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Intrahospital supervised exercise training: a complementary tool in the therapeutic armamentarium against childhood leukemia

Leukemia volume 19, pages 1334–1337 (2005)Cite this article

Acute lymphoblastic leukemia (ALL) is the commonest childhood malignancy, accounting for ∼26% of all childhood cancers. The dramatic improvements in treatment over the last decades have translated into a 70% cure rate for children with standard risk disease1, 2 However, as survival rate has improved, there has been an increasing recognition of adverse short-, mid-, or long-term effects associated with treatment and cancer itself such as impaired neuropsychological functioning, gross and fine motor disturbances, alterations in growth, endocrine and cardiac function, osteopenia, or obesity.3, 4, 5 In addition, muscle wasting leading to decreased muscle strength and impaired physical capacity is increasingly recognized as a problem in children treated for ALL.6, 7 Muscle atrophy (sarcopenia) is indeed a common problem in all cancer populations due to the catabolic effects of several chemotherapeutic agents such as vincristine and corticosteroids.8, 9, 10 Muscle wasting implies decreased force capability of muscle and less muscle mass to consume oxygen during exercise. Additionally, the metabolic function of remaining muscle fibers can be impaired, that is altered aerobic metabolism (due to decreased mitochondrial volume and/or mitochondrial myopathy) or reduced capillarization induced by immunosuppressive therapy.9 Owing to impaired muscle function, levels of habitual physical activity and thus total energy expenditure are usually reduced in children treated for11 or survivors of ALL.12 In addition, children with cancer may underestimate their own potential for performing physical tasks due to low selfesteem or overprotection by their parents.13 Sarcopenia and altered muscle function are further aggravated by sedentary habits due to the catabolic effects that a sedentary lifestyle induces on skeletal muscle tissue. Unfortunately, a sedentary lifestyle further exasperates sarcopenia and decreased muscle function.10 As a result, early fatigue during low-to-moderate physical tasks becomes a selfperpetuating condition. Only physical training can break the ‘vicious circle’ of sedentary habits and subsequent exercise intolerance.10

Anticancer therapy may also affect cardio-respiratory function, thus decreasing blood supply to body tissues, including exercising muscles. Anthracyclines can induce myocardial damage (eg, doxorubicin-induced cardiomyopathy) with subsequent decreases in cardiac output.14 Craniospinal irradiation, cyclophosphamide or lung infections during or subsequent to treatment for ALL might reduce total lung capacity and damage lung tissue, resulting in decreased blood oxygen transport to body tissues.15

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Acknowledgements

This project is supported by STRIVE Inc. (USA) and SID-CAN (Spain).

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Authors and Affiliations

  1. Exercise Physiology, Universidad Europea de Madrid, Madrid, Spain

    A Lucia & A F San Juan

  2. Servicio de Oncohematología y Trasplante Hematopoyético, Hospital Universitario Niño Jesús, Madrid, Spain

    M Ramírez, J García-Castro & L Madero

  3. Sport Science Department, Colorado College, Colorado Springs, CO, USA

    S J Fleck

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  1. A Lucia
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  6. L Madero
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Correspondence to A Lucia.

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Lucia, A., Ramírez, M., San Juan, A. et al. Intrahospital supervised exercise training: a complementary tool in the therapeutic armamentarium against childhood leukemia. Leukemia 19, 1334–1337 (2005). https://doi.org/10.1038/sj.leu.2403799

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