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Exercise in adult and pediatric hematological cancer survivors: an intervention review

Leukemia volume 24, pages 1113–1120 (2010)Cite this article

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Abstract

Observational research has shown that the physical activity levels of survivors of hematological cancer are low, with deleterious health consequences. This review summarizes the research on exercise interventions in adult and pediatric hematological cancer survivors. We searched MEDLINE, SPORTDiscus, CINAHL, Embase, Cochrane and PEDro through September 2009 for exercise intervention studies in children and adults with any type of hematological cancer. In the 24 adult intervention studies reviewed, we found strong evidence (that is, ⩾3 high-quality studies and ⩾75% reporting a significant benefit) for a benefit on body composition. Weak, but promising, evidence (⩾3 high-quality studies, but <75% reporting a significant benefit) was found for cardiorespiratory fitness, fatigue, muscle strength, physical functioning and quality of life. In pediatric interventions (13 studies), we found strong evidence for a benefit on muscle strength and cardiorespiratory fitness, particularly, if training was conducted in the hospital setting. Evidence is weak for ankle dorsiflexion, physical functioning and body composition. No exercise-related risks were identified in adults or children studies. Though more randomized controlled trials are needed, a growing body of literature supports the notion that regular physical activity is safe and has potential benefits for both adult and pediatric hematological cancer survivors.

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References

  1. Courneya KS, Friedenreich CM . Framework PEACE: an organizational model for examining physical exercise across the cancer experience. Ann Behav Med 2001; 23: 263–272.

    Article  CAS  PubMed  Google Scholar 

  2. Lucia A, Earnest C, Perez M . Cancer-related fatigue: can exercise physiology assist oncologists? Lancet Oncol 2003; 4: 616–625.

    Article  PubMed  Google Scholar 

  3. Turner-Gomes SO, Lands LC, Halton J, Hanning RM, Heigenhauser GJ, Pai M et al. Cardiorespiratory status after treatment for acute lymphoblastic leukemia. Med Pediatr Oncol 1996; 26: 160–165.

    Article  CAS  PubMed  Google Scholar 

  4. Felder-Puig R, di Gallo A, Waldenmair M, Norden P, Winter A, Gadner H et al. 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.

    Article  CAS  PubMed  Google Scholar 

  5. Duggan C, Bechard L, Donovan K, Vangel M, O’Leary A, Holmes C et al. Changes in resting energy expenditure among children undergoing allogeneic stem cell transplantation. Am J Clin Nutr 2003; 78: 104–109.

    Article  CAS  PubMed  Google Scholar 

  6. White AC, Terrin N, Miller KB, Ryan HF . Impaired respiratory and skeletal muscle strength in patients prior to hematopoietic stem-cell transplantation. Chest 2005; 128: 145–152.

    Article  PubMed  Google Scholar 

  7. Warner JT, Bell W, Webb DK, Gregory JW . Relationship between cardiopulmonary response to exercise and adiposity in survivors of childhood malignancy. Arch Dis Child 1997; 76: 298–303.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Tillmann V, Darlington AS, Eiser C, Bishop NJ, Davies HA . Male sex and low physical activity are associated with reduced spine bone mineral density in survivors of childhood acute lymphoblastic leukemia. J Bone Miner Res 2002; 17: 1073–1080.

    Article  CAS  PubMed  Google Scholar 

  9. Florin TA, Fryer GE, Miyoshi T, Weitzman M, Mertens AC, Hudson MM et al. Physical inactivity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev 2007; 16: 1356–1363.

    Article  PubMed  Google Scholar 

  10. Davies HA . Late problems faced by childhood cancer survivors. Br J Hosp Med 1993; 50: 137–140.

    CAS  PubMed  Google Scholar 

  11. Nysom K, Molgaard C, Holm K, Hertz H, Michaelsen KF . Bone mass and body composition after cessation of therapy for childhood cancer. Int J Cancer Suppl 1998; 11: 40–43.

    Article  CAS  PubMed  Google Scholar 

  12. Reinders-Messelink H, Schoemaker M, Snijders T, Goeken L, van Den Briel M, Bokkerink J et al. Motor performance of children during treatment for acute lymphoblastic leukemia. Med Pediatr Oncol 1999; 33: 545–550.

    Article  CAS  PubMed  Google Scholar 

  13. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402–407.

