Abstract
The purpose of this study was to determine if an eight-week intrahospital supervised,
conditioning program improves functional capacity and quality of life (QOL) in children
(4 boys, 4 girls) (mean [SD] age: 10.9 [2.8] years [range: 8 - 16]) who have undergone
bone marrow transplantation (BMT) for leukemia treatment within the last 12 months.
A group of 8 age and gender-matched healthy children served as controls. The experimental
group performed 3 weekly sessions of resistance and aerobic training inside an intra-hospital
gymnasium. A significant combined effect of group and time (p < 0.05) was observed
for muscle functional capacity (Timed Up and Down Stairs [TUDS] test) and peak oxygen
uptake (V·O2peak), i.e., with BMT children showing greater improvements than controls (V·O2peak at pre- and post-training of 25.9 (8.2) and 31.1 (7.6) mL/kg/min in diseased children).
Muscle strength (6 RM test for bench and leg press and seated row) also improved after
training (p < 0.05) in the BMT group. Concerning QOL, a significant combined effect
of group and time (p < 0.05) was also observed for children's self-report of comfort
and resilience and for parents' report of their children's satisfaction and achievement.
In summary, children who have received BMT experience physical and overall health
benefits after a relatively short-term (8 weeks) supervised exercise training program.
Key words
cancer - children - quality of life - graft‐versus‐host disease - resistance training
- V·O2peak
References
- 1
American Academy of Pediatrics .
Strength training, weight and power lifting and bodybuilding by children and adolescents.
Pediatrics.
1990;
86
801-803
- 2 Bar-Or O, Rowland (eds) T W. Pediatric Exercise Medicine: From Physiologic Principles
to Health Care Application. Champaign IL; Human Kinetics 2004: 5-7
- 3
Carlson K, Smedmyr B, Bäcklund L, Simonsson B.
Subclinical disturbances in cardiac function at rest and in gas exchange during exercise
are common findings after autologous bone marrow transplantation.
Bone Marrow Transplant.
1994;
14
949-954
- 4
Cooper D M, Weiler-Ravell D, Whipp B J, Wasserman K.
Aerobic parameters of exercise as a function of body size during growth in children.
J Appl Physiol.
1984;
56
628-634
- 5
Cunningham B A, Morris G, Cheney C L, Buergel N, Aker S N, Lenssen P.
Effects of resistive exercise on skeletal muscle in marrow transplant recipients receiving
total parenteral nutrition.
J Parenter Enter Nutr.
1986;
10
558-563
- 6
De Caro E, Fioredda F, Calevo M G, Smeraldi A, Saitta M, Hanau G, Faraci M, Grisolia F,
Dini G, Pongiglione G, Haupt R.
Exercise capacity in apparently healthy survivors of cancer.
Arch Dis Child.
2006;
91
47-51
- 7
Dimeo F, Bertz H, Finke J, Fetscher S, Mertelsmann R, Keul J.
An aerobic exercise program for patients with haematological malignancies after bone
marrow transplantation.
Bone Marrow Transplant.
1996;
18
1157-1160
- 8
Dimeo F, Fetscher S, Lange W, Mertelsmann R, Keul J.
Effects of aerobic exercise on the physical performance and incidence of treatment-related
complications after high dose chemotherapy.
Blood.
1997;
90
3390-3394
- 9
Dimeo F, Tilmann M HM, Bertz H, Kanz L, Mertelsmann R, Keul J.
Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy
and autologous peripheral stem cell transplantation.
Cancer.
1997;
79
1717-1722
- 10
Earnes G M, Crosson J, Steinberger J, Steinbuch M, Krabill K, Bass J, Ramsay N K,
Neglia J P.
Cardiovascular function in children following bone marrow transplant: a cross-sectional
study.
Bone Marrow Transplant.
1997;
19
61-66
- 11
Faigenbaum A D, Westcott W L, Micheli L J, Outerbridge A R, Long C J, La Rosa-Loud R L.
The effects of strength training and detraining on children.
J Strength Cond Res.
1996;
10
109-114
- 12
Felder-Puig R, Di Gallo A, Waldenmair M, Norden P, Winter A, Gadner H, Topf R.
Health-related quality of life of pediatric patients receiving allogeneic stem cell
or bone marrow transplantation: results of a longitudinal, multi-center study.
Bone Marrow Transplant.
2006;
38
119-126
- 13
Fournier M, Ricci J, Taylor A W, Ferguson R J, Montpetit R R, Chaitman B R.
Skeletal muscle adaptation in adolescent boys: sprint and endurance training and detraining.
Med Sci Sports Exerc.
1982;
14
453-456
- 14
Gandola L, Siena S, Bregni M, Sverzellati E, Piotti P, Stucchi C, Gianni A M, Lombardi F.
et al .
Prospective evaluation of pulmonary function in cancer patients treated with total
body irradiation, high-dose melphalan and autologous hematopoietic ítem cell transplantation.
Int J Radiat Oncol Biol Phys.
1990;
19
743-749
- 15
Gocha Marchese V G, Chiarello L A, Lange B J.
Strength and functional mobility in children with acute lymphoblastic leukemia.
Med Pediatr Oncol.
2003;
40
230-232
- 16
Hebestreit H, Staschen B, Hebestreit H.
Ventilatory threshold: a useful method to determine aerobic fitness in children.
Med Sci Sports Exerc.
2000;
32
1964-1969
- 17
Herrero F, San Juan A F, Fleck S J, Balmer J, Perez M, Cañete S, Earnest C P, Foster C,
Lucia A.
Combined aerobic and resistance training in breast cancer survivors: a randomized,
controlled pilot trial.
Int J Sports Med.
2006;
27
573-580
- 18
Hickson R C, Marone R J.
