Maxime Caru, PhD and Pr. Daniel Curnier, PhD
The importance of physical activity during cancer treatments in children Childhood cancer has become a public health problem over the years with an increase of 23% in new cases recorded worldwide. In the long term, cancer can induce chronic health problems (obesity, metabolic disorders, reduced bone density, heart problems) several years after the end of treatment. To counteract physiological and psychological adverse effects, physical activity has been reported as the most effective way to prevent a decline in physical functioning and to improve quality of life in childhood cancer patients. In this sense, physical activity plays an important role in pediatric oncology to improve patients’ chronic health conditions. With regular supervised physical activity, children with cancer can obtain the same benefits as observed in the general population. Physical activity has short- and long-term effects on the potential to improve skeletal, musculoskeletal, cardiovascular systems, inflammatory profile, oxidative pathways and immune system of children with cancer. This also has the consequence to reduce the side effects of cancer treatments. Evidence based medicine supports the need for children to be physically active in order to develop their motor skills and encourage their cognitive development. During and after cancer treatments, physical activity has been described as a non-pharmacological treatment that mainly: · Induces better cancer treatments tolerance and fewer side effects; · Reduces the feeling of fatigue; · Reduces the consequences of long-term health treatments; · Improves quality of life. Thus, interventions related to physical activity programs prescribed during chemotherapy treatment demonstrate that exercise is safe and beneficial for children with cancer. The Canadian physical activity guidelines and the World Health Organization recommend achieving at least 60 minutes per day of moderate to vigorous physical activities for children, which is also in accordance with the American College of Sports Medicine recommendations. Parental support for children’s physical activity behavior is extremely important. This is why we invite families to be active with their children.
Physical activity intervention in a multidisciplinary program in children with cancer
During the cancer treatments, exercise physiologists, as well as nutritionists and psychologists, have an important role to play in order to minimize or prevent the side effects of cancer treatments. Based on the American College of Sports Medicine recommendations, as well as evidence-based medicine, the VIE (valorization, implication, and education) study was developed to provide physical activity, nutritional, and psychological support in pediatric oncology. The main aim of this study has been to promote the long-term well-being of patients by accompanying them and educating them on the benefits of adopting a good lifestyle during and after their disease.
The VIE study involves children with cancer (i.e., acute lymphoblastic leukemia, acute myeloid leukemia, lymphoma, medulloblastoma, neuroblastoma, Wilms tumors, sarcoma, rare tumors) diagnosed and treated at the Charles-Bruneau oncology center of the Sainte-Justine University Health Center (Montreal, Canada). A 2-year follow-up is provided to children, as well as meetings every 2 months to allow for the implementation of an adapted physical activity program -coupled with therapeutic education sessions- in order to help patients optimize their rehabilitation process.
· Each patient receives a training program with long-term goals following the Canadian
guidelines in physical activity;
· The main structure of the training program is based on different parameters having an
influence on the patient’s motor capacity with a cardiovascular period of about 30 min,
followed by an exercise session and adapted functional activities (e.g., balance,
resistance, flexibility training, muscular fitness) of about 15 min, for a total of 45 min.
· Physical activity intensity is monitored through the patient’s heart rate and their rate of
perceived exertion.
The physical activity program is performed by kinesiologists, who are professionals in physical activity. Also, the program may be adapted according to the recommendations of the occupational therapists and physiotherapists who take care of the acute intervention with the patient.
“What we are learning today from the VIE study is that multidisciplinary approaches must be favored in pediatric oncology in order to offer the best care and follow-up to children with cancer.”
Key learning facts
· For young children, the training program focuses primarily on the child’s enjoyment
and mobility;
· The promotion of physical activity needs to be encouraged through the care system
with the involvement of oncologists, health care professionals, occupational therapists
and physiotherapists, as well as exercise physiologists.
· Parents play an important role in this process since they can favor a good physical
activity behavior undertaken by their children to enhance or maintain their health
condition.
The ultimate aim of this research is to study the feasibility of a physical activity program in a multidisciplinary program for children with cancer and also to assess the barriers and facilitators to the success or failure of this physical activity program. Findings will provide solid evidence of its efficacy and engage the discourse of pediatric oncology health professionals in order to make physical activity be clinically recognized in patient care. You can find all the details of this study by following the link to the CHU Sainte-Justine website about the VIE study: https://www.chusj.org/fr/soins-services/H/Hematologie/Projet-Vie/Volet-activite-physique
More about the authors:
Maxime Caru, PhD
Dr. Maxime Caru, Ph.D is a physiologist, psychologist and exercise scientist. He studied at the School of Kinesiology and Physical Activity Sciences of the Faculty of Medicine at the University of Montreal in Canada. He also studied at the department of Psychology at the University of Paris Nanterre in France. His research focuses on the effects of physical activity and cardiorespiratory fitness in patients with cancer at the Sainte-Justine University Hospital Research Centre in the Pediatric Hemato-Oncology unit. Over the course of his Ph.Ds, he studied the effects of exercise in childhood acute lymphoblastic leukemia (ALL) long-term survivors (PETALE study). In a broad outline, he is interested in how physical activity is associated with parameters in physiology, epidemiology, genetics, cardiac electrophysiology and psychology. In parallel, he participated with Dr. Daniel Curnier, Ph.D in the development of a supervised in-hospital physical activity program for children with cancer through a multidisciplinary program that includes physical activity, nutritional and psychological interventions in pediatric oncology (VIE study). Maxime’s research supports the importance of cancer prevention from non-pharmacological therapies to improve patients’ physiological and psychological health. To know more about him please visit: https://www.researchgate.net/profile/Maxime_Caru
Pr. Daniel Curnier, PhD
Franco-Canadian, obtained a doctorate from the University of Toulouse (France) in sports sciences (2000). After 2 post-doctorates at the Heart Institute (Montreal, CA) and at the University of Vermont (Burlington, VT, USA), he worked as a lecturer at the University of Toulouse until 2008 when he joined the University of Montreal and the School of Kinesiology and Sports Sciences. A specialist in exercise physiology, his current research focuses on the benefits of physical activity in children diagnosed with cancer as well as in children with congenital heart disease. He has coached multiple mountain biking world champion and Olympic gold medalist Anne Caroline Chausson and is himself an amateur sportsman with participation in more than 100 triathlons including 10 Ironman. From a societal point of view, he is interested in access to sport for people with disabilities and recommendations related to physical activities for people with chronic diseases.
To know more about his research please visit: https://www.ncbi.nlm.nih.gov/pubmed/?term=Curnier+D. or https://scholar.google.com/citations?user=9hAyddkAAAAJ&hl=fr&oi=ao