Whole-body vibration in children with disabilities demonstrates therapeutic potentials for pediatric cancer populations: a systematic review

PurposeLow levels of physical activity often observed in pediatric oncology might be attributed to various functional deficits, especially those of the lower limbs as these affect gait, mobility, and, consequently, physical activity. In the past few years, whole-body vibration (WBV) has emerged as a new therapy modality for improving physical functioning. Although WBV is increasingly applied in children with disabilities, its impact on lower limb function in pediatric cancer patients and survivors has not yet been investigated.MethodsTo establish whether there is evidence that WBV may be beneficial for pediatric cancer patients and survivors, this review summarizes current data on WBV studies among children with disabilities and extracts relevant information for the pediatric cancer population. Two independent reviewers performed a systematic literature search following the PRISMA guidelines.ResultsNine studies were included in the analysis. Results demonstrate that WBV is a safe, highly compliant, and effective approach in cohorts of children with disabilities. The largest effects of WBV were observed in lower extremity muscle mass and strength, balance control, gait, and walking ability. Furthermore, we were able to develop first recommendations for WBV protocols.ConclusionsWBV seems to be feasible and effective for improving parameters that may be relevant to the pediatric cancer population. Efforts are needed to conduct first WBV interventions in children with cancer proving the effects. The developed recommendations for WBV protocols might help to implement these intervention studies

Indoor Wall Climbing with Childhood Cancer Survivors: An Exploratory Study on Feasibility and Benefits

Background Exercise interventions in pediatric oncology include primarily traditional types of physical activity (PA) such as endurance and strength training, while there is a growing interest in recreational types of PA for pediatric cancer survivors, as well. One of these motivating and fun activities is indoor wall climbing. Therefore, this exploratory study aims to evaluate the feasibility and beneficial effects of a 10-week indoor wall climbing intervention in pediatric oncology. Patients Thirteen childhood cancer survivors aged 6-21 years were included after cessation of their inpatient medical treatment of whom eleven completed the study. Methods Study participants completed measurements of physical functioning at baseline (t0) and post-intervention (t1), as well as a questionnaire on program satisfaction at t1. Results Survivors participated in 57.43 +/- 31.77% of the climbing sessions and no adverse events occurred. Most study participants evaluated the climbing experience to be fun and motivational. One child stated that the climbing intervention was too exhausting/overstraining. Significant positive effects were found in terms of ankle DF-ROM and ankle DF strength. Discussion Indoor wall climbing seems feasible with childhood cancer survivors and suggests beneficial potentials on physical functioning. However, some preconditions (i. e. close supervision; slow increase of intensity; sufficient breaks) must be ensured. Conclusion Indoor wall climbing could be a motivational adjunct to traditional types of exercise in pediatric oncology

Exercise interventions for patients with pediatric cancer during inpatient acute care: A systematic review of literature

Physical inactivity has been shown to exacerbate negative side effects experienced by pediatric patients undergoing cancer therapy. Exercise interventions are being created in response. This review summarizes current exercise intervention data in the inpatient pediatric oncology setting. Two independent reviewers collected literature from three databases, and analyzed data following the PRISMA statement for systematic reviews and meta-analyses. Ten studies were included, representing 204 patients. Good adherence, positive trends in health status, and no adverse events were noted. Common strategies included individual, supervised, combination training with adaptability to meet fluctuating patient abilities. We recommend that general physical activity programming be offered to pediatric oncology inpatients

Participation in organized sports, physical education, therapeutic exercises, and non-organized leisure-time physical activity: how does participation differ between childhood cancer outpatients and healthy peers?

Most childhood cancer survivors are insufficiently active. Researchers are focusing on strategies to increase physical activity (PA). However, a detailed understanding of participation in specific types of PA is missing, meaning current strategies may lack relevant information. Thus, our study sought to analyze participation in different types of PA commonly engaged in by children: organized sports, physical education in school (PES), therapeutic exercise, and non-organized leisure-time PA. Thirty-eight childhood cancer outpatients and 51 healthy children completed questionnaires. Compared to healthy children, childhood cancer outpatients, especially those who are shortly after cessation of inpatient treatment, participated significantly less often in organized sports and PES and significantly more often in therapeutic exercise compared to the healthy children. Considering organized sports and PES afford children unique social benefits and provide the potential to motivate lifelong activity, future efforts should be placed on ensuring children with cancer can access these types of PA. Educating parents, teachers, and coaches, exploring referral pathways to exercise professionals and providing individual support may enhance participation rates in organized PA and should be investigated

Whole-Body Vibration Training Designed to Improve Functional Impairments After Pediatric Inpatient Anticancer Therapy: A Pilot Study

