Randomized controlled trial of a collaborative care intervention to manage cancer-related symptoms: lessons learned EXERCISE in pediatric autologous stem cell transplant patients: a randomized controlled trial protocol Physical Activity in Pediatric Cancer patients with solid tumors (PAPEC): trial rationale and design. The effect of individualized exercise interventions during treatment in pediatric patients with a malignant bone tumor Feasibility Study: The Effect of Therapeutic Yoga on Quality of Life in Children Hospitalized With Cancer Active video games to promote physical activity in children with cancer: a randomized clinical trial with follow-up Exercise Interventions in Children with Cancer: A Review Limitations on Physical Performance and Daily Activities among Long-Term Survivors of Childhood Cancer Exercise during hematopoietic stem cell transplant hospitalization in children. Impact of Exercise on Lower Activity Levels in Children with Acute Lymphoblastic Leukemia: A Randomized Controlled Trial from Turkey Fit4Life: a weight loss intervention for children who have survived childhood leukemia. Preliminary Findings of a 4-Month Intrahospital Exercise Training Intervention on IGFs and IGFBPs in Children with Leukemia Physical exercise for cancer patients with advanced disease: a randomized controlled trial. Effectiveness of an integrated adventure-based training and health education program in promoting regular physical activity among childhood cancer survivors. Feasibility and parent satisfaction of a physical therapy intervention program for children with acute lymphoblastic leukemia in the first 6 months of medical treatment. Fitness of Children With Standard-risk Acute Lymphoblastic Leukemia During Maintenance Therapy: Response to a Home-based Exercise and Nutrition Program A randomized trial investigating an exercise program to prevent reduction of bone mineral density and impairment of motor performance during treatment for childhood acute lymphoblastic leukemia. Implementation of structured physical activity in the pediatric stem cell transplantation. Effects of physical therapy intervention for children with acute lymphoblastic leukemia. Clinical field testing of an enhanced-activity intervention in hospitalized children with cancer.
Background Collaborative care interventions to treat depression have begun to be tested in setting s outside of primary care . However , few studies have exp and ed the collaborative care model to other setting s and targeted comorbid physical symptoms of depression . Purpose The aims of this report were to : ( 1 ) describe the design and methods of a trial testing the efficacy of a stepped collaborative care intervention design ed to manage cancer-related symptoms and improve overall quality of life in patients diagnosed with hepatobiliary carcinoma ; and ( 2 ) share the lessons learned during the design , implementation , and evaluation of the trial . Methods The trial was a phase III r and omized controlled trial testing the efficacy of a stepped collaborative care intervention to reduce depression , pain , and fatigue in patients diagnosed with advanced cancer . The intervention was compared to an enhanced usual care arm . The primary outcomes included the Center for Epidemiological Studies -Depression scale , Brief Pain Inventory , and Functional Assessment of Cancer Therapy (FACT)-Fatigue , and the FACT-Hepatobiliary . Sociodemographic and disease-specific characteristics were recorded from the medical record ; Natural Killer cells and cytokines that are associated with these symptoms and with disease progression were assayed from serum . Results and Discussion The issues addressed include : ( 1 ) development of collaborative care in the context of oncology ( e.g. , timing of the intervention , tailoring of the intervention , ethical issues regarding r and omization of patients , and changes in medical treatment over the course of the study ) ; ( 2 ) use of a website by chronically ill population s ( e.g. , design and access to the website , development of the website and intervention , ethical issues associated with website development , website usage , and unanticipated costs associated with website development ) ; ( 3 ) evaluation of the efficacy of intervention ( e.g. , patient preferences , proxy raters , changes in medical treatment , and inclusion of biomarkers as endpoints ) ; and ( 4 ) analyses and interpretation of the intervention ( e.g. , confounding factors , dose and active ingredients , and risks and benefits of collaborative care interventions in chronically ill patients ) . Limitations The limitations to the study , although not fully realized at this time as the trial is ongoing , include : ( 1 ) heterogeneity of the diagnoses and treatments of participants ; and ( 2 ) inclusion of caregivers as proxy raters but not as participants in the intervention . Conclusions Collaborative care interventions to manage multiple symptoms in a tertiary cancer center are feasible . However , research ers design ing and implementing interventions that are web-based , target multiple symptoms , and for oncology patients may benefit from previous experiences 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 