Sport activities and exercise as part of routine cancer care in children and adolescents

The burden of morbidities affecting cardiovascular and musculoskeletal systems, metabolism, and psychosocial health in young patients with cancer is high. It is alarming that patients and survivors of childhood cancer are less physically active than their healthy peers, since exercise may improve many of these conditions significantly and is associated with reduction in all‐cause mortality in the general population. Systematic integration of exercise programing into cancer care remains an exception, above all in children. Pediatric oncologists may contribute to a culture shift towards educating patients and stakeholders on the benefit of exercise and sports for children and adolescents with cancer.     

Physical activity and childhood cancer

This review provides a survey of studies investigating physical activity and exercise interventions in patients during tumor treatment and survivors of childhood cancer. PubMed and Medline databases were searched using relevant terms. References of selected papers were tracked. A total of 28 studies could be identified. Seventeen studies investigated physical activity, 11 studies determined the effect of activity enhancing interventions during and after therapy. Even though most studies showed limitations and results were not consistent, considerably reduced physical activity is highly probable in patients during and after therapy. Studies on interventions provided promising results and revealed challenges to be faced. Pediatr Blood Cancer 2010;54:501–510. © 2009 Wiley‐Liss, Inc.     

Aerobic exercise capacity in normal adolescents and those with type 1 diabetes mellitus

OBJECTIVE: To compare the aerobic exercise capacity between normal adolescents and those with type 1 diabetes mellitus (T1DM). METHODS: An experimental group with 72 individuals diagnosed with T1DM aged 9--20, time from diagnosis 4.9 +/- 3.6 yr, without clinical cardiopulmonary disease or anemia and a control group (C) with 46 healthy individuals aged 10--18, matched by age, weight, height, body mass index, and lean and fat mass (kg), underwent an incremental aerobic exercising test on a motorized treadmill, where gas exchange variables - peak pulmonary ventilation (VE), peak oxygen consumption (VO(2)), and carbon dioxide production (CO(2)) - as well as their heart rate (HR) and time to exhaustion were recorded. RESULTS: Body mass composition had no significant difference between experimental and control groups, and male and female subjects had similar exercising performances. The mean of hemoglobin A1c in the control group was 5.2+/- 0.9% and in the diabetic group 8.1+/- 2.2%; p=0.000. The patients with T1DM showed lower levels of aerobic capacity than the control group. Their respective values for each variable were as follows: (i) maximal VO(2) (T1DM: 41.57+/-7.68 vs. C: 51.12+/- 9.94 mL/kg/min; p< 0.001) and (ii) maximal VE (T1DM: 76.39+/-19.93 vs. C: 96.90 +/- 25.72 mL/kg/min; p< 0.001). Patients with T1DM also had an earlier time to exhaustion (T1DM: 8.75+/-1.60 vs. 10.82+/-1.44 min). CONCLUSIONS: Adolescent patients with T1DM showed a reduced aerobic exercising capacity when compared to healthy peers matched to anthropometric conditions. This potential condition should be taken into consideration by the time of evaluation of the aerobic performance of these patients with glycemic control level.     

Long-term follow-up of childhood cancer survivors: future directions for clinical care and research

Improvement in survival after childhood cancer has resulted in a growing population of childhood cancer survivors, causing the healthcare community to focus on providing appropriate care to the survivors, and addressing issues related to the etiology and prevention of long-term sequelae of cancer and its treatment. The overarching goal is to decrease the morbidity related to cancer treatment, and improve the overall quality of life, such that cancer survivors can successfully integrate back into society and lead productive lives. In order to achieve this goal, several issues need to be addressed, such as education of survivors and healthcare providers regarding the potential late effects; provision of standardized guidelines for appropriate follow-up of the survivors in a setting that is feasible and practical for the cancer survivor; ongoing communication between the cancer center that provided acute care for the patient and the healthcare facility providing follow-up care. Several challenges remain in addressing these issues, and will be the focus of this article.     

Normal physical working capacity in prepubertal children with type 1 diabetes compared with healthy controls

Background: Exercise testing has become a valuable help for the physician to examine the influence of recommended exercise training on physical fitness. However, the question as to how diabetic prepubertal children differ from their non-diabetic peers in their performance capacity has only partial and sometimes conflicting answers in the literature. Aim and methods: The aim of the current study was thus to evaluate aerobic fitness during an incremental submaximal test (measure of the Physical Working Capacity 170 (PWC₁₇₀)) in 17 well-controlled prepubertal insulin-dependent diabetic boys aged 8.5-13 y. Eighteen healthy prepubertal boys matched for age, body size and physical activity served as controls. Part of the method was to check capillary blood glucose level in the diabetic patients and in nine of the healthy subjects throughout the exercise. Results: From this experiment it appeared that the level of physical fitness was similar in diabetic and healthy boys (PWC₁₇₀ 2.28±0.09 vs 2.37±0.13 W·kg^-1). While glucose homeostasis was well maintained in the healthy group, diabetic children showed a marked fall in blood glucose during the exercise. In addition, the PWC₁₇₀ level correlated significantly with the estimate of energy expenditure attributed to vigorous activities in the diabetic boys.

Conclusion: By studying the responses to incremental exercise there is growing evidence that normal physical fitness is preserved in diabetic prepubertal boys given appropriate involvement in physical activity.     

Immune thrombocytopenia following successful treatment of cancer in children

A predisposition to developing immune thrombocytopenia (ITP) has not been reported in survivors of childhood cancer. We report a case series of childhood cancer survivors who developed an isolated thrombocytopenia in the presence of a normocellular bone marrow. Five children, two with endodermal sinus tumors and three with acute lymphoblastic leukemia, developed ITP at a median of 4 years (range: 0.2-8 years) after completion of therapy. We suggest the association of ITP in survivors of childhood malignancy may not be co-incidental as chemotherapy may cause persistent immune dysfunction.