The power of physical activity
The importance of physical activity and harmful effects of inactivity are becoming more and more evident. Organisations are investing more resources to tackle the rising trend of inactivity and the burden it places on healthcare. Having this in mind, in this post we look into the current research of physical activity and childhood cancer patients. Is it actually feasible and beneficial? If so, what should be the next steps?
Physical activity lies in the heart of child’s development and helps to create a pathway to healthy and active life. Kids who are active during childhood are more likely to maintain the good physical activity habits in the later life, and as a result of that, improve their quality of life and prevent developing chronic diseases.
Research suggests, however, that paediatric cancer patients are generally less active than their healthy peers, especially when staying in the hospital (Aznar et al, 2006; Götte et al 2014). This is not surprising - children undergoing cancer treatment may experience high levels of fatigue as well as acute injuries to certain organs, both of which prevent engaging in optimal PA. It’s also a possibility the low PA levels are a result of overprotection by concerned parents, school teachers, physicians, and a general lack of education around PA and cancer patients (Chamorro Vina et al, 2013).
To date, no harmful effects of PA on paediatric oncology patients has been demonstrated. On the contrary, recent findings have shown promising results in using exercise as a medicine to mitigate the negative effects of cancer, both during and after treatment (Klika et al, 2018). Not only has it shown to benefit cardiopulmonary and musculoskeletal function, reduce tiredness and improve physical wellbeing, it has been found to also have a positive effect on psychosocial behaviour, such as improved self-esteem. Furthermore, some forms of PA, such as martial arts, have emerged as a promising tool to reduce pain in children with cancer, although these finding are preliminary (Bluth et al, 2016).
What is less clear, however, is the duration, intensity and frequency of the PA that childhood patients should engage with. It is important to acknowledge that one size doesn’t fit all and that the extent is dependent on various factors, such as age, type and stage of cancer as well as the limitations caused by the disease. For example, the primary goal in phase I or during treatment should be decreasing the time being sedentary and increasing awareness, whereas paediatric patients that have been treatment-free for 6-12 months should engage in regular exercise (Klika et al, 2018). Having said that, the PA programs should be fun and provide an educational component of the basics of PA. Moreover, in order to guarantee the successful implementation, a multifactorial co-operation between various specialists, including cardiology, pulmonology, psychology, nutrition and exercise oncology specialists, should be implemented (Klika et al, 2018).
Considering that the benefits of PA and harmful effects of inactivity are obvious, it’s encouraging to see the recent research in paediatric oncology. However, majority of this evidence is conducted mainly on patients with ALL (leukaemia), lacks RCT and involves small sample sizes (Huang et al, 2011). This identifies the need of further research to prove the clear benefits of PA on different patient groups. More time and effort need to be put into designing safe and realistic PA interventions as well as increasing general awareness, both in children as well as parents, schools and physicians.
References:
Aznar, S., Webster, A. L., San Juan, A. F., Chamorro-Vina, C., Mate-Munoz, J. L., Moral, S., ... & Lucia, A. (2006). Physical activity during treatment in children with leukemia: a pilot study. Applied physiology, nutrition, and metabolism, 31(4), 407-413.
Götte, M., Kesting, S., Winter, C., Rosenbaum, D., & Boos, J. (2014). Comparison of self‐reported physical activity in children and adolescents before and during cancer treatment. Pediatric blood & cancer, 61(6), 1023-1028.
Chamorro Vina, C., Wurz, A. J., & Culos-Reed, S. N. (2013). Promoting physical activity in pediatric oncology. Where do we go from here? Frontiers in oncology, 3, 173.
Klika, R., Tamburini, A., Galanti, G., Mascherini, G., & Stefani, L. (2018). The Role of Exercise in Pediatric and Adolescent Cancers: A Review of Assessments and Suggestions for Clinical Implementation. Journal of Functional Morphology and Kinesiology, 3(1), 7.
Bluth, M. H., Thomas, R., Cohen, C., Bluth, A. C., & Goldberg, E. (2016). Martial arts intervention decreases pain scores in children with malignancy. Pediatric health, medicine and therapeutics, 7, 79.
Huang, T. T., & Ness, K. K. (2011). Exercise interventions in children with cancer: a review. International journal of pediatrics, 2011, doi:10.1155/2011/461512.