Advancing the Field of Pediatric Exercise Oncology: Research and Innovation Needs

The field of pediatric exercise oncology explores the relationships between physical activity (PA), including exercise, and a range of outcomes among children and adolescents affected by cancer. Although PA is safe and beneficial for this population, several important gaps in knowledge and practice remain. In this article, we describe research and innovation needs that were developed with a team of international experts and relevant literature, a series of online surveys, and an in-person meeting. Addressing these needs will contribute valuable knowledge and practice outputs to advance this field, ultimately enabling a greater number of children and adolescents affected by cancer to realize the benefits of moving more

The international Pediatric Oncology Exercise Guidelines (iPOEG)

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.</p

Ejercicio físico moderado como terapia adyuvante en la recuperación inmunológica y condición física en niños sometidos a trasplante alogénico de progenitores hematopoyéticos

Tesis inédita presentada en la Universidad Europea de Madrid. Facultad de Ciencias Biomédicas. Programa de Doctorado en Biomedicina y Ciencias de la SaludEsta tesis doctoral pretende ampliar el conocimiento sobre los efectos del ejercicio físico programado en la recuperación de niños bajo trasplante alogénico de progenitores hematopoyéticos. Nos hemos centrado en diferentes fases del trasplante, desde la fase neutropénica hasta el periodo comprendido dentro de los 12 meses post trasplante, y hemos evaluado las siguientes variables: calidad de vida, capacidad funcional, condición física y recuperación inmunológica Métodos: Todos los pacientes pediátricos fueron reclutados de la Unidad Hemato-Oncológica y Trasplante de Células Madre del Hospital Universitario Niño Jesús de Madrid. La muestra de esta tesis doctoral está conformada por un total de 44 niños de 4 a 18 años, de los cuales 19 pertenecieron al grupo intervención y 25 formaron parte del grupo control, los cuales fueron igualados en edad. El grupo intervención lo formaron pacientes sometidos a trasplante de progenitores hematopoyéticos (7 en fase neutropénica, 4 en fase temprana-post trasplante y 8 en fase intermedia-post trasplante) que realizaron diferentes programas de ejercicio físico y el grupo control lo conformaron 8 niños sanos y 17 niños sometidos a trasplante (13 en fase neutropénica y 4 en fase temprana post-trasplante) que no realizaron ningún programa de ejercicio y estuvieron igualados en edad. Hemos medido la recuperación del sistema inmune [función de células natural killer, número de las principales subpoblaciones de leucocitos y citosinas (IL-2, IL-4, IL-6, IL-8, GM-CSF, IFN-¿, TNF-¿)], calidad de vida, condición física (capacidad aeróbica, fuerza, movilidad funcional y composición corporal). Resultados: Los resultados más relevantes de esta tesis doctoral fueron los siguientes: 1- No se observaron efectos adversos o problemas de salud inducidos por el ejercicio durante o después de las sesiones de entrenamiento. 2- Los niños con TPH en fase intermedia post-trasplante presentan una condición física menor que los niños sanos de su misma edad, (p<0,05). 3- Los niños en fase intermedia post trasplante son capaces de mejorar significativamente la capacidad aeróbica, la fuerza y la movilidad funcional (p<0,05) tras un perdió de 8 semanas de entrenamiento. 4- El grupo intervención, tras el programa de entrenamiento realizado en fase intermedia post-trasplante mostro mejoras en los test de calidad de vida, tanto en los auto-reportes de los niños como en los reportes de los padres (p < 0.05). 5- Los niños en fase neutropénica del grupo intervención presentaron un incremento de las variables antropométricas durante el período de hospitalización mientras que las mismas disminuyeron en el grupo control (p<0,05). 6- En la intervención realizada en la fase temprana post-trasplante las células NK bright disminuyeron significativamente su número (p<0,05), desde el tiempo pre al tiempo post entrenamiento en el grupo control, mientras aumentaron en el grupo intervención. 7- Hemos encontrado un incremento de la actividad citotóxica de las células NK (p<0,05), tras el periodo de entrenamiento en los niños en fase temprana post trasplante del grupo intervención. Conclusiones: En base al análisis preliminar de las intervenciones realizadas en la presente tesis doctoral, concluimos que los programas de ejercicio físico que siguen las recomendaciones de las instituciones de referencia mundial para la prescripción de ejercicio físico, mejoran de numerosas variables, tales como: aumento de la actividad citotóxica de las células NK, disminución de las células NK bright, mejoras en la condición física y la calidad de vida, no encontrándose ningún efecto negativo en ninguna de las tres fases post trasplante estudiadas. [Resumen Teseo

EXERCISE in pediatric autologous stem cell transplant patients: a randomized controlled trial protocol