population s 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 r and omized-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 r and omly 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 st and ard 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 # BACKGROUND This r and omized controlled trial on Physical Activity in Pediatric Cancer ( PAPEC ) was design ed to assess the impact of an exercise program on pediatric cancer patients undergoing chemotherapy for solid tumors . METHODS AND DESIGN 60 pediatric patients of both sexes , aged 4 to 18 years and undergoing treatment for extracranial primary solid tumors will be recruited for this trial . Each participant will be r and omly assigned ( with blocking on sex ) to either an intervention or control ( normal care ) group . The intervention group will participate in combined inpatient physical training ( aerobic + strength ) for the duration of neoadjuvant chemotherapy . The intervention will include 3 weekly 60 - 70 min exercise sessions in the child 's room or in a pediatric gym at the hospital , depending on the child 's health state . In both groups , determination of several primary ( cardio-respiratory fitness , muscle strength , functional capacity , physical activity levels , body weight and quality of life ) and secondary outcomes [ immune function and inflammatory profile ( blood levels of 47 cytokines ) ] will be made at the following time points : ( i ) before the exercise intervention ( immediately after diagnosis and before treatment onset ) ; ( ii ) after the exercise intervention ( upon termination of neoadjuvant chemotherapy ) ; and ( iii ) after a detraining period ( 2 months after the intervention ) . DISCUSSION The PAPEC trial will provide relevant new information on biological mechanisms and inform on the potential clinical use of exercise during pediatric cancer treatment as a simple way to prevent future long-term treatment effects and improve the general health state of pediatric cancer patients Background While research on exercise interventions during anticancer treatment is well-established in adults , only very few studies exist in children . However , pediatric patients experience great limitations to being physically active , and appropriate interventions are desired . ProcedureThe present study aim ed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor . The parameter of interest was  physical activity ( PA ) . Patients ’ PA during home stays was assessed 6 weeks as well as 3 , 6 , 12 , and 18 months post-surgery . Patients were distinguished into an intervention  group and a  control group . All patients received endoprosthetic replacement of the affected bone in the same institution . Results A constant increase in all PA parameters was observed during follow-up . Exercise interventions were possible and appeared worthwhile . The intervention group showed better PA results at all measurements ; however , no significant differences between groups were found . Furthermore , differences decreased especially after the cessation of the intervention . General problems in reaching appropriate power and compliance were observed . Conclusions Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial . Such interventions should be implemented in adjuvant care ; however , future research is needed to underst and more about the effects of different interventions Purpose : To describe the effect of therapeutic yoga on child and parental reports of quality of life in children hospitalized with oncological diagnoses . Methods : Six children participated in 5 yoga sessions  over 2 months . The PedsQL 4.0 was administered to each child and participating parent/caregivers at baseline and after completion of the yoga intervention . The Wilcoxon nonparametric rank test measured individual differences over time . Results : Statistically significant differences ( P < .05 ) were found in child perception of gross motor function . Conclusion : These feasibility study data suggest that therapeutic yoga positively affected child perception of gross motor function measured on the PedsQL 4.0 . Further studies are needed , including a r and omized control trial and with a larger number of participants , to clarify and confirm the effect of therapeutic yoga Background Low levels of physical activity , musculoskeletal morbidity and weight gain are commonly reported problems in children with cancer . Intensive medical treatment and a decline in physical activity may also result in reduced motor performance . Therefore , simple and inexpensive ways to promote physical activity and exercise are becoming an increasingly important part of children ’s cancer treatment . Methods The aim of this study is to evaluate the effect of active video games in promotion of physical activity in children with cancer . The research is conducted as a parallel r and omized clinical trial with follow-up . Patients between 3 and 16 years old , diagnosed with cancer and treated with vincristine in two specialized medical centers are asked to participate . Based on statistical estimates , the target enrollment is 40 patients . The intervention includes playing elective active video games and , in addition , education and consultations for the family . The control group will receive a general recommendation for physical activity for 30 minutes per day . The main outcomes are the amount of physical activity and sedentary behavior . Other outcomes include motor performance , fatigue and metabolic risk factors . The outcomes are examined with question naires , diaries , physical examinations and blood tests at baseline and at 2 , 6 , 12 and 30 months after the baseline . Additionally , the children ’s perceptions of the most enjoyable activation methods are explored through an interview at 2 months . Discussion This trial will help to answer the question of whether playing active video games is beneficial for children with cancer . It will also provide further reasoning for physical activity promotion and training of motor skills during treatment . Trial registration Clinical Trials.gov identifier : NCT01748058 ( October 15 , 2012 ) The purpose of this review is to summarize literature that describes the impact of exercise on health and physical function among children during and after treatment for cancer . Relevant studies were identified by entering the following search terms into Pubmed : aerobic training ; resistance training ; stretching ; pediatric ; children ; AND cancer . Reference lists in retrieved manuscripts were also review ed to identify additional trials . We include fifteen intervention trials published between 1993 and 2011 that included children younger than age 21 years with cancer diagnoses . Nine included children with an acute lymphoblastic leukemia ( ALL ) diagnosis , and six children with mixed cancer diagnoses . Generally , interventions tested were either in-hospital supervised exercise training or home based programs design ed to promote physical activity . Early evidence from small studies indicates that the effects of exercise include increased cardiopulmonary fitness , improved muscle strength and flexibility , reduced fatigue and improved physical function . Generalizations to the entire childhood cancer and childhood cancer survivor population s are difficult as most of the work has been done in children during treatment for and among survivors of ALL . Additional r and omized studies are needed to confirm these benefits in larger population s of children with ALL , and in population s with cancer diagnoses other than ALL Context Long-term survivors of childhood cancer may be affected by treatment-associated impairments that limit physical performance and restrict participation in activities of daily living . Prevalence of these impairments and their association with particular types of cancer or treatment methods are not known . Contribution Patients surviving childhood cancer for at least 5 years were compared with their siblings who did not have cancer . All survivors were at an increased relative risk for persistent impairment , but survivors of brain and bone cancer were particularly likely to report performance limitations and restrictions in routine activities . Implication s Despite substantial improvements in treatment of childhood cancer , profound alterations in quality of life often persist into adulthood . The Editors Profound advances in treatment efficacy and a concomitant increase in the number of long-term survivors have generated a need for investigations into the adverse effects of childhood cancer and its treatment ( 1 - 5 ) . Surgery , chemotherapy , and radiotherapy are essential to providing a long-term cure in many children with malignant and nonmalignant neoplasms . Surgical procedures can result in structural and functional changes , which can have long-term implication s in young children who are growing and developing . Chemotherapy and radiotherapy are cytotoxic and thus can have deleterious effects on developing organ systems ( 6 - 18 ) . Long-term survivors of childhood cancer are at risk for many late effects , including early death , second cancer , and organ system dysfunction ( 19 - 22 ) . Endocrine , musculoskeletal , neurologic , sensory , cardiac , and pulmonary impairments also have been documented ( 1 , 19 , 20 , 22 - 29 ) . A malignant disease or its treatment may cause long-term impairments in intellectual , emotional , and physical domains that diminish functioning ( performance limitations ) . Performance limitations can restrict the survivor 's ability to participate fully in daily activities necessary for self-care , home management , or work ( participation restrictions ) . Delayed consequences of therapy are of special interest in children with cancer because of their young age and because of the potential remaining years of life that may be affected ( 30 ) . Performance limitations and participation restrictions have been reported in as many as 69 % of survivors of childhood cancer ( 31 - 33 ) . The aims of this analysis were to estimate the prevalence of performance limitations and participation restrictions among a cohort of long-term survivors of childhood cancer . We compared these results with similar findings in a comparative group of siblings of survivors . In addition , we evaluated whether performance limitations and participation restrictions were affected by cancer type ; treatment methods ; or delayed effects of the cancer , its treatment , or both . Methods Study Participants The Childhood Cancer Survivor Study ( 34 ) is an ongoing epidemiologic follow-up study of survivors of childhood cancer who received their primary treatment at 1 of 26 collaborating institutions . Eligibility was restricted to patients who received their diagnosis between 1970 and 1986 ; whose age at diagnosis was 20 years or younger ; and who survived at least 5 years after receiving the diagnosis of one of the following diseases : primary brain cancer , leukemia , Hodgkin disease , non-Hodgkin lymphoma , kidney tumor , neuroblastoma , soft-tissue sarcoma , or malignant bone tumor . The Human Subjects Research Review Committees at the University of Minnesota ( the study coordinating center ) and each collaborating institution approved the protocol s and documents of the Childhood Cancer Survivor Study . Participants provided informed consent to participate in the study and separate consent to allow the release and abstract ion of medical records , including treatment records . Siblings of the survivors were recruited as a comparison group . Of the enrolled survivors who indicated that they had a living sibling , 5800 whose r and omly generated 5-digit registration numbers ended with an odd digit were asked to seek permission for the investigators to contact the sibling who was closest in age to them . Four thous and six hundred ninety-one siblings ( 80.9 % ) agreed to be contacted . Data collection was conducted by abstract ing treatment-related information from medical records and by having participants , or a parent if the participant was younger than 18 years of age at the time of the survey , complete the Long Term Follow Up Study Question naire ( 35 ) , a 24-page document that contains questions regarding the presence and timing of medical conditions , the presence of physical limitations , and the presence of current participation restrictions . Variable Definitions Outcomes Performance limitations and participation restrictions were the primary outcome variables for this analysis . Physical performance was scored by adding the answers to a series of 6 questions about the participant 's performance of particular physical activities during the past 2 years . We asked , Over the past 2 years , how long ( if at all ) has your health limited you in each of the following activities : 1 ) vigorous activities like lifting heavy objects , running , or participating in strenuous sports ; 2 ) moderate activities like moving a table , carrying groceries , or bowling ; 3 ) walking uphill or climbing a few flights of stairs ; 4 ) bending , lifting , or stooping ; 5 ) walking 1 block ; and 6 ) eating , dressing , bathing , or using the toilet ? Scores of 1 to 3 were assigned to each of the 6 questions . A score of 1 indicated that the participant was limited for more than 3 months , a score of 2 indicated that the participant was limited for 3 months or less , and a score of 3 indicated that the participant was not limited at all . A lower score indicated a greater degree of limitation . On the basis of graphical examination of the distribution of physical performance for siblings and survivors , this continuous variable was dichotomized by using a natural cutoff value at or below the 10th percentile of the distribution of the sibling group . Survivors and siblings at or below this cutoff point were classified as having a performance limitation . Participation restrictions were evaluated in 3 separate categories : limited personal care skills ; limited routine activities ; and poor health preventing school or work attendance . A participation restriction was considered present if participants had a positive response to the following questions : 1 ) Because of any impairment or health problem , do you need the help of other persons with personal care needs , such as eating , bathing , dressing , or getting around the home ? 2 ) Because of any impairment or health problem , do you need the help of other persons in h and ling routine needs , such as everyday household chores , doing necessary business , shopping , or getting around for other purpose s ? 3 ) Does any impairment or health problem keep you from holding a job or attending school ? Predictor Variables Cancer type , treatment groups , and late effects were considered risk factors of interest for these analyses . Information about the original diagnosis was obtained from the treating institution , and information on primary therapy was abstract ed from the medical record . Because most survivors had had surgery , therapy was grouped into broad categories that included surgery only ; radiation with or without surgery ( radiation ) ; chemotherapy with or without surgery ( chemotherapy ) ; chemotherapy and radiation with or without surgery ( chemotherapy with radiation ) ; treatment other than surgery , radiation , or chemotherapy ; or unknown . Late effects were defined as dichotomous indicators based on participants ' self-reporting of answers to questions that asked if a doctor or other health care professional had ever told them that they had a particular condition . A late effect was considered