Julia Beulertz

Clinical exercise interventions in pediatric oncology: a systematic review.

Studies in pediatric oncology have shown a positive effect of physical activity on disease- and treatment-related side effects. Although several reviews have approved the benefits of therapeutic exercise for adult cancer patients, no systematic review exists summarizing the evidence of physical activity in pediatric oncology. We identified a total of 17 studies using the PubMed database and Cochrane library. To evaluate the evidence, we used the evaluation system of the Oxford Center for Evidence-Based Medicine 2001. The findings confirm that clinical exercise interventions are feasible and safe, especially with acute lymphoblastic leukemia (ALL) patients and during medical treatment. No adverse effects have been reported. Positive effects were found on fatigue, strength, and quality of life. Single studies present positive effects on the immune system, body composition, sleep, activity levels, and various aspects of physical functioning. Child-specific aspects such as cognitive abilities, growth, adolescence, and reintegration into peer-groups, school, and sports have barely been taken into consideration. The evidence for exercise interventions in pediatric 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.

Physical Activity in Breast Cancer Patients during Medical Treatment and in the Aftercare - a Review.

Most scientific studies regarding physical activity in cancer patients involve breast cancer patients. It is apparent that physical activity during medical treatment and aftercare is not only feasible and safe but also effective. Current studies clearly show that regular and specific endurance and/or resistance training can reduce a number of side effects caused by medical treatment. Among others, improvements in physical performance, body composition, and quality of life as well as a reduction in fatigue, have been observed. Since inactivity appears to exacerbate lymphedema, patients with lymphedema are also encouraged to exercise. Few studies have been carried out regarding physical exercise in metastatic patients. However, experts in the field also recommend regular physical activity for patients with advanced-stage breast cancer.

Exercise-induced natural killer cell activation is driven by epigenetic modifications

Exercise has been proven to reduce the risk and progression of various diseases, such as cancer, diabetes and neurodegenerative disorders. Increasing evidence suggests that exercise affects the cytokine profile and changes distribution and function of tumor-competitive immune cells. Initial studies have shown that different exercise interventions are associated with epigenetic modifications in different tissues and cell types, such as muscle, fat, brain and blood. The present investigation examines the effect of an intense endurance run (half marathon) on global epigenetic modifications in natural killer (NK) cells in 14 cancer patients compared to 14 healthy controls. We were able to show that histone acetylation and NKG2D expression, a functional NK cell marker, were elevated for at least 24 h after the run. Thus, this is the first study to present a potential mechanism of how exercise may impact NK cell activity on the subcellular level. Further studies should focus on epigenetic mechanisms and dose-dependent effects of exercise.

Specific Deficit Analyses in Motor Performance and Quality of Life of Pediatric Cancer Patients—A Cross-Sectional Pilot Study

Although survival rates in childhood cancer have distinctly improved, pediatric cancer patients often experience various disease- and treatment-related side effects with long-term consequences. Despite current studies investigating inactivity and limitations in physical functioning and quality of life in pediatric cancer patients, only little information regarding specific deficits in physical functioning and quality of life has been available until now. No study has yet analyzed these parameters from a global perspective and then identified specific deficits in a mixed childhood cancer population. Within this cross-sectional pilot study, motor performance and quality of life of 26 pediatric cancer patients were assessed after inpatient medical treatment, using standardized motor test batteries (MOT 4–6; DMT 6–18) and a quality of life questionnaire (KINDL®). Reference data have been mainly provided by the German “Children and Young People Health Survey” (KiGGS). Patients achieved lower motor performance scores (p = .000) (more than 27% below the average of healthy peers). Specific deficits were identified in motor speed and motor control (4–6 years), as well as in endurance, strength and coordination under time pressure (6–17 years). In terms of quality of life, no significant differences were examined compared to healthy children of the same age. The results of this study confirm that children with oncological diseases frequently have specific motor problems. Future research in pediatric oncology must investigate the impact of targeted, individualized exercise interventions addressing these specific deficits.

Effects of a 6-Month, Group-Based, Therapeutic Exercise Program for Childhood Cancer Outpatients on Motor Performance, Level of Activity, and Quality of Life

Exercise interventions in pediatric oncology are feasible and safe. However, scarce data are available with regard to the effectiveness of outpatient, group‐based exercise interventions. As well, the potential role of exercise to improve motor performance has not been adequately explored despite being a meaningful outcome during childhood with important implications for physical activity behavior. No study has yet demonstrated significant changes in motor performance after an exercise intervention.

Limitations in Ankle Dorsiflexion Range of Motion, Gait, and Walking Efficiency in Childhood Cancer Survivors.

Background: Improvements in survival rates in pediatric oncology have resulted in a growing need to identify adverse effects and improve rehabilitation in this population. Objective: This cross-sectional study aimed to investigate active ankle dorsiflexion (DF) range of motion (ROM), gait, walking efficiency, and motor performance in a mixed childhood cancer survivor population in comparison to healthy peers. Methods: Active ankle DF-ROM (goniometer), gait (Microgate Optogait 2D Gait Analysis), walking efficiency (6-minute walk test), and motor performance (German Motor Test 6–18) were assessed in a mixed childhood cancer survivor population after cessation of medical treatment (n = 13) in comparison to healthy children matched for age and gender (n = 13). Results: Active ankle DF-ROM, gait (stance, swing, and preswing phase), and walking efficiency were significantly impaired in survivors compared with control subjects. No significant difference between groups was found in motor performance. Conclusion: Despite sufficient total motor performance levels, specific limitations in physical functioning were identified in a mixed childhood cancer survivor sample. This highlights the importance of the present findings. Implication for Practice: The results from this study highlight the potential significance of limited ankle DF function, inhibited gait, and reduced walking efficiency as adverse effects of various types of childhood cancer. It is hoped this enhanced recognition by pediatric cancer patients, parents, and exercise professionals will initiate specific supportive strategies and potentially prevent further limitations.