BACKGROUND: Hematopoietic stem cell transplantation is an intensive therapy used to improve survivorship and cure various oncologic diseases. However, this therapy is associated with high mortality rates and numerous negative side-effects. The recovery of the immune system is a special concern and plays a key role in the success of this treatment. In healthy populations it is known that exercise plays an important role in immune system regulation, but little is known about the role of exercise in the hematological and immunological recovery of children undergoing hematopoietic stem cell transplant. The primary objective of this randomized-controlled trial (RCT) is to study the effect of an exercise program (in- and outpatient) on immune cell recovery in patients undergoing an autologous stem cell transplantation. The secondary objective is to determine if an exercise intervention diminishes the usual deterioration in quality of life, physical fitness, and the acquisition of a sedentary lifestyle. METHODS: This RCT has received approval from The Conjoint Health Research Ethics Board (CHREB) of the University of Calgary (Ethics ID # E-24476). Twenty-four participants treated for a malignancy with autologous stem cell transplant (5 to 18 years) in the Alberta Children’s Hospital will be randomly assigned to an exercise or control group. The exercise group will participate in a two-phase exercise intervention (in- and outpatient) from hospitalization until 10 weeks after discharge. The exercise program includes strength, flexibility and aerobic exercise. During the inpatient phase this program will be performed 5 times/week and will be supervised. The outpatient phase will combine a supervised session with two home-based exercise sessions with the use of the Wii device. The control group will follow the standard protocol without any specific exercise program. A range of outcomes, including quantitative and functional recovery of immune system, cytokine levels in serum, natural killer (NK) cells and their subset recovery and function, and gene expression of activating and inhibitory NK cell receptors, body composition, nutrition, quality of life, fatigue, health-related fitness assessment and physical activity levels will be examined, providing the most comprehensive assessment to date. DISCUSSION: We expect to find improvements in immunological recovery and quality of life, and decreased acquisition of sedentary behavior and fitness deconditioning. The comprehensive outcomes generated in this RCT will provide preliminary data to conduct a multisite study that will generate stronger outcomes. TRIAL REGISTRATION: Gov identification # NCT0166601

Influence of a moderate-intensity exercise program on early nk cell immune recovery in pediatric patients after reduced-intensity hematopoietic stem cell transplantation

After allogeneic hematopoietic stem cell transplantation (HSCT), NK cell reconstitution, which is crucial for positive outcomes, is dominated by the CD56bright subset with low NK cell cytotoxicity (NKCC) activity. Moderate exercise has been described as a potent NK cell stimulus in adults with cancer. The purpose of this study is to determine the effects of a moderate-intensity exercise program on NK cell recovery early after HSCT and the feasibility of this intervention. Six children undergoing allogeneic HSCT were randomized to an exercise program (EP) or control (CT) group. The EP group performed a 10-week training combining in-hospital and home-based EP. We observed a significant increase in the posttraining/pretraining ratio of the CD56dim subset (EP = 1.27 ± 0.07; CT = 0.99 ± 0.08; P < .005) of the EP group. The ratio of NKCC was 8 times greater in the EP group. Data suggest that a moderate-intensity EP program performed early after HSCT is feasible and might redistribute the CD56dim/CD56brigh NK cell subset, improving NKCC. The results are still preliminary and must be interpreted with caution.Sin financiación2.657 JCR (2017) Q1, 5/27 Integrative and Complementary Medicine; Q3, 137/223 Oncology0.766 SJR (2017) Q1, 12/106 Complementary and Alternative Medicine; Q2, 184/378 OncologyNo data IDR 2017UE

Benefits of intrahospital exercise training after pediatric bone marrow transplantation

The purpose of this study was to determine if an eight-week intrahospital supervised, conditioning program improves functional capacity and quality of life (QOL) in children (4 boys, 4 girls) (mean [SD] age: 10.9 [2.8] years [range: 8-16]) who have undergone bone marrow transplantation (BMT) for leukemia treatment within the last 12 months. A group of 8 age and gender-matched healthy children served as controls. The experimental group performed 3 weekly sessions of resistance and aerobic training inside an intra-hospital gymnasium. A significant combined effect of group and time (p < 0.05) was observed for muscle functional capacity (Timed Up and Down Stairs [TUDS] test) and peak oxygen uptake (V.O(2peak)), i.e., with BMT children showing greater improvements than controls (V.O(2peak) at pre- and post-training of 25.9 (8.2) and 31.1 (7.6) mL/kg/min in diseased children). Muscle strength (6 RM test for bench and leg press and seated row) also improved after training (p < 0.05) in the BMT group. Concerning QOL, a significant combined effect of group and time (p < 0.05) was also observed for children's self-report of comfort and resilience and for parents' report of their children's satisfaction and achievement. In summary, children who have received BMT experience physical and overall health benefits after a relatively short-term (8 weeks) supervised exercise training program.1.626 JCR (2008) Q2, 27/71 Sport sciencesUE

Physiological characteristics of the best Eritrean runners-exceptional running economy

