Wilhelm Bloch

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.

Exercise Intervention Studies in Patients with Peripheral Neuropathy: A Systematic Review

IntroductionPeripheral neuropathies (PNPs) encompass a large group of disorders of heterogeneous origin which can manifest themselves with sensory and/or motor deficits depending on the predominantly affected nerve fiber modality. It represents a highly prevalent disease group which can be associated with significant disability and poor recovery. Exercise has the potential to improve side effects of PNP.ObjectiveOur objective in this systematic review was to analyze exercise interventions for neuropathic patients in order to evaluate the possible benefits of exercise.MethodsThree independent reviewers used PubMed, MEDPILOT® (MEDLINE), Cochrane, and relevant reference lists to obtain the data. Relevant studies were graded according to the Oxford Levels of Evidence.ResultsEighteen studies (ten randomized controlled trials and eight controlled clinical trials) met all inclusion criteria. Three (diabetic) studies were ranked very high quality [1b (A)], nine high quality (four diabetes, one cancer, four others) [2b (B)], while six (four diabetes, two others) showed low quality (4/C). Current data suggests that exercise is a feasible, safe, and promising supportive measure for neuropathic patients. This is best documented for patients with diabetic peripheral neuropathy (DPN), suggesting that endurance training has the potential to prevent the onset of and reduce the progression of DPN. In general, balance exercises showed the highest effect on the motor as well as sensory symptoms in all types of PNP.ConclusionOverall, balance training appears to be the most effective exercise intervention. Studies focusing exclusively on strength, or a combination of endurance and strength, appear to have a lower impact. For metabolically-induced neuropathies, endurance training also plays an important role. Further research with high methodological quality needs to be conducted in order to establish evidence-based clinical recommendations for neuropathic 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.

Post-chemotherapy cognitive impairment in patients with B-cell non-Hodgkin lymphoma: a first comprehensive approach to determine cognitive impairments after treatment with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone or rituximab and bendamustine

Abstract To assess the effects of chemoimmunotherapy on post-chemotherapy cognitive impairments (PCCI) in patients with B-cell non-Hodgkin lymphoma (NHL), we used objective and subjective measures of cognitive functions in combination with serum parameters and neuroelectric recordings. Self-perceived status of cognition, fatigue and emotional functioning were reduced in patients (n = 30) compared to healthy controls (n = 10). Cognitive performance was impaired in patients with NHL compared to controls and a norm sample (n = 1179). PCCI was more severe in patients treated with rituximab and bendamustine (BR) than in patients who received R in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) polychemotherapy (R-CHOP). Individual alpha peak frequency and serum brain-derived neurotrophic factor (BDNF) levels in patients with NHL correlated with accuracy in the objective cognition test. Higher serum interleukin-6 (IL-6) concentrations were associated with higher fatigue levels. Patients with NHL and especially those who were treated with BR were affected by PCCI. BDNF and IL-6 might be involved in the pathogenesis of PCCI and fatigue.

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.

Impact of exercise on pro inflammatory cytokine levels and epigenetic modulations of tumor-competitive lymphocytes in Non-Hodgkin-Lymphoma patients-randomized controlled trial.

Physical activity is associated with decreased cancer (recurrence) risk and a reduction in treatment‐specific side effects. Exercise modulates cytokine expression and shows beneficial effects on cancer patients’ immune system. We investigated the following: (i) whether Non‐Hodgkin‐Lymphoma patients have increased serum macrophage migration inhibiting factor (MIF) and Interleukin‐6 (IL‐6) levels after immunochemotherapy; (ii) whether physical activity influences cytokine serum levels; and (iii) whether serum cytokine levels are associated with histone modifications in tumor‐competitive immune cells.

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.

Impact of a half marathon on cellular immune system, pro-inflammatory cytokine levels, and recovery behavior of breast cancer patients in the aftercare compared to healthy controls

Exercise has beneficial effects on cancer prevention as well as on prognosis of patients with cancer. To optimize the outcomes of exercise programs, more knowledge about the underlying mechanisms is needed. This study investigates the short‐term effects of a half marathon on immune cell proportions, pro‐inflammatory cytokine levels, and recovery behavior of patients with breast cancer in the aftercare compared to healthy controls.

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.

Durch Bewegungsinterventionen Symptome reduzieren

Entwickeln Krebspatienten eine chemotherapieinduzierte Polyneuropathie (CIPN), verringert dies nicht nur deren Lebensqualität, sondern es kann auch die medizinische Therapie negativ beeinflussen. Bisher gibt es keine zufriedenstellende präventive oder symptomatische Behandlung. Vielversprechend erweisen sich nach neuesten wissenschaftlichen Erkenntnissen jedoch bewegungstherapeutische Ansätze wie Sensomotorik- und Vibrationstraining.