Treatment of childhood cancer is associated with a spectrum of late effects, including impaired growth and development, cognitive dysfunction, diminished neurological function, cardiopulmonary compromise, musculoskeletal sequelae, and secondary malignancy. Therefore, attention today is focused not only on survival but also on the quality of survival.
Impaired physical fitness has been reported during and after childhood cancer treatment. Impaired physical fitness typically includes reduced cardiopulmonary function, decreased muscle strength, fatigue, and altered physical function. Treatments for childhood cancer, including radiotherapy, chemotherapy, and surgery, can result in acute and long-term injury to the heart, lungs, and skeletal muscles, systems necessary for optimal physical fitness
Exercise intervention has the potential to improve cardiopulmonary and musculoskeletal function, perhaps preventing long-term deficits in physical fitness if incorporated during or soon after treatment in children with cancer diagnoses.
Survivors face unique challenges related to the risk of cancer recurrence and the development of other chronic diseases. The potential benefits of exercise during and after treatment are significant and research has proved its effectiveness.
Exercise as a Complementary Therapy
Studies in paediatric oncology have shown a positive effect of physical activity on disease and treatment-related side effects.
Research findings confirm that clinical exercise interventions are feasible and safe, especially with Acute Lymphoblastic Leukaemia (ALL) patients and during medical treatment. Positive effects were found on fatigue, strength, and quality of life.
Some children with cancer can benefit from simple exercises such as wrapping silly putty around the hands of a physical therapist. The exercise helps strengthen their hands where neuropathy has developed as a result of chemotherapy.
The Single studies present positive effects on the immune system, body composition, sleep, activity levels, and various aspects of physical functioning.
The evidence for exercise interventions in paediatric oncology is rated level “3.” Although the results are very promising, future research of high methodological quality and focusing on child-specific aspects is needed to establish evidence-based exercise recommendations, particularly for childhood cancer patients.
Most people with cancer notice that they have a lot less energy. During chemotherapy and radiation, most patients have fatigue. Fatigue is when your body and brain feel tired. This tiredness does not get better with rest. For many, fatigue is severe and limits their activity. But inactivity leads to muscle wasting and loss of function.
An aerobic training program can help break this cycle. In research studies, regular exercise has been linked to reduced fatigue. It’s also linked to being able to do normal daily activities without major problems. An aerobic exercise program can be prescribed as treatment for fatigue in cancer patients. Talk with your doctor about this.
A growing body of research now suggests that exercise may not only help protect people from developing cancer but also may increase survival in those already diagnosed.
- A 2005 prospective, observational study, which followed almost 3000 women diagnosed with non-metastatic breast cancer, found that those who engaged in moderate physical activity — equivalent to walking 3-5 hours each week at a modest pace — significantly lowered their risk of dying from breast cancer compared with their more sedentary peers.
- Exercise may also enhance survival for those diagnosed with non-metastatic colorectal cancer. In one observational study which followed 573 women diagnosed with stage I, II, or III colorectal cancer, those who were physically active after their diagnosis, regardless of their pre-diagnosis exercise regimen, were less likely to die from cancer or in general.
- The more exercise they did, the better their odds became: Those who engaged in 6 or more hours of moderate exercise each week, including walking, bicycling, swimming, and running, reduced their risk of dying from cancer by about half compared with their peers who exercised less than 1 hour per week.
The decreased level of activity present in children who have leukaemia has been studied extensively.
Implementing physical fitness programs, both during the acute hospitalisation phase and following the cancer treatment, may be beneficial for decreasing side effects, such as osteoporosis, decreased muscle tone and slowing the weight gain often associated with post cancer treatment.
These programs will also assist in establishing healthy lifestyle habits for decreasing secondary cancer risks in this population.
A 3-week in-patient walking program intervention consisting of 12 minutes of daily walking significantly improved fatigue and decreased symptoms of distress and depression in patients undergoing bone marrow transplantation.
Another study evaluating the effects of increased fitness on decreasing osteoporosis for children undergoing treatment for ALL did not show any benefit; however, the exercise intervention group did regain their pre-treatment weight through significantly faster weight loss compared with the control group. The authors postulated that the lack of improvement in bone mineral density was due to the low level of patient adherence to the fitness program and recommended that future studies find methods to increase patient participation.
