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Effect of a 1-year physical activity intervention on cardiovascular health in long-term childhood cancer survivors—a randomised controlled trial (SURfit)

British Journal of Cancer volume 129, pages 1284–1297 (2023)Cite this article

Subjects

Abstract

Background

This randomised controlled trial (RCT) assessed the effect of a 1-year, partially supervised, physical activity (PA) intervention on a cardiovascular disease (CVD) risk score in adult survivors of childhood cancer.

Methods

We included childhood cancer survivors ≥16 y at enrolment, <16 y at diagnosis and ≥5 y in remission. The intervention group was asked to perform an additional ≥2.5 h of intense physical activity/week, controls continued exercise as usual; assessments were performed at baseline, 6 months (T6) and 12 months (T12). The primary endpoint was change in a CVD risk score (average z-score of waist circumference, blood pressure, fasting glucose, inverted high-density lipoprotein cholesterol, triglycerides, and inverted cardiorespiratory fitness) from baseline to T12. We performed intention-to-treat (ITT, primary) and 3 per protocol analyses.

Results

We randomised 151 survivors (44% females, 30.4 ± 8.6 years). We found a significant and robust reduction of the CVD risk score in the intervention compared to the control group at T6 and T12 across all analyses; with a difference in the reduction of the CVD risk z-score of −0.18 (95% confidence interval −0.29 to −0.06, P = 0.003) at T12 in favour of the intervention group (ITT analysis).

Conclusions

This RCT showed that a long-term PA intervention can reduce CVD risk in long-term survivors of childhood cancer.

Trial registration

Clinicaltrials.gov: NCT02730767.

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Fig. 1: Flow diagram of the SURfit study.
Fig. 2: Marginal mean changes of the CVD risk score (primary outcome) over time and by study group for the intention-to-treat (ITT) and three per protocol (PP) allocations.
Fig. 3: Marginal mean changes of the single outcomes included in the CVD risk score for the intention-to-treat (ITT) and three per protocol (PP) allocations.

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Data availability

De-identified individual participant data that underlie the results reported in this article, statistical programmes (Stata do-files) and data dictionary are available upon request to the corresponding author, immediately following publication and without end date, to anyone who provides a sound proposal. The study protocol, statistical analysis plan, patient information and informed consent forms are published at the Open Science Framework platform: https://osf.io/w6j4y/.

Code availability

Statistical programmes (Stata do-files) and data dictionary are available upon request to the corresponding author, immediately following publication and without end date, to anyone who provides a sound proposal. The study protocol, statistical analysis plan, patient information and informed consent forms are published at the Open Science Framework platform: https://osf.io/w6j4y/.

References

  1. Gatta G, Zigon G, Capocaccia R, Coebergh JW, Desandes E, Kaatsch P, et al. Survival of European children and young adults with cancer diagnosed 1995-2002. Eur J Cancer. 2009;45:992–1005.

  2. Ness KK, Armstrong GT, Kundu M, Wilson CL, Tchkonia T, Kirkland JL. Frailty in childhood cancer survivors. Cancer. 2015;121:1540–7. https://doi.org/10.1002/cncr.29211.

    Article  PubMed  Google Scholar 

  3. Hudson MM, Ness KK, Gurney JG, et al. Clinical ascertainment of health outcomes among adults treated for childhood cancer. J Am Med Assoc. 2013;309:2371–81. https://doi.org/10.1001/jama.2013.6296.

    Article  CAS  Google Scholar 

  4. Mertens AC, Liu Q, Neglia JP, Wasilewski K, Leisenring W, Armstrong GT, et al. Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2008;100:1368–79. https://doi.org/10.1093/jnci/djn310.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Armstrong GT, Ross JD. Late cardiotoxicity in aging adult survivors of childhood cancer. Prog Pediatr Cardiol. 2014;36:19–26. https://doi.org/10.1016/j.ppedcard.2014.09.003.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Armstrong GT, Oeffinger KC, Chen Y, Kawashima T, Yasui Y, Leisenring W, et al. Modifiable risk factors and major cardiac events among adult survivors of childhood cancer. J Clin Oncol. 2013;31:3673–80. https://doi.org/10.1200/jco.2013.49.3205.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Green DM, Cox CL, Zhu L, Krull KR, Srivastava DK, Stovall M, et al. Risk factors for obesity in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2012;30:246–55.

