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Cancers
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Pediatric/Adolescent Cancer and Exercise
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Pediatric/Adolescent Cancer and Exercise

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Pediatric Oncology".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 18005

Special Issue Editors

Dr. Carmen Fiuza-Luces

E-Mail Website
Guest Editor
Physical Activity and Health Laboratory, Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), 28041 Madrid, Spain
Interests: exercise and disease; exercise and molecular biology; exercise and pediatric/adolescent cancer
Prof. Dr. Alejandro Lucia

E-Mail Website
Guest Editor
1. Faculty of Sports Sciences, Universidad Europea de Madrid, Madrid, Spain
2. Physical Activity and Health Laboratory, Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), 28041 Madrid, Spain
Interests: exercise prescription; exercise and chronic diseases; responses and adaptations to exercise; exercise physiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

There is growing evidence for a protective association of regular physical activity and the risk of many prevalent adult cancers, and even of cancer-related outcomes––including mortality––once a tumor has developed. The first biological evidence for this association was published nearly eight decades ago, when Rush and Kline showed a slower rate of tumor growth–– inoculated fibrosarcoma––in treadmill-trained mice compared to a control group with a similar calorie intake but not subjected to forced exercise (Cancer Research 1943;4:116-118). In the current millennium, a growing number of preclinical studies are providing insight into the mechanisms responsible for the antitumoral effects of exercise, particularly improved cancer immunosurveillance. This is quite an important finding because evading immune destruction is a hallmark of cancer and immunotherapy is reshaping cancer treatment. On the other hand, since Winningham published her doctoral thesis (1983) showing the benefits of cycle-ergometer exercise on the functional capacity and wellbeing of women with breast cancer, strong evidence has accumulated over the years supporting the role of exercise practice as a co-adjuvant treatment to attenuate tumor/treatment side effects (e.g., fatigue), with world experts currently endorsing ‘that people living with and beyond cancer should be as active as is possible for them’ (CA Cancer J Clin 2019 Nov;69(6):468-484).

Yet, many questions remain open, especially with regard to the great forgotten, pediatric/adolescent cancer. The tumor biology indeed differs compared to most adult malignancies (and sometime develops in the context of an immature immune system) and thus poses alternative, fascinating questions. The preventive effects of an active lifestyle are likely to be less important than in adults given the very early occurrence in life of these tumors but, on the other hand, a young survivor faces a whole lifetime of potential side effects aggravated by inactivity. In addition, affected adolescents must face cancer in a particularly challenging period of life, when nutrition and activity habits are usually poor.

This issue welcomes preclinical and clinical papers dealing with exercise effects in the entire pediatric/adolescent cancer control continuum.

Dr. Carmen Fiuza-Luces
Prof. Dr. Alejandro Lucia
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • exercise
  • disease
  • molecular biology
  • pediatric/adolescent cancer
  • physical activity

Published Papers (6 papers)