The effects of physical exercise training interventions for childhood cancer participants are not yet convincing due to small numbers of participants and insufficient study methodology. Despite that, first results show a trend towards an improved physical fitness in the intervention group compared to the control group.
How is Exercise Administered?
Hospital type supervised exercise interventions such as aerobic training, resistance, and flexibility exercises have better cardiopulmonary outcomes than do those that are home or community based. Supervised exercise training also appears to have promise during the maintenance phase of chemotherapy and for childhood cancer survivors with long-term cardiopulmonary compromise.
Being active is good for you! Increasing activity levels can produce physical, psychological, social and academic benefits.
There are many reasons why children and adolescents have low fitness levels, especially within the hospital environment.
Experts at Nationwide Children’s Hospital Sports Medicine have developed Play Strong, a medically-supervised, wellness program using “play” to show that exercise can be enjoyable.
Physical therapy focuses on gross motor skills including learning to walk, run and jump. Gross motor skills play an important role in peer play and the organisation of the child’s developing neuromuscular system.
Exercising with traditional equipment such as BOSU, stability balls, medicine balls and hand weights together with playing fun games is a great way for children with cancer to get exercise in a group setting.
Unfortunately, supervised training is expensive and often unrealistic for families who may have to travel long distances to a centre that specialises in cancer care.
- Do not exercise if you have a low red blood cell count (anaemia).
- If you have low white blood cell counts or if you take medicines that make you less able to fight infection, stay away from public gyms and other public places until your counts are at safe levels.
- Do not exercise if the level of minerals in your blood, such as sodium and potassium, are not normal. This can happen if you have had a lot of vomiting or diarrhoea.
- Do not exercise above a moderate level of exertion without talking with your doctor first. Remember, moderate exertion is about as much effort as a brisk walk.
- If you have a catheter or feeding tube, avoid pool, lake, or ocean water and other exposures that may cause infections. Also, do not do resistance training that uses muscles in the area of the catheter to keep from dislodging it. Talk with your cancer team about what’s safe for you.
- To avoid skin irritation, people getting radiation should not expose skin in the treatment area to the chlorine in swimming pools.
- Stay away from uneven surfaces or any weight-bearing exercises that could cause you to fall and hurt yourself.
- If you have numbness in your feet or problems with balance, you are at higher risk for falls. You might do better with a stationary reclining bicycle, for example, than a treadmill.
- Watch for swollen ankles, unexplained weight gain, or shortness of breath while at rest or with a small amount of activity. Let your doctor know if you have any of these problems.
- Start slowly. Even if you can only do an activity for a few minutes a day it will help you. How often and how long you do a simple activity like walking can be increased slowly. Your muscles will tell you when you need to slow down and rest.
- Try short periods of exercise with frequent rest breaks. For example, walk briskly for a few minutes, slow down, and walk briskly again, until you have done 30 minutes of brisk activity. You can divide the activity into three 10-minute sessions, if you need to. You’ll still get the benefit of the exercise.
- Exercise as you are able. Don’t push yourself while you are in treatment. Listen to your body and rest when you need to.
Side Effects or Risks
No adverse effects have been reported. It appears that exercise training can be safely undertaken during treatment for ALL and HCT with no major effects on the immune system and that exercise does not have a deleterious effect on growth factors during treatment for ALL.
Chemotherapy treatment for paediatric cancer suppresses the immune system and may interfere with normal growth, increasing susceptibility to infection and stunting or delaying musculoskeletal development during treatment. There is some concern regarding the effects of exercise on immune function and growth factors including the possibility that exercise may tax an already compromised immune or endocrine system, possibly either delaying recovery or further impacting normal skeletal growth.
If you haven’t already been exercising regularly, check with your doctor before you begin an exercise program. Start slowly, adding more exercise as you go. Aim to work your way up to at least 30 minutes of exercise most days of the week.
Please note that the Little Fighters Cancer Trust shares information regarding various types of cancer treatments on this blog merely for informational use. LFCT does not endorse or promote any specific cancer treatments – we believe that the public should be informed but that the option is theirs to take as to what treatments are to be used.
Always consult your medical practitioner prior to taking any other medication, natural or otherwise.