  8. Olsen JH, Möller T, Anderson H, Langmark F, Sankila R, Tryggvadóttír L, et al. Lifelong cancer incidence in 47 697 patients treated for childhood cancer in the Nordic countries. J Natl Cancer Inst. 2009;101:806–13. https://doi.org/10.1093/jnci/djp104.

    Article  PubMed  Google Scholar 

  9. Wilson CL, Ness KK. Bone mineral density deficits and fractures in survivors of childhood cancer. Curr Osteoporos Rep. 2013;11:329–37. https://doi.org/10.1007/s11914-013-0165-0.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Clanton NR, Klosky JL, Li C, Jain N, Srivastava DK, Mulrooney D, et al. Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood. Cancer Cancer. 2011;117:2559–68. https://doi.org/10.1002/cncr.25797.

    Article  PubMed  Google Scholar 

  11. Gianinazzi ME, Rueegg CS, Wengenroth L, Bergstraesser E, Rischewski J, Ammann RA, et al. Adolescent survivors of childhood cancer: are they vulnerable for psychological distress? Psycho-Oncol. 2013;22:2051–8. https://doi.org/10.1002/pon.3249.

    Article  Google Scholar 

  12. Rueegg CS, Gianinazzi ME, Rischewski J, Beck Popovic M, Von der Weid NX, Michel G, et al. Health-related quality of life in survivors of childhood cancer: the role of chronic health problems. J Cancer Survivorship. 2013;7:511–22. https://doi.org/10.1007/s11764-013-0288-4.

    Article  Google Scholar 

  13. Zhang FF, Hudson MM, Huang IC, Bhakta N, Ness KK, Brinkman TM, et al. Lifestyle factors and health-related quality of life in adult survivors of childhood cancer: a report from the St. Jude Lifetime Cohort Study. Cancer. 2018. https://doi.org/10.1002/cncr.31647.

  14. Arem H, Moore SC, Patel A, Hartge P, Berrington de Gonzalez A, Visvanathan K, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. 2015;175:959–67. https://doi.org/10.1001/jamainternmed.2015.0533.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jurdana M. Physical activity and cancer risk. Actual knowledge and possible biological mechanisms. Radiol Oncol. 000010247820200063. 2021. https://doi.org/10.2478/raon-2020-0063.

  16. Rimer J, Dwan K, Lawlor DA, Greig CA, McMurdo M, Morley W, et al. Exercise for depression. Cochrane Database Syst Rev. 2012;11. https://doi.org/10.1002/14651858.CD004366.pub5.

  17. Leon AS, Connett J, Jacobs DRJ, Rauramaa R. Leisure-time physical activity levels and the risk of coronary heart disease and death. The Multiple Risk Factor Intervention Trial. J Am Med Assoc. 1987;258:2388–95.

    Article  CAS  Google Scholar 

  18. Paffenbarger RS, Hyde RT, Wing AL, Lee I-M, Jung DL, Kampert JB. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med. 1993;328:538–45. https://doi.org/10.1056/NEJM199302253280804.

    Article  PubMed  Google Scholar 

  19. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ Can Med Assoc J = J de l’Assoc Med Canadienne. 2006;174:801–9. https://doi.org/10.1503/cmaj.051351.

    Article  Google Scholar 

  20. Pedersen BK, Saltin B. Evidence for prescribing exercise as therapy in chronic disease. Scand J Med Sci Sports. 2006;1:3–63.

  21. Wolff I, van Croonenborg JJ, Kemper HCG, Kostense PJ, Twisk JW. The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women. Osteoporos Int. 1999;9:1–12.

    Article  CAS  PubMed  Google Scholar 

  22. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA A Cancer J Clin. 2012;62:30–67. https://doi.org/10.3322/caac.20140.

    Article  Google Scholar 

  23. Walker KZ, O’Dea K, Gomez M, Girgis S, Colagiuri R. Diet and exercise in the prevention of diabetes. J Hum Nutr Diet. 2010;23:344–52.

