The international Pediatric Oncology Exercise Guidelines (iPOEG)

Abstract

Physical activity (PA) and exercise are safe and beneficial for children and adolescents affected by cancer. Yet, this population is not active enough to receive benefits. PA guideline and recommendation statements can support individual behavior and practice change. The purpose of this project was to develop the international Pediatric Oncology Exercise Guidelines (iPOEG), comprised of guideline and recommendation statements, to promote PA among children and adolescents affected by cancer. Guideline development procedures, stakeholder engagement strategies, and the Delphi technique were used. Four online surveys were distributed to the iPOEG network (n = 9 core team members, n = 122 expert consensus committee members). Surveys included closed- and open-ended items informed by a literature synthesis and an in-person meeting. Responses were analyzed using descriptive statistics and content analysis. Consensus was defined as ≥ 80% agreement. Response rates to online surveys ranged from 82% to 91%. The iPOEG network agreed on four guideline and five recommendation statements, which highlight that movement is important for all children and adolescents affected by cancer. These statements are generic in nature as more research is still required to provide specific guidance on the frequency, intensity, time, and type of PA for this population. Nevertheless, the iPOEG statements represent available evidence and expert opinion, collectively suggesting that it is time for children and adolescents affected by cancer to move more.

Metabolites Associated With Fatigue and Physical Activity in Childhood Cancer

“…To date, no consensus has been reached to specify the best intervention (walking, resistance exercises, etc.) or the intensity/duration needed to improve fatigue during childhood cancer, although the general consensus is that physical activity is generally of benefit (Malysse et al, 2021; Wurz et al, 2021b). Commonly, discussions related to appropriate levels of physical activity intensity to induce change in patient-reported outcomes (i.e., fatigue) have cited dose response U-shaped curves to depict “low” intensity physical activity as ineffective, “moderate” levels of physical activity as optimal, and “high” levels of physical activity as aversive (Ekkekakis et al, 2005).…”

Exercise and Childhood Cancer—A Historical Review

“…Overall, exercise or regular PA in general is to be considered as a (i) safe and (ii) overall beneficial coadjuvant strategy to attenuate cancer-related adverse effects, with no major contraindications, at least with regard to the different types of pediatric cancers (i.e., in the absence of comorbidities other than cancer per se) ( Figure 2 ). Recently, pediatric oncology exercise guidelines and a recommendation statement have been published [ 119 ]. Using the Delphi technique, a panel of experts agreed that movement is important for all children and adolescents affected by cancer and that an exercise professional is recommended, who must consider the patient’s age, their type of cancer, the setting, treatment-related considerations, and individual factors (e.g., previous experience, preferences) [ 119 ].…”

“…Recently, pediatric oncology exercise guidelines and a recommendation statement have been published [ 119 ]. Using the Delphi technique, a panel of experts agreed that movement is important for all children and adolescents affected by cancer and that an exercise professional is recommended, who must consider the patient’s age, their type of cancer, the setting, treatment-related considerations, and individual factors (e.g., previous experience, preferences) [ 119 ]. However, these statements are generic in nature and more research is still required to provide specific guidance on the frequency, intensity, duration, and type of PA for this population.…”

“…cents affected by cancer and that an exercise professional is recommended, who must consider the patient's age, their type of cancer, the setting, treatment-related considerations, and individual factors (e.g., previous experience, preferences) [119]. However, these statements are generic in nature and more research is still required to provide specific guidance on the frequency, intensity, duration, and type of PA for this population.…”

Can Steps per Day Reflect Symptoms in Children and Adolescents Undergoing Cancer Treatment?

“…12 Although there are recommendations for adult oncology patients related to physical activity during therapy and after therapy, 13 guidance during childhood cancer is more generic advocating for children to "move more" while noting the safety of engaging in physical activity and/or exercise during therapy. 14 In the absence of pediatric oncology specific guidance, activity levels are currently benchmarked against recommendations for the healthy pediatric/adolescent population. As such, children with cancer often fall very short of meeting these recommendations, with well-documented decreases in physical activity during and after treatment.…”