Despite their young age, limited training history, and lack of running tradition compared with other East African endurance athletes (e.g., Kenyans and Ethiopians), male endurance runners from Eritrea have recently attained important running successes. The purposes of our study were (i) to document the main physical and physiological characteristics of elite black Eritrean distance runners (n = 7; age: 22 +/- 3 years) and (ii) to compare them with those of their elite white Spanish counterparts. For this second purpose we selected a control group of elite Spanish runners (n = 9; 24 +/- 2 years), owing to the traditionally high success of Spanish athletes in long-distance running compared with other white runners, especially in cross-country competitions. The subjects' main anthropometric characteristics were determined, together with their maximum oxygen uptake (VO↓2 max) and VO↓2 (mL.kg(-↑1).min(-↑1)), blood lactate, and ammonia concentrations while running at 17, 19, or 21 km.h(-↑1). The body mass index (18.9 +/- 1.5 kg.m(-↑2)) and maximal calf circumference (30.9 +/- 1.5 cm) was lower in Eritreans than in Spaniards (20.5 +/- 1.7 kg.m(-↑2) and 33.9 +/- 2.0 cm, respectively) (p < 0.05 and p < 0.01, respectively) and their lower leg (shank) length was longer (44.1 +/- 3.0 cm vs. 40.6 +/- 2.7 cm, respectively) (p < 0.05). VO↓2 max did not differ significantly between Eritreans and Spaniards (73.8 +/- 5.6 mL.kg(-↑1).min(-↑1) vs. 77.8 +/- 5.7 mL.kg(-↑1).min(-↑1), respectively), whereas the VO↓2 cost of running was lower (p < 0.01) in the former (e.g., 65.9 +/- 6.8 mL.kg(-↑1).min(-↑1) vs. 74.8 +/- 5.0 mL.kg(-↑1).min(-↑1) when running at 21 km.h(-↑1)). Our data suggest that the excellent running economy of Eritreans is associated, at least partly, with anthropometric variables. Comparison of their submaximal running cost with other published data suggests that superior running economy, rather than enhanced aerobic capacity, may be the common denominator in the success of black endurance runners of East African origin.Sin financiaciónNo data (2006)UE

Early-phase adaptations to intrahospital training in strength and functional mobility of children with leukemia

Improvements in chemotherapy and radiotherapy have contributed to the high survival rate (approximately 70%) of childhood acute lymphoblastic leukemia (ALL). However, during treatment, lack of physical activity and treatment cause various short- to long-term side effects, such as muscle atrophy and physical deconditioning. The purpose of this study was to determine the effects of an intrahospital, short-duration (8 weeks) exercise training program on muscle strength and endurance and functional mobility of children with ALL. Seven children (4 boys and 3 girls; 4-7 years of age) who were in the maintenance phase of treatment for ALL were selected as subjects. Three training sessions of 90- to 120-minute duration were performed each week. Each session included 11 different strength exercises engaging the major muscle groups and aerobic training. Gains in strength and endurance were assessed with a 6 repetition maximum test for upper (seated bench press and seated lateral row) and lower extremities (leg press). Gains in functional mobility were assessed with the time up and go test (TUG) and the timed up and down stairs test (TUDS). Performance was significantly improved after the training program in all strength tests (p < 0.01 for seated bench press and p < 0.05 for both seated lateral row and seated leg press) and in the TUG test (p < 0.05). In summary, a period of time as short as 8 weeks is enough to produce clinically relevant early-phase adaptations in children receiving treatment against ALL (i.e., improved functional mobility and muscle strength). Although more research is needed in the area of exercise training and pediatric cancer, exercise sciences can play a beneficial role in assisting both oncologists in treating cancer and improving children's quality of life during and after treatment.Sin financiación1.393 JCR (2007) Q2, 26/72 Sport sciencesUE

Exercise during hematopoietic stem cell transplant hospitalization in children

Purpose: Methods: Results: Conclusion: The purpose of this controlled trial was to assess the effect of an approximately 3-wk intrahospital exercise intervention performed during inpatient hospitalization for pediatric allogeneic hematopoietic stem cell transplant (HSCT) on (i) immune cell recovery and (ii) body composition.Immune (i.e., blood counts of leukocytes, monocytes, lymphocytes, and lymphocyte subpopulations) and anthropometric variables (i.e., body mass, body mass index, and estimated fat-free mass) were measured before and after (+15 and 30 d) HSCT. Seven children (5 boys and 2 girls; age (mean +/- SD) = 8 +/- 4 yr) with high-risk cancer performed an individualized training program (aerobic + resistance exercises) in their isolated hospital rooms. We also assessed a control group (n = 13; 9 boys and 4 girls; age = 7 +/- 3 yr) with similar medical conditions and following the same transplant protocol.In both groups, the dendritic cell count decreased from pre-HSCT to +15 d post-HSCT and thereafter (up to +30 d) remained stabile; however, the posttransplant decrease was more abrupt in the control group than that in the intervention group (-87% vs -63%, respectively, from pre-HSCT to +15 d). The rest of the immune cell parameters measured showed a similar response from pre-HSCT to post-HSCT in both groups. We found a significant effect of the interaction group x time for all anthropometric variables (weight, body mass index, body fat, and fat-free mass), indicating an increase over the hospitalization period only in the intervention group, for example, body mass increased from 32.9 +/- 18.7 kg pre-HSCT to 35.4 +/- 18.6 kg at +30 d in the intervention group versus a decrease from 30.2 +/- 16.6 to 29.3 +/- 6.3 kg in the control group.Our findings support the feasibility of exercise training interventions during hospitalization, including immunocompromised children.4.106 JCR (2010) Q1, 3/80 Sport sciencesUE