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Research

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12 pages, 214 KiB  
Article
Lifestyle and Subsequent Malignant Neoplasms in Childhood Cancer Survivors: A Report from the St. Jude Lifetime Cohort Study
by Aron Onerup, Sedigheh Mirzaei, Shalini Bhatia, Maria Åberg, Megan E. Ware, Lenat Joffe, Lucie M. Turcotte, Chelsea G. Goodenough, Yadav Sapkota, Stephanie B. Dixon, Matthew D. Wogksch, Matthew J. Ehrhardt, Gregory T. Armstrong, Melissa M. Hudson and Kirsten K. Ness
Cancers 2024, 16(5), 864; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers16050864 - 21 Feb 2024
Viewed by 678
Abstract
Introduction: This study aimed to assess longitudinal associations between lifestyle and subsequent malignant neoplasms (SMNs) in young adult childhood cancer survivors. Methods: Members of the St. Jude Lifetime Cohort (SJLIFE) aged ≥18 years and surviving ≥5 years after childhood cancer diagnosis were queried [...] Read more.
Introduction: This study aimed to assess longitudinal associations between lifestyle and subsequent malignant neoplasms (SMNs) in young adult childhood cancer survivors. Methods: Members of the St. Jude Lifetime Cohort (SJLIFE) aged ≥18 years and surviving ≥5 years after childhood cancer diagnosis were queried and evaluated for physical activity, cardiorespiratory fitness (CRF), muscle strength, body mass index (BMI), smoking, risky drinking, and a combined lifestyle score. Time to first SMN, excluding nonmalignant neoplasms and nonmelanoma skin cancer, was the outcome of longitudinal analysis. Results: Survivors (n = 4072, 47% female, 29% smokers, 37% risky drinkers, 34% obese, and 48% physically inactive) had a mean (SD) time between baseline evaluation and follow-up of 7.0 (3.3) years, an age of 8.7 (5.7) years at diagnosis, and an age of 30 (8.4) years at baseline lifestyle assessment. Neither individual lifestyle factors nor a healthy lifestyle score (RR 0.8, 0.4–1.3, p = 0.36) were associated with the risk of developing an SMN. Conclusions: We did not identify any association between lifestyle factors and the risk of SMN in young adult childhood cancer survivors. Full article
(This article belongs to the Special Issue Pediatric/Adolescent Cancer and Exercise)
14 pages, 554 KiB  
Article
Safety, Feasibility and Efficacy of Lokomat® and Armeo®Spring Training in Deconditioned Paediatric, Adolescent and Young Adult Cancer Patients
by Morgan Atkinson, Angela Tully, Carol A. Maher, Christopher Innes-Wong, Ray N. Russo and Michael P. Osborn
Cancers 2023, 15(4), 1250; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15041250 - 16 Feb 2023
Viewed by 1762
Abstract
Background: Rehabilitation robotics is a field of study which aims to understand and augment rehabilitation through the use of robotics devices. Objective: This proof of concept study aimed to test the safety (no. adverse events, incidence of infection), feasibility (program demand, adherence, participant [...] Read more.
Background: Rehabilitation robotics is a field of study which aims to understand and augment rehabilitation through the use of robotics devices. Objective: This proof of concept study aimed to test the safety (no. adverse events, incidence of infection), feasibility (program demand, adherence, participant satisfaction) and efficacy (Peak Oxygen uptake (VO2peak), 6-min walk test, gait speeds, Canadian Occupational Performance Measure, quality of life) of Lokomat® and Armeo®Spring training in children and adolescents and young adults (AYAs) during or soon after cancer treatment. Method: This was a 6-week single arm pre-post study. Cancer patients with significant musculoskeletal, neurological, gait and/or upper limb deficiency aged 5 to 25 years were recruited. The rehabilitation program included access to two robotic orthoses: the Lokomat® and/or Armeo®Spring. Robotic devices utilised real-time biofeedback and computer games to engage and guide participants through a repetitive functional range of movement aimed at improving functional deficiencies. Progressive increases in exercise intensity and duration were encouraged. Results: Twentey-eight participants were approached for study; twenty-one consented. Seventy-six percent completed the six-week intervention with an overall adherence of 83%. The mean participant satisfaction score was 8.8/10. Forty-nine adverse events were recorded throughout the course of the study, forty-five grade 1, three grade 2 and one grade 3. No adverse events led to withdrawal from the study. Preliminary efficacy results indicate large beneficial effects on VO2peak (r = 0.63), 10 m comfortable pace walk (r = 0.51) and maximal pace walk (r = 0.60), 6-min walk test (r = 0.60), maximal back and leg strength (r = 0.71), trunk flexibility (r = 0.60), The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) (r = 0.61), Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT F) r = 0.53 and the Canadian Occupational Performance Measure, satisfaction (r = 0.88) and performance scores (r = 0.83), and moderate beneficial effects on Leisure Score Index (LSI) (r = 0.30). Conclusion: Our results suggest that Lokomat® and Armeo®Spring training is safe and feasible for use in children and AYAs who are currently undergoing or have recently completed cancer therapy. A larger controlled trial investigating the efficacy of robotics rehabilitation in this cohort is warranted. Full article
(This article belongs to the Special Issue Pediatric/Adolescent Cancer and Exercise)
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16 pages, 1211 KiB  
Article
A Bout of High-Intensity Interval Training (HIIT) in Children and Adolescents during Acute Cancer Treatment—A Pilot Feasibility Study
by Sabine Kesting, Peter Weeber, Martin Schönfelder, Anja Pfluger, Henning Wackerhage and Irene von Luettichau
Cancers 2022, 14(6), 1468; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14061468 - 12 Mar 2022
Viewed by 3024
Abstract
Low- and moderate-intensity exercise is safe and feasible during childhood cancer treatment. The feasibility of a bout of high-intensity interval training (HIIT) in this population has not been analyzed to date. Pediatric cancer patients aged between 6 and 18 years were selected based [...] Read more.