prevalent if a participant answered yes to condition-specific questions . Late effects included impairment to any body system that occurred from the onset of the initial therapy to the time when the baseline question naire was completed . Participants who answered do n't know or who left a question blank were included in the no or not present category for that variable . Late effects were grouped as follows according to major body system : endocrine impairments ; bone and joint health ; neurologic impairments ; sensory impairments ; cardiac impairments ; and pulmonary impairments , as previously described ( 25 , 27 , 36 ) . Statistical Analyses The prevalence of performance limitations and participation restrictions among survivors was compared with that among the participating siblings , using generalized estimating equations with a Poisson distribution and a log link ( 37 - 39 ) , and was reported as a st and ardized risk ratio ( RR ) . These methods were used in all models to account for the possible correlation between survivors and siblings from the same family ( 40 ) . The Poisson distribution with a log link was selected to allow model convergence with conservative CIs . Cancer type , treatment group , and presence of a late effect were also evaluated in relation to the outcome variables in generalized estimating equations . All models were adjusted for the participant 's age at interview and sex . The model evaluating treatment was also adjusted for cancer type . Because the participant 's age at diagnosis and race and ethnicity were not independent predictors of the outcomes , and because they did not appreciably alter the estimates , they were not included in the final models . To confirm the results we obtained using generalized estimating equation models , we also completed matched analyses for each outcome , limiting these models to only survivors with a sibling in the comparison group . To evaluate the sensitivity of the results to dichotomization of the physical performance variable , this outcome measure was also evaluated as a continuous variable comparing survivors with PURPOSE 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 . METHODS Immune ( i.e. , blood counts of leukocytes , monocytes , lymphocytes , and lymphocyte sub population s ) 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 . RESULTS 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 . CONCLUSION Our findings support the feasibility of exercise training interventions during hospitalization , including immunocompromised children & NA ; This r and omized , controlled experimental study was carried out to determine the effects of an exercise program on both physical parameters and the quality of life of children with acute lymphoblastic leukemia ( ALL ) . A total of 41 children with ALL ( 20 trial and 21 control cases ) at two university hospitals were accepted into the study . Due to the demise of one of the children in the trial group , the study was completed with 19 trial and 21 control patients , a total of 40 children and their parents .  Regular and systematic exercise regimens implemented by children with ALL have result ed in improved testing results , enhanced physical performance , and better laboratory results compared with a control group and to children 's scores before the initiation of such a program BACKGROUND Children surviving acute lymphoblastic leukemia ( ALL ) are at increased risk for overweight and obesity over that of the general population . Whether a generic or tailored approach to weight management is needed for cancer survivors has yet to be tested . PROCEDURE Thirty-eight youth 8 - 18 years with BMI ≥ 85 % who had survived ALL were recruited for a r and omized clinical trial evaluating a weight management intervention ( WMI ) tailored for childhood ALL survivors ( Fit4Life ) . Fit4Life recipients received a 4-month web , phone , and text message-delivered WMI tailored for cancer survivorship . Controls received a general WMI delivered via phone and mail . Assessment s were performed at baseline and 4 months . Outcome data were analyzed according to assigned treatment condition over time . RESULTS Most ( 80 % , ( 70 % , 100 % ) [ median ( IQR ) ] ) of the assigned curriculum was received by Fit4Life participants as compared to 50 % ( 40 % , 65 % ) among controls . Fit4Life recipients ≥ 14 years demonstrated less weight gain ( P = 0.05 ) and increased moderate-to-vigorous physical activity ( P < 0.01 ) while all Fit4Life recipients reported reduced negative mood ( P < 0.05 ) over time as compared to control counterparts . CONCLUSIONS We demonstrated acceptable feasibility of a WMI tailored for overweight and obese children surviving ALL utilizing a multimodal technology approach . Improved weight , weight-related behavior , and psychological outcomes were demonstrated among Fit4Life intervention as compared to youth receiving a generic WMI . Data from this pilot trial may be used to design a larger trial to determine whether youth of all ages also can derive a benefit from a cancer survivor-tailored WMI and whether short-term outcomes translate into improved long-term outcomes for childhood ALL survivors Ruiz , JR , Fleck , SJ , Vingren , JL , Ramírez , M , Madero , L , Fragala , MS , Kraemer , WJ , and Lucia , A. Preliminary findings of a 4-month intrahospital exercise training intervention on IGFs and IGFBPs in children with leukemia . 