    Article  CAS  PubMed  Google Scholar 

  14. Bellizzi KM, Rowland JH, Arora NK, Hamilton AS, Miller MF, Aziz NM . Physical activity and quality of life in adult survivors of non-Hodgkin's lymphoma. J Clin Oncol 2009; 27: 960–966.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Vallance JK, Courneya KS, Jones LW, Reiman T . Differences in quality of life between non-Hodgkin's lymphoma survivors meeting and not meeting public health exercise guidelines. Psychooncology 2005; 14: 979–991.

    Article  PubMed  Google Scholar 

  16. Vallance JK, Courneya KS, Jones LW, Reiman T . Exercise preferences among a population-based sample of non-Hodgkin's lymphoma survivors. Eur J Cancer Care 2006; 15: 34–43.

    Article  CAS  Google Scholar 

  17. Ng AK, Li S, Recklitis C, Neuberg D, Chakrabarti S, Silver B et al. A comparison between long-term survivors of Hodgkin's disease and their siblings on fatigue level and factors predicting for increased fatigue. Ann Oncol 2005; 16: 1949–1955.

    Article  CAS  PubMed  Google Scholar 

  18. Hacker ED, Ferrans C, Verlen E, Ravandi F, van Besien K, Gelms J et al. Fatigue and physical activity in patients undergoing hematopoietic stem cell transplant. Oncol Nurs Forum 2006; 33: 614–624.

    Article  Google Scholar 

  19. Jones LW, Courneya KS, Vallance JK, Ladha AB, Mant MJ, Belch AR et al. Association between exercise and quality of life in multiple myeloma cancer survivors. Support Care Cancer 2004; 12: 780–788.

    Article  PubMed  Google Scholar 

  20. Oldervoll LM, Loge JH, Kaasa S, Lydersen S, Hjermstad MJ, Thorsen L et al. Physical activity in Hodgkin's lymphoma survivors with and without chronic fatigue compared with the general population—a cross-sectional study. BMC Cancer 2007; 7: 210.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Elbl L, Vasova I, Tomaskova I, Jedlicka F, Kral Z, Navratil M et al. Cardiopulmonary exercise testing in the evaluation of functional capacity after treatment of lymphomas in adults. Leuk Lymphoma 2006; 47: 843–851.

    Article  PubMed  Google Scholar 

  22. Courneya KS, Keats MR, Turner AR . Physical exercise and quality of life in cancer patients following high dose chemotherapy and autologous bone marrow transplantation. Psychooncology 2000; 9: 127–136.

    Article  CAS  PubMed  Google Scholar 

  23. Reilly JJ, Ventham JC, Ralston JM, Donaldson M, Gibson B . Reduced energy expenditure in preobese children treated for acute lymphoblastic leukemia. Pediatr Res 1998; 44: 557–562.

    Article  CAS  PubMed  Google Scholar 

  24. Mayer EI, Reuter M, Dopfer RE, Ranke MB . Energy expenditure, energy intake and prevalence of obesity after therapy for acute lymphoblastic leukemia during childhood. Horm Res 2000; 53: 193–199.

    CAS  PubMed  Google Scholar 

  25. Warner JT, Bell W, Webb DK, Gregory JW . Daily energy expenditure and physical activity in survivors of childhood malignancy. Pediatr Res 1998; 43: 607–613.

    Article  CAS  PubMed  Google Scholar 

  26. Bell W, Warner JT, Evans WD, Webb DK, Mullen RH, Gregory JW . Perception of effort at low and moderate intensity exercise in survivors of childhood acute lymphoblastic leukaemia. Ann Hum Biol 2006; 33: 357–371.

    Article  CAS  PubMed  Google Scholar 

  27. Jenney ME, Faragher EB, Jones PH, Woodcock A . Lung function and exercise capacity in survivors of childhood leukaemia. Med Pediatr Oncol 1995; 24: 222–230.

    Article  CAS  PubMed  Google Scholar 

  28. San Juan AF, Chamorro-Vina C, Moral S, Fernandez del Valle M, Madero L, Ramirez M et al. Benefits of intrahospital exercise training after pediatric bone marrow transplantation. Int J Sports Med 2008; 29: 439–446.

    Article  CAS  PubMed  Google Scholar 

  29. van Brussel M, Takken T, van der Net J, Engelbert RH, Bierings M, Schoenmakers MA et al. Physical function and fitness in long-term survivors of childhood leukaemia. Pediatr Rehabil 2006; 9: 267–274.