Exercise and inhibition of glucocorticoid-induced muscle atropy.
Exerc Sport Sci Rev.
1993;
21
135-167
- 19
Hogarty A N, Leahey A, Zhao H, Hogarty M D, Bunin N, Cnaan A, Paridon S M.
Longitudinal evaluation of cardiopulmonary performance during exercise after bone
marrow transplantation in children.
J Pediatrics.
2000;
136
311-317
- 20
Jenney M E, Faragher E B, Jones P H, Woodcock A.
Lung function and exercise capacity in survivors of childhood leukaemia.
Med Pediatr Oncol.
1995;
24
222-230
- 21 Kraemer W, Fry A.
Strength testing development and evaluation of methodology. Mauch PJ, Foster C Physiological Assessment of Human Fitness. Champaign IL; Human
Kinetics 1995: 115-138
- 22
Larsen R L, Barber G, Heise C T, August C S.
Exercise assessment of cardiac function in children and young adults before and after
bone marrow transplantation.
Pediatrics.
1992;
89
722-729
- 23
Lucia A, Ramirez M, San Juan A F, Fleck S J, García-Castro J, Madero L.
Intrahospital supervised exercise training: a complementary tool in the therapeutic
armamentarium against childhood leukaemia.
Leukemia.
2005;
19
1334-1337
- 24
Lund M B, Kongerud J, Brinch L, Evensen S A, Boe J.
Decreased lung function in one year survivors of allogeneic bone marrow transplantation
conditioned with high-dose busulphan and cyclophosphamide.
Eur Respir J.
1995;
8
1269-1274
- 25
Mahon A D, Gay J A, Stolen K Q.
Differentiated ratings of perceived exertion at ventilatory threshold in children
and adults.
Eur J Appl Physiol Occup Physiol.
1998;
78
115-120
- 26
Mahon A D, Marsh M L.
Reliability of the rating of perceived exertion at ventilatory threshold in children.
Int J Sports Med.
1992;
13
567-571
- 27
Marchese V G, Chiarello L A, Lange B J.
Effects of physical therapy intervention for children with acute lymphoblastic leukemia.
Pediatr Blood Cancer.
2004;
42
127-133
- 28
Mazzetti S A, Kraemer W J, Volek J S, Duncan N D, Ratamess N A, Gomez A L, Newton R U,
Hakkinen K, Fleck S J.
The influence of direct supervision of resistance training on strength performance.
Med Sci Sports Exerc.
2000;
32
1175-1184
- 29
Mello M, Tanaka C, Dulley F L.
Effects of an exercise program on muscle performance in patients undergoing allogeneic
bone marrow transplantation.
Bone Marrow Transplant.
2003;
32
723-728
- 30
Meyer T, Lucia A, Earnest C P, Kindermann W.
A conceptual framework for performance diagnosis and training prescription from submaximal
parameters - theory and application.
Int J Sports Med.
2005;
(Suppl 1)
S38-S48
- 31
Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood J E.
Exercise capacity and mortality among men referred for exercise testing.
N Engl J Med.
2002;
4
793-801
- 32
National Strength and Conditioning Association .
Youth resistance training: position statement paper and literature review.
J Strength Cond Res.
1996;
18
62-76
- 33 Norkin C C, White (eds) D J. Measurement of Joint Motion: A Guide to Goniometry.
3rd edn. Philadelphia, PA; FA Davis Compan 2003: 256-259
- 34
Rajmil L, Serra-Sutton V, Alonso J, Starfield B, Riley A, Váquez J R.
The Spanish version of the child health and illness profile-adolescent edition (CHIP‐AE).
Quality of Life Res.
2003;
12
303-313
- 35
Riley A W, Forrest C B, Rebok G W, Starfield B, Green B F, Robertson J A, Friello P.
The child report form of CHIP-child edition: reliability and validity.
Med Care.
2004;
42
221-231
- 36
Riley A W, Forrest C B, Starfield B, Rebok G W, Robertson J A, Green B F.
The parent report form of the CHIP-child edition: reliability and validity.
Med Care.
2004;
42
210-220
- 37
San Juan A F, Fleck S J, Chamorro-Viña C, Maté-Muñoz J L, Moral S, García-Castro J,
Ramirez M, Madero L, Lucia A.
Early-phase adaptations to intra-hospital training in strength and functional mobility
of children with leukemia.
J Strength Cond Res.
2007;
21
173-177
- 38
San Juan A F, Fleck S J, Chamorro-Viña C, Maté-Muñoz J L, Moral S, Pérez M, Ramirez M,
Madero L, Lucia A.
Effects of an intra-hospital exercise program intervention for children with leukemia.
Med Sci Sports Exerc.
2007;
39
13-21
- 39
Stevens A M, Sullivan K M, Nelson J L.
Polymyositis as a manifestation of chronic graft-versus-host disease.
Rheumatology.
2003;
42
34-39
- 40
Tsolaris C K, Vagenas G K, Dessypris A G.
Strength adaptations and hormonal responses to resistance training and detraining
in preadolescent males.
J Strength Cond Res.
2006;
18
625-629
- 41
van Brussel M, Takken T, Lucia A, van der Net J, Helders P J.
Is physical fitness decreased in survivors of childhood leukemia? A systematic review.
Leukemia.
2005;
19
13-17
- 42
Wright M J, Hanna S E, Haltona J M, Barr R D.
Maintenance of ankle range of motion in children treated for acute lymphoblastic leukaemia.
Ped Phys Ther.
2003;
15
146-152
Prof. Alejandro Lucia
Department of Physiology
Universidad Europea de Madrid
Villaviciosa de Odón
28670 Madrid
Spain
Phone: + 34 9 16 64 78 00
Fax: + 34 9 16 16 82 65
Email: alejandro.lucia@uem.es