Refine
Keywords
- physical activity (3)
- Malignant bone tumor (2)
- Physical activity (2)
- Sporttherapie (2)
- childhood cancer (2)
- Adoleszenz (1)
- Areal Bone Mineral Density (1)
- Bewegungsförderung (1)
- Bone Mineral Density (1)
- Bone Mineral Density Loss (1)
Background
While research on exercise interventions during anticancer treatment is well-established in adults, only very few studies exist in children. However, pediatric patients experience great limitations to being physically active, and appropriate interventions are desired.
Procedure
The present study aimed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor. The parameter of interest was physical activity (PA). Patients’ PA during home stays was assessed 6 weeks as well as 3, 6, 12, and 18 months post-surgery. Patients were distinguished into an intervention group and a control group. All patients received endoprosthetic replacement of the affected bone in the same institution.
Results
A constant increase in all PA parameters was observed during follow-up. Exercise interventions were possible and appeared worthwhile. The intervention group showed better PA results at all measurements; however, no significant differences between groups were found. Furthermore, differences decreased especially after the cessation of the intervention. General problems in reaching appropriate power and compliance were observed.
Conclusions
Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial. Such interventions should be implemented in adjuvant care; however, future research is needed to understand more about the effects of different interventions.
Tumorerkrankungen im Kindes- und Jugendalter haben während der Akuttherapie und darüber hinaus einen signifikanten Einfluss auf das Aktivitätsniveau und den Knochenstoffwechsel. Dieser Beitrag untersucht, inwiefern bewegungstherapeutische Interventionen das Aktivitätsniveau und damit auch die Entwicklung der Knochendichte während der Akuttherapie von Patienten mit Knochentumoren der unteren Extremität beeinflussen können. 21 Kinder und Jugendliche im Alter von 13,6 Jahren konnten in die Untersuchung aufgenommen werden und wurden einer Interventions- (IG, n=10) oder einer Kontrollgruppe (KG, n=11) zugeordnet. Sämtliche Patienten erhielten die standardisierte physiotherapeutische Behandlung. Der IG wurde zusätzlich ein Sportprogramm angeboten, das an jedem zweiten Tag während der Akuttherapie absolviert werden sollte. Die Knochendichte der Lendenwirbelsäule und des nicht betroffenen Schenkelhalses wurde mittels Dual-Röntgen-Absorptiometrie (DXA) während der Lokaltherapie, sowie nach sechs und nach zwölf Monaten erfasst. Die Alltagsaktivitäten wurden zeitgleich nach sechs und zwölf Monaten im heimischen Umfeld objektiv mit einem Beschleunigungsaufnehmer über einen Zeitraum von sieben Tage erhoben. In beiden Patientengruppen wurde während der Akuttherapie eine deutliche Reduktion der Knochendichte beobachtet. Im Gruppenvergleich zeigten sich in der Entwicklung der Knochendichte zwischen den Messzeitpunkten kleine bis große Effekte zugunsten der bewegungstherapeutischen Intervention. Zudem weist die Interventionsgruppe im Vergleich zur Kontrollgruppe durchweg signifikant höhere Alltagsaktivitäten (durchschnittliche Schrittzahl pro Tag und Phasen hoher körperlicher Aktivität) auf. Die Ergebnisse belegen die Durchführbarkeit und den Nutzen eines therapiebegleitenden Sportprogramms für Kinder und Jugendliche während der Akutphase der Behandlung einer Knochentumorerkrankung der unteren Extremität.
This review provides a survey of studies investigating physical activity and exercise interventions in patients during tumor treatment and survivors of childhood cancer. PubMed and Medline databases were searched using relevant terms. References of selected papers were tracked. A total of 28 studies could be identified. Seventeen studies investigated physical activity, 11 studies determined the effect of activity enhancing interventions during and after therapy. Even though most studies showed limitations and results were not consistent, considerably reduced physical activity is highly probable in patients during and after therapy. Studies on interventions provided promising results and revealed challenges to be faced. Pediatr Blood Cancer
Purpose
The diagnosis of a malignant bone tumor in the lower limb is a risk factor for physical disability, limiting physical performance. Walking ability especially, which is essential for most activities of daily living, is limited in those patients. In the present study, the extent of limitations during the course of treatment was investigated to determine when the assessment of functional parameters is meaningful in those patients.
Methods
In the present study, activity levels were determined in 20 patients with a malignant bone tumor in the lower limb who received endoprosthetic replacement of the affected bone and in 20 healthy individuals. A uniaxial accelerometer was used to investigate patients at five different time points after surgery.
Results
Patients performed significantly less amounts and intensities of activity than control individuals at all measurements. Significant increases in the volume of activity were observed after cessation of treatment. However, the intensity of activity only showed minor increases. Patients experiencing complications of surgery revealed greater restriction than those without even 18 months after surgery.
Conclusions
After cessation of treatment for their disease, patients recovered markedly and showed great improvements in physical activity. However, some limitations appeared to persist. Comparisons with patients with longer follow-up revealed that meaningful functional assessment does not make sense within the first 12 months after surgery. More research is needed to show if longer follow-up periods reveal further improvements. Based on such information, it should be more promising to develop individually tailored activity recommendations and intervention programs.