    Article  PubMed  Google Scholar 

  30. Ness KK, Baker KS, Dengel DR, Youngren N, Sibley S, Mertens AC et al. Body composition, muscle strength deficits and mobility limitations in adult survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2007; 49: 975–981.

    Article  PubMed  Google Scholar 

  31. San Juan AF, Chamorro-Vina C, Mate-Munoz JL, Fernandez del Valle M, Cardona C, Hernandez M et al. Functional capacity of children with leukemia. Int J Sports Med 2008; 29: 163–167.

    Article  CAS  PubMed  Google Scholar 

  32. Wright MJ, Halton JM, Martin RF, Barr RD . Long-term gross motor performance following treatment for acute lymphoblastic leukemia. Med Pediatr Oncol 1998; 31: 86–90.

    Article  CAS  PubMed  Google Scholar 

  33. Liu RD, Chinapaw MJ, Huijgens PC, van Mechelen W . Physical exercise interventions in haematological cancer patients, feasible to conduct but effectiveness to be established: a systematic literature review. Cancer Treat Rev 2009; 35: 185–192.

    Article  PubMed  Google Scholar 

  34. Battaglini CL, Hackney AC, Garcia R, Groff D, Evans E, Shea T . The effects of an exercise program in leukemia patients. Integr Cancer Ther 2009; 8: 130–138.

    Article  PubMed  Google Scholar 

  35. Blaauwbroek R, Bouma MJ, Tuinier W, Groenier KH, de Greef MHG, Meyboom-de Jong B et al. The effect of exercise counselling with feedback from a pedometer on fatigue in adult survivors of childhood cancer: a pilot study. Support Care Cancer 2009; 17: 1041–1048.

    Article  PubMed  Google Scholar 

  36. Chang PH, Lai YH, Shun SC, Lin LY, Chen ML, Yang Y et al. Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial. J Pain Symptom Manage 2008; 35: 524–534.

    Article  PubMed  Google Scholar 

  37. Courneya KS . Effects of aerobic exercise on physical functioning and quality of life in lymphoma patients: a randomized controlled trial. J Clin Oncol 2009, 1–21.

  38. Courneya KS, Sellar CM, Stevinson C, McNeely ML, Friedenreich CM, Peddle CJ et al. Moderator effects in a randomized controlled trial of exercise training in lymphoma patients. Cancer Epidemiol Biomarkers Prev 2009; 18: 2600–2607.

    Article  PubMed  Google Scholar 

  39. Coleman EA, Coon SK, Kennedy RL, Lockhart KD, Stewart CB, Anaissie EJ et al. Effects of exercise in combination with epoetin alfa during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for multiple myeloma. Oncol Nurs Forum 2008; 35: E53–E61.

    Article  PubMed  PubMed Central  Google Scholar 

  40. DeFor TE, Burns LJ, Gold EM, Weisdorf DJ . A randomized trial of the effect of a walking regimen on the functional status of 100 adult allogeneic donor hematopoietic cell transplant patients. Biol Blood Marrow Transplant 2007; 13: 948–955.

    Article  PubMed  Google Scholar 

  41. Chamorro-Viña C, Ruiz JR, Santana-Sosa E, González Vicent M, Madero L, Pérez M et al. Exercise during hematopoietic stem cell transplant hospitalization in children. Med Sci Sports Exerc 2009; e-pub ahead of print 9 December 2009.

  42. Hartman A, te Winkel ML, van Beek RD, de Muinck Keizer-Schrama SM, Kemper HC, Hop WC et al. A randomized trial investigating an exercise program to prevent reduction of bone mineral density and impairment of motor performance during treatment for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2009; 53: 64–71.

    Article  CAS  PubMed  Google Scholar 

  43. Keats MR, Culos-Reed SN . A community-based physical activity program for adolescents with cancer (project TREK): program feasibility and preliminary findings. J Pediatr Hematol Oncol 2008; 30: 272–280.

    Article  PubMed  Google Scholar 

  44. Moyer-Mileur LJ, Ransdell L, Bruggers CS . Fitness of children with standard-risk acute lymphoblastic leukemia during maintenance therapy: response to a home-based exercise and nutrition program. J Pediatr Hematol Oncol 2009; 31: 259–266.

    Article  PubMed  Google Scholar 

  45. Ruiz JR, Fleck SJ, Vingren JL, Ramirez M, Madero L, Fragala MS et al. Preliminary findings of a 4-month intra-hospital exercise training intervention on IGFs and IGFBPs in children with leukemia. J Strength Cond Res 2010; e-pub ahead of print March 2010.

