Precision-based exercise as a new therapeutic option for children and adolescents with haematological malignancies

Abstract

Children and adolescents with haematological malignancies (PedHM) are characterized by a severe loss of exercise ability during cancer treatment, lasting throughout their lives once healed and impacting their social inclusion prospects. The investigation of the effect of a precision-based exercise program on the connections between systems of the body in PedHM patients is the new frontier in clinical exercise physiology. This study is aimed at evaluating the effects of 11 weeks (3 times weekly) of combined training (cardiorespiratory, resistance, balance and flexibility) on the exercise intolerance in PedHM patients. Two-hundred twenty-six PedHM patients were recruited (47% F). High or medium frequency participation (HAd and MAd) was considered when a participant joined; > 65% or between 30% and < 64% of training sessions, respectively. The "up and down stairs'' test (TUDS), "6 min walking" test (6MWT), the "5 Repetition Maximum strength" leg extension and arm lateral raise test (5RM-LE and 5RM-ALR), flexibility (stand and reach), and balance (stabilometry), were performed and evaluated before and after training. The TUDS, the 5RM-LE and 5RM-ALR, and the flexibility exercises showed an increase in HAd and MAd groups (P < 0.05), while the 6MWT and balance tests showed improvement only in HAd group (P < 0.0001). These results support the ever-growing theory that, in the case of the treatment of PedHM, 'exercise is medicine' and it has the potential to increase the patient's chances of social inclusion.

Figure 1

PedHM patients eligible for precision exercise training. Age, gender and clinical phases of treatment are shown. High (HAd), medium (MAd) and low (LAd) frequency adherence to training sessions are represented.

Figure 2

Performances during different tests by the PedHM patients before (T0, circles) and after (T1, squares) 11 weeks of precision training. The PedHM patients has been compared to the CTRL group (triangles). Left side of the panel shows the PedHM patients at high frequency adherence to training sessions (HAd), while at right the medium frequency adherence (MAd). (a) Timed up and down stairs test (TUDS). (b) 6 min walking test (6MWT). (c) strength of quadricep muscles during a leg extension test. (d) strength of deltoids muscles during a lateral arm raise test. (e) flexibility of posterior muscular chains during a stand and reach test. Continuous lines of statistical significance: ordinary one way ANOVA. Dashed lines: paired t test. Speckled line: unpaired t test.

Figure 3

Correlation between age and performance during timed up and down stairs test (TUDS). Three age’s cohorts (3–7 years; 8–11 years; > 12 years) are represented before (empty circle and dotted line) and after (empty squares and continuous line) training and compared to CTRL (empty triangle and dotted-continuous line). PedHM patients that could not take part in the T0 evaluation session due to walking inability, are represented only after training (T1, full stars).

Figure 4

Precision exercise training made by the same patient during 2 different times of her clinical history: 2 days (in room) and 3 months (in gym, climbing wall) after haematological stem cells transplant.