24(5 ) : 1292 - 1297 , 2010-The aim of this study was to determine the effect of a 16-week intrahospital supervised , conditioning program including both resistance and aerobic type training on insulin-like growth factors 1 and 2 ( IGF-1 , IGF-2 ) , several IGF-binding proteins ( IGFBPs ) , and growth hormone ( GH ) in children receiving treatment against acute lymphoblastic leukemia ( ALL ) . We also analyzed the effects of a 20-week detraining period on these hormones . Seven children ( 3 girls and 4 boys ) aged 4 - 7 years in the maintenance phase of treatment against ALL performed 3 training sessions per week for 16 weeks of resistance ( 1 set of 8 - 15 repetitions of 11 exercises ) and aerobic training ( 30 minutes at ≥50 % heart rate max ) followed by 20 weeks of detraining where no structured exercise program was performed . Levels of IFG-1 and IFG-2 did not significantly change after the intervention period or after the detraining phase . Likewise , levels of GH , IGFBP-2 , and IGFBP-3 remained stable pre and posttraining and after the detraining period . IGFBP-1 levels significantly decreased after training ( −43.8 % , p = 0.014 ) , whereas there were no significant differences between pretraining vs. detraining ( −17.8 % , p = 0.108 ) nor between posttraining vs. detraining ( 17.7 % , p = 0.251 ) . Exercise training did not have major effects on the IGFs , IGFBPs , and GH in children with ALL . Although the importance of these findings to long-term cancer prognosis and /or recurrence remains to be determined , the present data ( particularly those on IGF-1 and IGFBP-3 ) support the idea that exercise training can be safely undergone during treatment against ALL with no major adverse effect BACKGROUND Physical exercise can improve cancer patients ' functioning and reduce their symptom levels . A r and omized , controlled trial was launched to test the hypothesis that physical exercise reduces fatigue and improves physical performance in cancer patients with advanced and incurable disease . METHODS Cancer patients ( n = 231 ) with a life expectancy ≤2 years were r and omized to a physical exercise group ( PEG , n = 121 ) or a control usual care group ( UCG , n = 110 ) . The PEG exercised under supervision 60 minutes twice a week for 8 weeks . Assessment s were performed before and after the intervention . The primary outcome was physical fatigue ( PF ) measured by the Fatigue Question naire . Physical performance was a secondary outcome measured by the Shuttle Walk Test ( SWT ) and h and grip strength ( HGS ) test . Analyses were performed after multiple imputations for missing data . The trial is registered with Clinical Trials.gov ( identifier , NCT00397774 ) . FINDINGS Thirty-six percent of the PEG were lost to follow-up compared with 23 % of the UCG , primarily as a result of disease progression . Seventy-eight PEG and 85 UCG patients completed the intervention . Analyses showed no significant between-group effects in PF . However , clinical ly and statistically significant between-group effects were found for the SWT and HGS test . INTERPRETATION Fatigue was not reduced but physical performance ( SWT and HGS test ) was significantly improved after 8 weeks of physical exercise . Physical exercise might therefore be a suitable approach for maintaining physical capacity in cancer patients with incurable and advanced disease BACKGROUND There is growing concern about declining levels of physical activity in childhood cancer survivors . This study aim ed to examine the effectiveness of an integrated adventure-based training and health education program in promoting changes in exercise behavior and enhancing the physical activity levels , self-efficacy , and quality of life of Hong Kong Chinese childhood cancer survivors . METHODS A r and omized controlled trial , two-group pretest and repeated post-test , between-subjects design was conducted to 71 childhood cancer survivors ( 9- to 16-year-olds ) . Participants in the experimental group joined a 4-day integrated adventure-based training and health education program . Control group participants received the same amount of time and attention as the experimental group but not in such a way as to have any specific effect on the outcome measures . Participants ' exercise behavior changes , levels of physical activity , self-efficacy , and quality of life were assessed at the time of recruitment , 3 , 6 , and 9 months after starting the intervention . RESULTS Participants in the experimental group reported statistically significant differences in physical activity stages of change ( p < 0.001 ) , higher levels of physical activity ( p < 0.001 ) and self-efficacy ( p = 0.04 ) than those in the control group . Besides , there were statistically significant mean differences ( p < 0.001 ) in physical activity levels ( -2.6 ) , self-efficacy ( -2.0 ) , and quality of life ( -4.3 ) of participants in the experimental group from baseline to 9 months after starting the intervention . CONCLUSIONS The integrated