  46. San Juan AF, Fleck SJ, Chamorro-Vina C, Mate-Munoz JL, Moral S, Garcia-Castro J et al. Early-phase adaptations to intrahospital training in strength and functional mobility of children with leukemia. J Strength Cond Res 2007; 21: 173–177.

    Article  PubMed  Google Scholar 

  47. Takken T, van der Torre P, Zwerink M, Hulzebos EH, Bierings M, Helders PJ et al. Development, feasibility and efficacy of a community-based exercise training program in pediatric cancer survivors. Psychooncology 2009; 18: 440–448.

    Article  PubMed  Google Scholar 

  48. Shore S, Shepard RJ . Immune responses to exercise in children treated for cancer. J Sports Med Phys Fitness 1999; 39: 240–243.

    CAS  PubMed  Google Scholar 

  49. Schmitz KH, Holtzman J, Courneya KS, Masse LC, Duval S, Kane R . Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2005; 14: 1588–1595.

    Article  PubMed  Google Scholar 

  50. Elter T, Stipanov M, Heuser E, von Bergwelt-Baildon M, Bloch W, Hallek M et al. Is physical exercise possible in patients with critical cytopenia undergoing intensive chemotherapy for acute leukaemia or aggressive lymphoma? Int J Hematol 2009; 90: 199–204.

    Article  CAS  PubMed  Google Scholar 

  51. Cohen L, Warneke C, Fouladi RT, Rodriguez MA, Chaoul-Reich A . Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 2004; 100: 2253–2260.

    Article  PubMed  Google Scholar 

  52. Carlson LE, Smith D, Russell J, Fibich C, Whittaker T . Individualized exercise program for the treatment of severe fatigue in patients after allogeneic hematopoietic stem-cell transplant: a pilot study. Bone Marrow Transplant 2006; 37: 945–954.

    Article  CAS  PubMed  Google Scholar 

  53. Coleman EA, Coon S, Hall-Barrow J, Richards K, Gaylor D, Stewart B . Feasibility of exercise during treatment for multiple myeloma. Cancer Nurs 2003; 26: 410–419.

    Article  PubMed  Google Scholar 

  54. Coleman EA, Hall-Barrow J, Coon S, Stewart CB . Facilitating exercise adherence for patients with multiple myeloma. Clin J Oncol Nurs 2003; 7: 529–534, 540.

    Article  PubMed  Google Scholar 

  55. Decker WA, Turner-McGlade J, Fehir KM . Psychosocial aspects and the physiological effects of a cardiopulmonary exercise program in patients undergoing bone marrow transplantation (BMT) for acute leukemia (AL). Transplant Proc 1989; 21 (1 Part 3): 3068–3069.

    CAS  PubMed  Google Scholar 

  56. Cunningham BA, Morris G, Cheney CL, Buergel N, Aker SN, Lenssen P . Effects of resistive exercise on skeletal muscle in marrow transplant recipients receiving total parenteral nutrition. JPEN J Parenter Enteral Nutr 1986; 10: 558–563.

    Article  CAS  PubMed  Google Scholar 

  57. 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.

    CAS  PubMed  Google Scholar 

  58. Dimeo F, Schwartz S, Fietz T, Wanjura T, Boning D, Thiel E . Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy. Support Care Cancer 2003; 11: 623–628.

    Article  PubMed  Google Scholar 

  59. Hayes S, Davies PS, Parker T, Bashford J . Total energy expenditure and body composition changes following peripheral blood stem cell transplantation and participation in an exercise programme. Bone Marrow Transplant 2003; 31: 331–338.

    Article  CAS  Google Scholar 

  60. Hayes S, Davies PS, Parker T, Bashford J, Newman B . Quality of life changes following peripheral blood stem cell transplantation and participation in a mixed-type, moderate-intensity, exercise program. Bone Marrow Transplant 2004; 33: 553–558.

    Article  CAS  PubMed  Google Scholar 

  61. Hayes SC, Davies PS, Parker TW, Bashford J, Green A . Role of a mixed type, moderate intensity exercise programme after peripheral blood stem cell transplantation. Br J Sports Med 2004; 38: 304–309; discussion 309.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Hayes SC, Rowbottom D, Davies PS, Parker TW, Bashford J . Immunological changes after cancer treatment and participation in an exercise program. Med Sci Sports Exerc 2003; 35: 2–9.