Background
The diagnosis of cancer bears severe implications for pediatric patients. One immense restriction consists in a reduced level of activity due to different factors. Physical activity affects various aspects of development and can be regarded as an essential part of a child's life. In the present study physical activity in patients undergoing cancer therapy was quantified in order to determine the extent of the restriction and to provide baseline information for the assessment of possible interventions.
Procedure
Physical activity in 80 patients and 45 healthy children matched for age and gender was measured using the StepWatch 3™ Activity Monitor (SAM, OrthoCare Innovations).
Results
Pediatric cancer patients, at 2,787 gait cycles (gcs) per day, were significantly less active than their healthy counterparts (8,096 gcs). Patients were significantly more active at home than during inpatient stays (3,185 gcs compared to 1,830 gcs), and patients with bone tumors were less active than those with leukemia regarding both, the amount (1,849 gcs vs. 2,992 gcs) and the intensity of activity.
Conclusion
The present study quantified an often observed but so far hardly assessable problem. Activity in cancer patients is considerably reduced and patients with bone tumors are at increased risk from the detrimental effects of prolonged inactivity. Both our findings and the accepted fact that activity is an essential element of child development confirm the need for interventions tailored to a patient's needs and abilities during the course of treatment.
The aim was to evaluate the effects of additional exercises during inpatient stays on bone mass in pediatric bone tumor patients. 21 patients were non-randomly allocated either to the exercise group (n=10) or the control group (n=11). DXA of the lumbar spine, the non-affected femur and both calcanei was performed after completion of neoadjuvant chemotherapy (baseline), as well as 6 and 12 months after baseline. Bone mineral content (BMC), bone mineral density (BMD) and height-corrected lumbar spine Z-scores were determined. Group changes after 6 and 12 months were compared by covariance analyses. Additionally, daily physical activities (PA) were assessed by means of accelerometry. After adjusting for initial age, height and weight, mean reductions in lumbar spine and femoral BMC were lower in the exercise group (not significant). Effect sizes during the observational period for lumbar spine and femur BMC were generally small (partial η²=0.03). The exercise group demonstrated substantially higher PA levels in terms of gait cycles per day, per hour and moderate PA (activities above 40 gait cycles per minute). Additional exercises for bone tumor patients are feasible during hospitalization. Though the intervention did not influence BMC, it appeared beneficial regarding PA promotion with respect to volume and intensity.
Background
Bone mineral density (BMD) accrual during childhood and adolescence is important for attaining peak bone mass. BMD decrements have been reported in survivors of childhood bone sarcomas. However, little is known about the onset and development of bone loss during cancer treatment. The objective of this cross-sectional study was to evaluate BMD in newly diagnosed Ewing's and osteosarcoma patients by means of dual-energy x-ray absorptiometry (DXA) after completion of neoadjuvant chemotherapy.
Methods
DXA measurements of the lumbar spine (L2-4), both femora and calcanei were performed perioperatively in 46 children and adolescents (mean age: 14.3 years, range: 8.6-21.5 years). Mean Z-scores, areal BMD (g/cm2), calculated volumetric BMD (g/cm3) and bone mineral content (BMC, g) were determined.
Results
Lumbar spine mean Z-score was -0.14 (95% CI: -0.46 to 0.18), areal BMD was 1.016 g/cm2 (95% CI: 0.950 to 1.082) and volumetric BMD was 0.330 g/cm3 (95% CI: 0.314 to 0.347) which is comparable to healthy peers. For patients with a lower extremity tumor (n = 36), the difference between the affected and non-affected femoral neck was 12.1% (95% CI: -16.3 to -7.9) in areal BMD. The reduction of BMD was more pronounced in the calcaneus with a difference between the affected and contralateral side of 21.7% (95% CI: -29.3 to -14.0) for areal BMD. Furthermore, significant correlations for femoral and calcaneal DXA measurements were found with Spearman-rho coefficients ranging from ρ = 0.55 to ρ = 0.80.
Conclusions
The tumor disease located in the lower extremity in combination with offloading recommendations induced diminished BMD values, indicating local osteopenia conditions. However, the results revealed no significant decrements of lumbar spine BMD in pediatric sarcoma patients after completion of neoadjuvant chemotherapy. Nevertheless, it has to be taken into account that bone tumor patients may experience BMD decrements or secondary osteoporosis in later life. Furthermore, the peripheral assessment of BMD in the calcaneus via DXA is a feasible approach to quantify bone loss in the lower extremity in bone sarcoma patients and may serve as an alternative procedure, when the established assessment of femoral BMD is not practicable due to endoprosthetic replacements.
Die weitreichenden Potenziale individualisierter Bewegungsförderung für krebskranke Kinder und Jugendliche sollten über den gesamten Zeitraum der Akuttherapie, in der Nachsorge und bei der Rückkehr in den Alltag genutzt und als Bestandteil der Normalität aufrechterhalten und gefördert werden. Dieser Artikel stellt beispielhaft für den Standort Münster Ergebnisse und Erfahrungen aus den letzten 5 Jahren sporttherapeutischer und sportpädagogischer Bewegungsförderung im kinderonkologischen Setting dar und liefert konkrete Zahlen über die Bewegungsumfänge, die erreichten Patienten sowie die Möglichkeiten und Grenzen eines derartigen Angebots.