Purpose: To assess a whole-body vibration (WBV) intervention for children after cancer treatment. Methods: Eleven children after inpatient anticancer therapy participated in a 12-week supervised WBV intervention, which consisted of one 9- to 13-minute WBV session per week, with 5 to 9 minutes' overall vibration time. Feasibility was defined as the ability to participate in WBV training without reporting adverse events. The number of offered and completed training sessions, program acceptance, and measures of function were assessed. Results: Nine participants completed the WBV intervention without any WBV-related adverse events. The adherence rate was 87.96%. Only minor side effects were reported and there was general program acceptance. We found indications that WBV has positive effects on knee extensor strength and active ankle dorsiflexion range of motion. Conclusions: WBV was feasible, safe, and well received among children after inpatient anticancer therapy. No health deteriorations were observed. Positive effects need to be confirmed in future trials

Whole-body vibration training for inpatient children and adolescents receiving chemotherapy for first cancer diagnosis: an exploratory feasibility study

Whole-body vibration (WBV) is a feasible and potentially beneficial exercise strategy for managing neuromuscular impairments like decreased strength or flexibility, mobility limitations and bone health in pediatric cancer survivors. However, as starting rehabilitation as early as possible is recommended to preserve physical function, this study investigated the feasibility of WBV for patients receiving cancer treatment for first cancer diagnosis. Eleven patients (various types of cancer, ages 7-17) participated in the supervised WBV intervention concomitant to acute cancer treatment, which involved chemotherapy. Training was implemented as part of a general exercise program and offered 3 days per week during hospitalization (warm-up, four progressive training exercises comprising 60-120 s, 21-27 Hz, 2 mm peak-to-peak-displacement). Feasibility, which was defined as the absence of WBV-related serious adverse events leading to study dropout, was primarily evaluated. Training documentation was additionally analyzed. As a main result, no serious adverse events leading to study dropout were reported. However, two incidents of bleeding (adverse events) were observed in patients with bleeding tendencies and low platelets (thrombocytes < 30,000/mu L). After adjusting the platelet count threshold for WBV participation to 30,000/mu L, no further incidents occurred. Moreover, due to WBV-related side effects like physical exhaustion, 11% of all training sessions had to be stopped and another 11% required reductions in the vibration load. Patients participated in 48% of the planned sessions. While main reasons for non-attendance were medical issues (35%), only few WBV sessions were missed, not completed or needed modifications due to motivational issues. Consequently, WBV seems to be feasible for inpatient pediatric patients receiving chemotherapy for first cancer diagnosis, given a sufficiently high platelet count of at least 30,000/mu L. Although WBV tolerance and training motivation appear high, patient's reduced medical condition during hospitalization can negatively impact training progression and attendance. Future research is required to confirm our findings on feasibility and to assess efficiency of WBV training for pediatric cancer patients receiving cancer treatment

Sensorimotor Training in Paediatric Oncology: Implementation of a Child-Friendly and Playful Training Concept

In sensorimotor training (SMT), in this case balance training as a sub-category of SMT, exercises are carried out on different surfaces and in different standing positions. SMT has the potential to induce regenerative and adaptive mechanisms, contributing to the plasticity of the nervous system. While the effort and material involved for this exercise modality is minimal, effects remain high and reproducibility is good. It can be adjusted individually to the participant's daily performance level. To date, SMT has been conducted in the context of rehabilitation as well as injury and fall prevention. In recent years, SMT has also been successfully implemented in adult oncology in order to improve common impairments of the lower extremities, such as reduced balance control. Children after inpatient oncological treatment also suffer from various mobility-related impairments of their lower extremities which can lead to further physical inactivity. These impairments may occur as a result of chemotherapy induced peripheral neuropathy (CIPN). SMT seems to have the potential to improve sensory and motor dysfunctions, contributing to higher physical activity in general. With the objective of implementing a child-friendly, motivating and individual SMT, a specific training concept for paediatric oncology was developed at the Department of Sport, Exercise and Health at the University of Basel. In this training concept, children use a turntable to compose the sensorimotor exercises based on their daily performance level. The feasibility of the training concept was tested in a 4-week pilot study, conducted within an established exercise program after cancer treatment of the German Sport University Cologne in the Children's Hospital Amsterdamer Strasse Cologne. 6 children and adolescents after oncological treatment took part. The preliminary results of the pilot study and a case example show that a child-friendly and playful SMT after paediatric oncological disease is feasible without occurrence of adverse events. Therefore, SMT might be a valuable and targeted training modality supplementing exercise therapy in paediatric oncology