    Article  PubMed  Google Scholar 

  63. Kim SD, Kim HS . A series of bed exercises to improve lymphocyte count in allogeneic bone marrow transplantation patients. Eur J Cancer Care 2006; 15: 453–457.

    Article  Google Scholar 

  64. Mello M, Tanaka C, Dulley FL . Effects of an exercise program on muscle performance in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant 2003; 32: 723–728.

    Article  CAS  PubMed  Google Scholar 

  65. Shelton ML, Lee JQ, Morris GS, Massey PR, Kendall DG, Munsell MF et al. A randomized control trial of a supervised versus a self-directed exercise program for allogeneic stem cell transplant patients. Psychooncology 2009; 18: 353–359.

    Article  PubMed  Google Scholar 

  66. Wilson RW, Jacobsen PB, Fields KK . Pilot study of a home-based aerobic exercise program for sedentary cancer survivors treated with hematopoietic stem cell transplantation. Bone Marrow Transplant 2005; 35: 721–727.

    Article  CAS  PubMed  Google Scholar 

  67. Wilson DB, Porter JS, Parker G, Kilpatrick J . Anthropometric changes using a walking intervention in African American breast cancer survivors: a pilot study. Prev Chronic Dis 2005; 2: A16.

    PubMed  PubMed Central  Google Scholar 

  68. Ladha AB, Courneya KS, Bell GJ, Field CJ, Grundy P . Effects of acute exercise on neutrophils in pediatric acute lymphoblastic leukemia survivors: a pilot study. J Pediatr Hematol Oncol 2006; 28: 671–677.

    Article  PubMed  Google Scholar 

  69. Marchese VG, Chiarello LA, Lange BJ . Effects of physical therapy intervention for children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2004; 42: 127–133.

    Article  PubMed  Google Scholar 

  70. Oldervoll LM, Kaasa S, Knobel H, Loge JH . Exercise reduces fatigue in chronic fatigued Hodgkins disease survivors—results from a pilot study. Eur J Cancer 2003; 39: 57–63.

    Article  CAS  PubMed  Google Scholar 

  71. San Juan AF, Fleck SJ, Chamorro-Vina C, Mate-Munoz JL, Moral S, Perez M et al. Effects of an intrahospital exercise program intervention for children with leukemia. Med Sci Sports Exerc 2007; 39: 13–21.

    Article  PubMed  Google Scholar 

  72. Sharkey AM, Carey AB, Heise CT, Barber G . Cardiac rehabilitation after cancer therapy in children and young adults. Am J Cardiol 1993; 71: 1488–1490.

    Article  CAS  PubMed  Google Scholar 

  73. Hankinson SE, Willett WC, Colditz GA, Hunter DJ, Michaud DS, Deroo B et al. Circulating concentrations of insulin-like growth factor-I and risk of breast cancer. Lancet 1998; 351: 1393–1396.

    Article  CAS  PubMed  Google Scholar 

  74. Chan JM, Stampfer MJ, Giovannucci E, Gann PH, Ma J, Wilkinson P et al. Plasma insulin-like growth factor-I and prostate cancer risk: a prospective study. Science 1998; 279: 563–566.

    Article  CAS  PubMed  Google Scholar 

  75. Tower RL, Spector LG . The epidemiology of childhood leukemia with a focus on birth weight and diet. Crit Rev Clin Lab Sci 2007; 44: 203–242.

    Article  PubMed  Google Scholar 

  76. Dimeo FC, Tilmann MH, 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.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study was partially funded by the Spanish Ministry of Education (EX-2007-1124) and Fondo de Investigaciones Sanitarias (P1061183 and PS09/00194). We thank Angela Tanner for her assistance.

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Authors and Affiliations

  1. Department of Surgery, Washington University in School of Medicine, St Louis, MO, USA

    K Y Wolin & H Tuchman

  2. Department of Biosciences and Nutrition at NOVUM, Unit for Preventive Nutrition, Karolinska Institutet, Stockholm, Sweden

    J R Ruiz

  3. Department of Biomedicine, Universidad Europea de Madrid, Madrid, Spain

    A Lucia

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  1. K Y Wolin
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  2. J R Ruiz
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  4. A Lucia
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Correspondence to K Y Wolin.

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Wolin, K., Ruiz, J., Tuchman, H. et al. Exercise in adult and pediatric hematological cancer survivors: an intervention review. Leukemia 24, 1113–1120 (2010). https://doi.org/10.1038/leu.2010.54

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