TY - JOUR

T1 - Effects of a physical activity program from diagnosis on cardiorespiratory fitness in children with cancer

T2 - a national non-randomized controlled trial

AU - Nielsen, Martin Kaj Fridh

AU - Christensen, Jesper Frank

AU - Frandsen, Thomas Leth

AU - Thorsteinsson, Troels

AU - Andersen, Lars Bo

AU - Christensen, Karl Bang

AU - Wehner, Peder Skov

AU - Hasle, Henrik

AU - Adamsen, Lis Orgaard

AU - Schmiegelow, Kjeld

AU - Larsen, Hanne Bækgaard

PY - 2020

Y1 - 2020

N2 - Background Children with cancer experience impaired cardiorespiratory fitness and physical function during and after treatment restricting their possibilities to engage in social activities including sport, leisure activities, and school. The objectives were to determine the effects of classmate-supported, controlled, supervised, in-hospital, physical activity program to preserve cardiorespiratory fitness and physical function from time of diagnosis in children with cancer. Methods National non-randomized controlled trial including schoolchildren aged 6-18 years at diagnosis treated with chemo-/radiotherapy. We included 120 of 128 eligible patients (94%) in the intervention group (62.5% boys, 11.2 +/- 3.1 years) from East Denmark and 58 patients in the control group (57% boys, 11.0 +/- 3.2 years) from West Denmark. Eight children from the control group withdrew from participation. The groups were comparable in anthropometrics and cancer diagnoses (p > 0.05). The intervention consisted of (i) supervised in-hospital physical activity from diagnosis and throughout intensive treatment, (ii) 90-min general educational session on cancer and therapy in the child's school class, and (iii) selection of two classmates as ambassadors who took turns to support the child's physical training during the daytime. The primary outcome was cardiorespiratory fitness (VO(2)peak, mL/min/kg) at 6 months after diagnosis (sex, age, diagnosis adjusted). Secondary outcomes were sit-to-stand, timed-up-and-go, handgrip strength, and balance test scores. Results Ambassadors were identified for all, and 2542 individual and 621 group training sessions were held. VO(2)peak deteriorated over time in the control group (- 0.17 [95% CI - 0.32 to - 0.02] per week,p = 0.02), but not in the intervention group (p = 0.14). At 6 months from diagnosis, VO(2)peak was higher in the intervention group (29.6 +/- 5.6 mL/kg/min) than in the control group (22.1 +/- 5.6 mL/kg/min) (p = 0.01), and the intervention group had a better physical function at 3 and 6 months (p <0.0001). Conclusions Peer-supported, supervised, in-hospital, physical activity is safe and feasible in children with cancer during treatment. Further, the results suggest that the intervention might mitigate impairments in cardiorespiratory fitness during treatment in children with cancer.

AB - Background Children with cancer experience impaired cardiorespiratory fitness and physical function during and after treatment restricting their possibilities to engage in social activities including sport, leisure activities, and school. The objectives were to determine the effects of classmate-supported, controlled, supervised, in-hospital, physical activity program to preserve cardiorespiratory fitness and physical function from time of diagnosis in children with cancer. Methods National non-randomized controlled trial including schoolchildren aged 6-18 years at diagnosis treated with chemo-/radiotherapy. We included 120 of 128 eligible patients (94%) in the intervention group (62.5% boys, 11.2 +/- 3.1 years) from East Denmark and 58 patients in the control group (57% boys, 11.0 +/- 3.2 years) from West Denmark. Eight children from the control group withdrew from participation. The groups were comparable in anthropometrics and cancer diagnoses (p > 0.05). The intervention consisted of (i) supervised in-hospital physical activity from diagnosis and throughout intensive treatment, (ii) 90-min general educational session on cancer and therapy in the child's school class, and (iii) selection of two classmates as ambassadors who took turns to support the child's physical training during the daytime. The primary outcome was cardiorespiratory fitness (VO(2)peak, mL/min/kg) at 6 months after diagnosis (sex, age, diagnosis adjusted). Secondary outcomes were sit-to-stand, timed-up-and-go, handgrip strength, and balance test scores. Results Ambassadors were identified for all, and 2542 individual and 621 group training sessions were held. VO(2)peak deteriorated over time in the control group (- 0.17 [95% CI - 0.32 to - 0.02] per week,p = 0.02), but not in the intervention group (p = 0.14). At 6 months from diagnosis, VO(2)peak was higher in the intervention group (29.6 +/- 5.6 mL/kg/min) than in the control group (22.1 +/- 5.6 mL/kg/min) (p = 0.01), and the intervention group had a better physical function at 3 and 6 months (p <0.0001). Conclusions Peer-supported, supervised, in-hospital, physical activity is safe and feasible in children with cancer during treatment. Further, the results suggest that the intervention might mitigate impairments in cardiorespiratory fitness during treatment in children with cancer.

KW - Childhood cancer

KW - Exercise

KW - Cardiorespiratory fitness

KW - QUALITY-OF-LIFE

KW - CHILDHOOD-CANCER

KW - MUSCLE STRENGTH

KW - FUNCTIONAL MOBILITY

KW - PEER VICTIMIZATION

KW - MOTOR-PERFORMANCE

KW - PEDIATRIC CANCER

KW - EXERCISE PROGRAM

KW - SOCIAL OUTCOMES

KW - INTERVENTION

U2 - 10.1186/s12916-020-01634-6

DO - 10.1186/s12916-020-01634-6

M3 - Journal article

C2 - 32624004

VL - 18

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

IS - 1

M1 - 175

ER -