adventure-based training and health education program was found to BACKGROUND Children with acute lymphoblastic leukemia ( ALL ) are at risk for developing musculoskeletal complications during and after their medical treatment . The objective of this study was to examine the feasibility of an in-hospital physical therapy- and home exercise program during the first four phases of medical treatment , for children with newly diagnosed ALL . PROCEDURE Nine patients , between the ages of 2 - 14 years old were enrolled within 2 weeks of diagnosis in the study . Each patient was evaluated at study entry , after each of the first four phases of therapy and each time patients were re-admitted to the hospital . Following the initial physical therapy evaluation an individualized home exercise program was developed , consisting of stretching , strengthening , and aerobic exercises . The following end points were measured at each evaluation : gross motor assessment as measured by gross motor function measure ( GMFM ) , health-related quality of life as measured by the PedsQL and parent satisfaction question naire . RESULTS This study was feasible with 98 % of the evaluation sessions completed . The GMFM and PedsQL improved steadily throughout the study ; however , the PedsQL slightly decreased from interim maintenance to delayed intensification . The parents reported being satisfied with the physical therapy program . CONCLUSION We demonstrated that an in-hospital- and home exercise physical therapy program during the first four phases of medical treatments is feasible for children with ALL . Future r and omized studies are needed to confirm whether an initial physical therapy program at diagnosis in children with ALL will limit functional impairments , improve overall fitness and increase health-related quality of life Background Altered nutrient intake and decreased exercise in response to cancer therapies and their side effects , particularly corticosteroids , may be key factors in the increased body weight and differences in physical fitness reported in survivors of childhood acute lymphoblastic leukemia ( ALL ) . Purpose To assess ( 1 ) the effect of a home-based nutrition and exercise intervention program on cardiovascular fitness , strength , and flexibility in children with ALL during maintenance therapy and ( 2 ) the feasibility of conducting and evaluating a home-based exercise and nutrition program in this patient population . Design Children ages 4 to 10 years with st and ard-risk ALL were r and omized when starting maintenance therapy to a 12-month home-based exercise and nutrition program ( n=6 , 3 males/3 females ) or control ( n=7 , 4 males/3 females ) group . Assessment of anthropometrics , dietary intake , physical activity , and fitness was performed at baseline and 6 and 12 months of study . Results Although age , body size , and nutrient intakes were similar between both subject groups at 0 , 6 , and 12 months , exercise and nutrition program children had greater improvement in physical activity and cardiovascular fitness between 6 and 12 months than control children . Conclusions These results suggest that a home-based exercise intervention during maintenance therapy encouraged greater physical activity and improved cardiovascular fitness in children with st and ard-risk ALL . Further investigation involving larger population s of children with ALL is warranted BACKGROUND Reduced bone mineral density ( BMD ) , altered body composition , impaired motor performance and passive ankle dorsiflexion are side effects of acute lymphoblastic leukemia ( ALL ) treatment . We performed a r and omized study investigating whether an exercise program could prevent these side effects . PROCEDURE At diagnosis we r and omized 51 ALL patients ( median age : 5.4 years ) into a group receiving a 2-year exercise program or a control group receiving st and ard care .  BMD of total body ( BMD(TB ) ) , lumbar spine ( BMD(LS ) ) and body composition were measured using dual energy X-ray absorptiometry , motor performance with Bayley Scales of Infant Development or Movement-ABC , and passive ankle dorsiflexion with a goniometer . The investigator was blinded to the r and omization . RESULTS Body fat increased equally during treatment in both groups . One year after cessation of therapy more rapid decline of excessive body fat was observed in the intervention group than in the controls ( P = 0.01 ) . Lean body mass , BMD(TB ) and BMD(LS ) of both groups decreased equally during treatment and increased equally thereafter . Both groups showed a similar decrease in passive ankle dorsiflexion and motor performance during treatment . Adherence to the intervention program varied considerably . Adherence to intervention : 11 % of children exercised daily , 37 % > once a week , 16 % once weekly , 36 % < once a week . CONCLUSIONS The exercise program was not more beneficial than st and ard care in preventing reduction in BMD , motor performance and passive ankle dorsiflexion than st and ard care , most likely due to unsatisfactory compliance . Increased BMI and body fat in the intervention group normalized faster after cessation of chemotherapy The peripheral blood stem cell transplantation ( PBSCT ) represents a specific , but stressful therapy for hemato-oncological diseases . While for adults , data suggest positive eff ects for a supportive sport therapy , this question is not evaluated sufficiently for children . The objective of this study was to examine the integration of sports activity into pediatric PBSCT and to indicate attainable results . This 2-step case-control- study included 23 children and adolescents from the PBSCT : During the isolation phase 13 patients trained 3 times per week on a cycle ergometer and passed a course with different sports equipment . Apart from recording physiologic adaptations , quality of live was inquired in a pre-post design using question naires . Guided interviews according to necessity and requirements for sports activity at the PBSCT unit completed the evaluation and were used for the intervention as well as for the control group ( n = 10 ) without sports therapy . On the ergometer , patients trained average 25 min with 0.6 watt / kg . In the majority , a loss of muscular power could be avoided . Quality of life and fatigue symptoms improved by trend . Interview analysis showed general acceptance of physical activity during PBSCT . After initial skepticism due to the additional burden , our implementation study showed the feasibility of  supportive sports therapy  in PBSCT . Quality and flexibility of the equipment should be higher than normal and different physical and psychological conditions of the patients should be anticipated and integrated into the training program BACKGROUND The purpose of this study was to examine the effects of physical therapy intervention in children with acute lymphoblastic leukemia ( ALL ) . PROCEDURE Twenty-eight children aged 4 - 15 years were r and omly assigned to an intervention or control group . The intervention group received five sessions of physical therapy and was instructed to perform an individualized home exercise program consisting of ankle dorsiflexion stretching , lower extremity strengthening , and aerobic exercise . RESULTS After 4 months children who received physical therapy intervention had significantly improved ankle dorsiflexion active range of motion and knee extension strength ( P < 0.01 ) . Differences were not found between the two groups for any of the other dependent variables . CONCLUSIONS Physical therapy intervention for children with ALL receiving maintenance chemotherapy improved two body functions important for normal gait .  Physical therapy programs initiated earlier in treatment and with greater emphasis on endurance activities may also improve stamina and quality of life ( QOL ) This prospect i ve , two-site , r and omized , controlled pilot study assessed the feasibility of an enhanced physical activity ( EPA ) intervention in hospitalized children and adolescents receiving treatment for a solid tumor or for acute myeloid leukemia ( AML ) , and assessed different statistical techniques to detect the intervention 's sleep and fatigue outcomes .  Twenty-nine patients ( 25 with a solid tumor and 4 with AML ) participated . Data were collected from actigraph ; patient , parent , and staff nurse reports of patient fatigue ; parent sleep diaries ; and patient charts . The intervention was successfully implemented 85.4 % of the scheduled times . We used two different statistical methods to analyze the longitudinal data . Using an ANOVA model , sleep was significantly more efficient in the experimental arm than in the control arm when daily differences from baseline sleep efficiency values were averaged and compared ( F=4.17 , P=0.053 ) . However , in a mixed model ( repeated measures ) analysis , sleep duration ( F=0.54 , P=0.47 ) and sleep efficiency ( F=0.04 , P=0.85 ) were not seen to differ between study arms . We conclude that an inpatient intervention of EPA can be delivered to children and adolescents receiving chemotherapy . Our findings identify design and statistical considerations for a future effectiveness study of the EPA intervention in hospitalized pediatric oncology patients
BACKGROUND A decreased physical fitness has been reported in patients and survivors of childhood cancer .
This is influenced by the negative effects of the disease and the treatment of childhood cancer .
Exercise training for adult cancer patients has frequently been reported to improve physical fitness .
In recent years , literature on this subject has also become available for children and young adults with cancer , both during and after treatment .
This is an up date of the original review that was performed in 2011 .
OBJECTIVES To evaluate the effect of a physical exercise training intervention on the physical fitness ( i.e. aerobic capacity , muscle strength , or functional performance ) of children with cancer within the first five years from their diagnosis ( performed either during or after cancer treatment ) , compared to a control group of children with cancer who did not receive an exercise intervention .
To determine whether physical exercise within the first five years of diagnosis has an effect on fatigue , anxiety , depression , self efficacy , and HRQoL and to determine whether there are any adverse effects of the intervention .