13 Feb Exercise & Childhood Cancer
Exercise whether organized or not has an impact on chronic diseases. More specifically, in childhood cancer it helps in better symptom management. Childhood cancer is characterized by aberrant cell growth and division, causing tissue and organ system dysfunction as dysfunctional cancer cells replace healthy, functional cells. Treatment includes surgical removal of the tumour, local or total radiotherapy, chemotherapy or a combination of these. Chemotherapy and radiotherapy are both non-specific cytotoxic treatments that can have long-term effects on the health and functionality of pediatric patients, with one of these effects being reduced exercise tolerance (1).
Physical activity is a key factor in child development and appears to improve cardiorespiratory fitness, strength and the ability to successfully carry out daily activities in a wide range of pediatric chronic diseases (2). At the same time, it is encouraging that more than 80% of children who become ill will survive. However, treatment does not come without cost. During treatment, children are faced with nausea, fatigue, disrupted sleep patterns, pain, anxiety and depression. Still, about 70% of children who survive childhood cancer develop complications in adulthood, including cardiomyopathy, obesity, insulin resistance, stress, osteoporosis and chronic fatigue (3). Decreased exercise tolerance promotes the disruption of their aerobic and anaerobic fitness, reduction in muscle strength and disruption of their neuromuscular coordination, balance and flexibility. The complications that persist due to treatment and affect children’s physiology vary depending on the type of treatment and dose. For example, intravenous chemotherapy and total radiotherapy cause systemic inflammation and oxidative stress, where they are likely to damage vascular endothelial cells and skeletal muscle cells, disrupt oxygen transport and aerobic metabolism of skeletal muscles during physical activity (1).
Promoting physical activity in both children with cancer and cancer survivors is very important, as these children are at greater risk for developing sedentary lifestyles and comorbidities throughout their lives (2). The literature review to date supports that early participation in exercise programs prevents or reduces severe musculoskeletal consequences (1, 2). At the same time, it appears that despite these benefits, the proportion of children who exercise both during and after treatment is low compared to healthy peers (4).