Low- and moderate-intensity exercise is safe and feasible during childhood cancer treatment. The feasibility of a bout of high-intensity interval training (HIIT) in this population has not been analyzed to date. Pediatric cancer patients aged between 6 and 18 years were selected based on clinical conditions to perform ten sets of 15 s HIIT (>90% of estimated maximal heart rate (HRmax)) and 1 min active recovery on a bicycle ergometer within the first three chemotherapy courses. We assessed safety and feasibility criteria and the following parameters: perceived exertion rate, heart rate, and lactate and adrenaline concentrations. Out of 212 eligible patients, 11 patients aged 13.9 ± 3.6 years (n = 7 ♂) with lymphoma, leukemia, rhabdomyosarcoma, nephroblastoma, and synovial sarcoma completed the bout of HIIT without serious adverse events. During exercise, patients reached a BORG value maxima of 16 ± 1.2, and their heart rates rose from 78 ± 17 beats per minute (bpm) at rest to 178 ± 12 bpm after exercise (90 ± 6% estimated HRmax). The power-to-weight ratio was 2 ± 0.5 W/kg (watt per kilogram). Blood lactate concentrations increased from 1.09 ± 0.50 mmol/L (millimole per liter) at rest to 5.05 ± 1.88 mmol/L post-exercise. Our preliminary data suggest that HIIT is applicable only in a small number of childhood cancer patients. Individually adapted exercise protocols for patients with multiple impairments are needed. Full article
(This article belongs to the Special Issue Pediatric/Adolescent Cancer and Exercise)
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18 pages, 2735 KiB  
Article
The Impact of a Precision-Based Exercise Intervention in Childhood Hematological Malignancies Evaluated by an Adapted Yo-Yo Intermittent Recovery Test
by William Zardo, Emanuele Villa, Eleonora Corti, Tommaso Moriggi, Giorgia Radaelli, Alessandra Ferri, Mauro Marzorati, Cristiano Eirale, Paola Vago, Andrea Biondi, Momcilo Jankovic, Adriana Balduzzi and Francesca Lanfranconi
Cancers 2022, 14(5), 1187; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14051187 - 25 Feb 2022
Cited by 3 | Viewed by 2497
Abstract
During cancer treatments in childhood hematological malignancies, reduced exercise tolerance is one of the main hardships. Precision-based training programs help children, adolescents, and young adults and their families to resume regular physical activity, exercise, and sports once they return to their communities after [...] Read more.
During cancer treatments in childhood hematological malignancies, reduced exercise tolerance is one of the main hardships. Precision-based training programs help children, adolescents, and young adults and their families to resume regular physical activity, exercise, and sports once they return to their communities after the intensive phases spent in hospital. This study was aimed at verifying whether an intermittent recovery test, the Yo-Yo AD, could provide a simple and valid way to evaluate an individual’s capacity to perform repeated intense exercise and to follow up on the impact of tailored exercise in children, adolescents, and young adults with hematological malignancies. The Yo-Yo AD involved the repetition of several shuttles to muscle exhaustion, at pre-established speeds (walking and slow running). The heart rate (HR) and oxygen saturation (SaO2) were monitored during the test. The total distance and the walking/running ability, measured as the slope of the HR vs. distance correlation, were investigated before (T0) and after 11 weeks (T1) of precision exercise intervention. The Yo-Yo AD was also performed by healthy children (CTRL). Ninety-seven patients (10.58 ± 4.5 years, 46% female) were enrolled. The Yo-Yo AD showed the positive impact of the exercise intervention by increasing the distance covered by the individuals (T0 = 946.6 ± 438.2 vs. T1 = 1352.3 ± 600.6 m, p < 0.001) with a more efficient walking/running ability (T0 = 2.17 ± 0.84 vs. T1 = 1.73 ± 0.89 slope, p < 0.0164). CTRLs performed better (1754.0 ± 444.0 m, p = 0.010). They were equally skillful (1.71 ± 0.27 slope) when compared to the patients after they received the precision-based intervention. No adverse events occurred during the Yo-Yo AD and it proved to be an accurate way of correctly depicting the changes in performance in childhood hematological malignancies. Full article
(This article belongs to the Special Issue Pediatric/Adolescent Cancer and Exercise)
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14 pages, 1394 KiB  
Article
Osteopathic Treatment and Evaluation in the Clinical Setting of Childhood Hematological Malignancies
by Monica Barbieri, William Zardo, Chiara Frittoli, Clara Rivolta, Valeria Valdata, Federico Bouquin, Greta Passignani, Alberto Maggiani, Momcilo Jankovic, Andrea Cossio, Andrea Biondi, Adriana Balduzzi and Francesca Lanfranconi
Cancers 2021, 13(24), 6321; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13246321 - 16 Dec 2021
Cited by 1 | Viewed by 3027
Abstract
Children: adolescents, and young who are adults affected with hematological malignancies (CAYA-H) and who are undergoing intensive phases of cancer treatment, including hematopoietic stem cell transplantation (HSCT), experience diminished functional ability. This study was aimed at assessing the feasibility, efficacy, safety, and satisfaction [...] Read more.
Children: adolescents, and young who are adults affected with hematological malignancies (CAYA-H) and who are undergoing intensive phases of cancer treatment, including hematopoietic stem cell transplantation (HSCT), experience diminished functional ability. This study was aimed at assessing the feasibility, efficacy, safety, and satisfaction of an osteopathic intervention in CAYA-H attending an 11-week precision-based exercise program (PEx). All of the participants were given 4–10 treatments according to the prescription ordered by the sports medicine doctor in charge of the PEx, and the following outcomes were assessed: (1) spinal column range of motion (ROM) by palpation; (2) lower and upper limb joints ROM by a goniometer; (3) orthostatic posture by plumb line assessment; (4) chest and abdomen mobility by inspection and palpation; (5) cranial-sacral rhythmic impulse (CRI) by palpation; and (6) adverse effects. Goal attainment scaling (GAS) was used to identify the accomplishment of a desired clinical result. Moreover, HSCT patients who were affected with graft-versus-host disease and/or osteonecrosis had their joints assessed in terms of ROM as tools to monitor the effectiveness of immunosuppressive treatment. A total of 231 CAYA-H were identified, and 104 participated in the study (age 10.66 ± 4.51 yrs; 43% F). PEx plus osteopathy reached positive GAS scores by improving the ROMs of the spinal column and/or limbs (81% and 78%, respectively), chest and abdomen mobility (82%), and CRI (76%). Only minor reversible adverse effects were noticed during the study. Together, our data seem to initiate a new course where osteopathy could be useful in evaluating structural edges due to the clinical history of each CAYA-H. Given the contributions that were obtained by the GAS scores, osteopathic treatment seems to reveal interesting potential that can be targeted in the future. Full article
(This article belongs to the Special Issue Pediatric/Adolescent Cancer and Exercise)
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Review