Ankle Dorsiflexion in Childhood Cancer Patients: A Review of the Literature.

Background: Improved treatment protocols necessary for survival in pediatric oncology are associated with the development of serious late effects. Of particular importance, especially with regard to physical activity, may be ankle dorsiflexion (DF). Objective: This review summarizes the results of observational and exercise intervention studies exploring ankle DF-range of motion (DF-ROM) and/or ankle DF strength in pediatric oncology. Methods: PUBMED, Medline, Cochrane library, and SportDiscus were searched by 2 researchers using predefined search terms. The reference lists of included papers and Google scholar were then searched to that ensure all appropriate articles were included. Results: Twelve studies were identified and were observational (n = 8), providing information regarding the status of DF-ROM and/or DF strength, or intervention studies (n = 4) using exercise as a strategy to improve DF function. All observational studies reported some degree of impairment in ankle DF. Two intervention studies found a positive effect of exercise on ankle DF-ROM. Conclusion: The preliminary results suggest that pediatric cancer patients and survivors suffer from limitations in ankle DF with interventions varying in efficacy. Implication for Practice: It is hoped that this review will enhance the recognition of the limited ankle DF function in pediatric oncology and initiate further research programs focused on targeting and evaluating ankle DF.

Bewegungstherapie in der pädiatrischen Onkologie

ZusammenfassungIn Zusammenhang mit der Verbesserung der Qualität des Überlebens spielt die Vermeidung von Nebenwirkungen und Spätfolgen onkologischer Erkrankungen im Kindes- und Jugendalter eine wichtige Rolle und Bewegungsprogramme für krebskranke Kinder und Jugendliche gewinnen mehr und mehr an Bedeutung. Aufbauend auf einer Problemanalyse sowie aktuellen wissenschaftlichen Erkenntnissen wurden strukturelle und inhaltliche Rahmenbedingungen für Bewegungsprogramme in der pädiatrischen Onkologie definiert. Diese sollten in einer vertrauten Umgebung durchgeführt werden und sowohl Eltern als auch Geschwisterkinder einbeziehen. Insbesondere betreutes Training zeigt positive Effekte, muss jedoch in den Alltag der Kinder und Jugendlichen integrierbar sein. Inhaltlich sollte sich die Bewegungsförderung an den altersphysiologischen Grundlagen, der Diagnose, den Nebenwirkungen sowie der körperlichen Leistungsfähigkeit orientieren, um positive Veränderungen auf physischer, psychischer, sozialer und edukativer Ebene zu erzielen. Die gewonnenen wissenschaftlichen Erkenntnisse werden im Sinne des translationalen Ansatzes im Rahmen eines Pilotprojekts in die Praxis umgesetzt.AbstractThe prevention of disease- and treatment-related side effects is essential in pediatric oncology in order to improve the quality of survival. Additionally, clinical exercise programs are becoming increasingly important in pediatric oncology. Based on a specific problem analysis and data from the current literature, recommendations concerning the content and structural conditions of exercise programs in pediatric oncology were defined. The exercise programs should be conducted in familiar surroundings integrating parents and siblings. While supervised programs seem to be more effective, they must also fit into the patient’s daily life. Exercise programs should consider age-related physiological principles, diagnosis, side-effects, and physical functioning in order to achieve positive effects on physiological, psychological, social, and educative levels. According to the translational approach, all scientific results are integrated into the care structure within a pilot project.

Lebensqualität – Konzepte und Methoden in der Onkologie

Bereits seit ihren Anfangen beschaftigt sich die Psychoonkologie mit der Messung der Effekte ihrer Interventionen. Dabei standen „damals“ (1975) zunachst lediglich Instrumente zur Beurteilung der wesentlichen Symptome wie Schmerz oder Emesis zur Verfugung, doch die vermuteten „breiteren“ Effekte psychoonkologischer Masnahmen konnten noch nicht abgebildet werden. 1985 fand sich schlieslich aufgrund einer europaischen Initiative (u.a. des deutschen Chirurgen Hans Troidl) eine interdisziplinare Arbeitsgruppe (Mediziner, Psychologen, Methodiker u.a.m.) zur Erforschung der Lebensqualitat zusammen. Die „EORTC Studygroup on Quality of Life“ ist noch heute eine hochaktive Arbeitsgruppe der EORTC, einer europaischen multinationalen Organisation zur Erforschung von Tumorleiden. Von besonderer Bedeutung war in diesem Zusammenhang ab 1986 die Entwicklung eines international validierten Lebensqualitatsfragebogens, auf den in ▶ Abschn. 11.3erneut Bezug genommen wird. Dieser stellt (aus heutiger Sicht) eine der herausragenden Errungenschaften der Arbeitsgruppe dar.

Körperliche Aktivität und Sport bei Krebs

Auch wenn der Einsatz korperlicher Aktivitaten in der Onkologie nicht mehr wegzudenken ist, so war es lange Zeit umstritten, ob oder gar inwiefern Bewegung als rehabilitative oder praventive Komponente bei Krebspatienten eingesetzt werden kann. Die Verunsicherung seitens der Arzte und Therapeuten war gros, und man empfahl im Zweifelsfall Schonung und Ruhe, mit dem Hintergedanken, dass man so nichts falsch machen konne. Die Verunsicherung, herruhrend aus Mangel an Wissen und Fakten, ubertrug sich auch auf den an Krebs erkrankten Patienten, der bereits seinerseits durch die Diagnose geschockt und verunsichert war. Menschen in solchen Ausnahmesituationen neigen zu Passivitat und sozialem Ruckzug.