?,” and “If extra PE were prescribed for a pupil returning to school during or after successful treatment for cancer, e.g.…”

“…The interviews conducted by Götte et al in pediatric cancer survivors reported that the average patient only engaged in 24.3 min of exercise with the majority occurring in the cancer ward. Barriers included physical aspects such as: fatigue (15, 18, 43), concern for increased risk of infection (18, 32), side effects of treatment, GI problems, pain, dizziness, and weakness (32). Many patients associated these barriers with chemotherapy.…”

“…Some of these barriers, such as fatigue, may be improved by exercise (44). Psychological barriers included: lack of energy, bad moods/not feeling like it, preference for other things like staying in bed (32, 43), concern for injury, fear of soreness and sweating (43), falling behind academically (15, 18), and preference for sleeping to not feel side effects (32). Organizational barriers included: lack of time, lack of sports equipment, bad weather, lack of ideas (32, 43), lack of space for physical activities (especially when on infusion), and no one to play with (32).…”

Open thinking in neurorehabilitation

“…If take-up of traditional therapy services is low (Kuhlthau et al (this issue); Villela et al (this issue)), then we should be questioning the appropriateness of those services. Taking the previous examples, should there be a greater focus on long-term provision of exercise in school and community [10], greater access to sports physiotherapists, and easier access to sleep clinics?…”