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32 pages, 1017 KiB  
Review
Exercise and Childhood Cancer—A Historical Review
by Javier S. Morales, Pedro L. Valenzuela, Daniel Velázquez-Díaz, Adrián Castillo-García, David Jiménez-Pavón, Alejandro Lucia and Carmen Fiuza-Luces
Cancers 2022, 14(1), 82; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14010082 - 24 Dec 2021
Cited by 18 | Viewed by 5677
Abstract
Childhood cancer survivors are at risk of developing important adverse effects, many of which persist for years after the end of treatment. The implementation of interventions aiming at attenuating tumor/treatment-associated adverse effects is therefore a major issue in pediatric oncology, and there is [...] Read more.
Childhood cancer survivors are at risk of developing important adverse effects, many of which persist for years after the end of treatment. The implementation of interventions aiming at attenuating tumor/treatment-associated adverse effects is therefore a major issue in pediatric oncology, and there is growing evidence that physical exercise could help in this regard. The present review aims to summarize the main milestones achieved in pediatric exercise oncology. For this purpose, we conducted a systematic review of relevant studies written in English in the electronic database PubMed (from inception to 14 August 2021). This review traces the field of pediatric exercise oncology throughout recent history based on three fundamental pillars: (i) exercise during childhood cancer treatment; (ii) exercise during/after hematopoietic stem cell transplantation; and (iii) exercise after childhood cancer treatment. Accumulating evidence––although still preliminary in many cases––supports the safety and potential benefits of regular exercise (with no major contraindications in general) in the childhood cancer continuum, even during the most aggressive phases of treatment. Exercise can indeed represent an effective coadjuvant therapy for attenuating cancer-related adverse effects. Full article
(This article belongs to the Special Issue Pediatric/Adolescent Cancer and Exercise)
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