    Article  CAS  PubMed  Google Scholar 

  24. Wogksch MD, Goodenough CG, Finch ER, Partin RE, Ness KK. Physical activity and fitness in childhood cancer survivors: a scoping review. Aging Cancer. 2021;2:112–28. https://doi.org/10.1002/aac2.12042.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Morales JS, Valenzuela PL, Herrera-Olivares AM, Rincón-Castanedo C, Martín-Ruiz A, Castillo-García A, et al. What are the effects of exercise training in childhood cancer survivors? A systematic review. Cancer Metastasis Rev. 2020;39:115–25. https://doi.org/10.1007/s10555-020-09852-3.

    Article  PubMed  Google Scholar 

  26. Scott JM, Li N, Liu Q, Yasui Y, Leisenring W, Nathan PC, et al., Association of exercise with mortality in adult survivors of childhood cancer. JAMA Oncol. 2018. https://doi.org/10.1001/jamaoncol.2018.2254.

  27. Mizrahi D, Wakefield CE, Fardell JE, Quinn VF, Lim Q, Clifford BK, et al. Distance-delivered physical activity interventions for childhood cancer survivors: a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2017;118:27–41. https://doi.org/10.1016/j.critrevonc.2017.08.008.

    Article  PubMed  Google Scholar 

  28. Bourdon A, Grandy SA, Keats MR. Aerobic exercise and cardiopulmonary fitness in childhood cancer survivors treated with a cardiotoxic agent: a meta-analysis. Support Care Cancer. 2018;26:2113–23. https://doi.org/10.1007/s00520-018-4208-z.

    Article  PubMed  Google Scholar 

  29. Morales JS, Valenzuela PL, Herrera-Olivares AM, Baño-Rodrigo A, Castillo-García A, Rincón-Castanedo C, et al. Exercise interventions and cardiovascular health in childhood cancer: a meta-analysis. Int J Sports Med. 2020;41:141–53. https://doi.org/10.1055/a-1073-8104.

    Article  PubMed  Google Scholar 

  30. Braam KI, van der Torre P, Takken T, Veening MA, van Dulmen-den Broeder E, Kaspers GJ. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev. 2016;3:Cd008796. https://doi.org/10.1002/14651858.CD008796.pub3.

    Article  PubMed  Google Scholar 

  31. Esbenshade AJ, Ness KK. Dietary and exercise interventions for pediatric oncology patients: the way forward. J Natl Cancer Inst Monogr. 2019;2019:157–62. https://doi.org/10.1093/jncimonographs/lgz021.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Cheung AT, Li WHC, Ho LLK, Ho KY, Chan GCF, Chung JOK. Physical activity for pediatric cancer survivors: a systematic review of randomized controlled trials. J Cancer Survivorship. 2021. https://doi.org/10.1007/s11764-020-00981-w.

  33. Howell CR, Krull KR, Partin RE, Kadan-Lottick NS, Robison LL, Hudson MM, et al. Randomized web-based physical activity intervention in adolescent survivors of childhood cancer. Pediatr Blood Cancer. 2018;65:e27216. https://doi.org/10.1002/pbc.27216.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Huang JS, Dillon L, Terrones L, Schubert L, Roberts W, Finklestein J, et al. Fit4Life: a weight loss intervention for children who have survived childhood leukemia. Pediatr Blood Cancer. 2014;61:894–900. https://doi.org/10.1002/pbc.24937.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Li HC, Chung OK, Ho KY, Chiu SY, Lopez V. Effectiveness of an integrated adventure-based training and health education program in promoting regular physical activity among childhood cancer survivors. Psychooncology. 2013;22:2601–10. https://doi.org/10.1002/pon.3326.

    Article  PubMed  Google Scholar 

  36. Li WHC, Ho KY, Lam KKW, Lam HS, Chui SY, Chan GCF, et al. Adventure-based training to promote physical activity and reduce fatigue among childhood cancer survivors: a randomized controlled trial. Int J Nurs Stud. 2018;83:65–74. https://doi.org/10.1016/j.ijnurstu.2018.04.007.

    Article  PubMed  Google Scholar 

  37. Mendoza JA, Baker KS, Moreno MA, Whitlock K, Abbey-Lambertz M, Waite A, et al. A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: a pilot study. Pediatr Blood Cancer. 2017;64. https://doi.org/10.1002/pbc.26660.

  38. Sabel M, Sjölund A, Broeren J, Arvidsson D, Saury JM, Blomgren K, et al. Active video gaming improves body coordination in survivors of childhood brain tumours. Disabil Rehabil. 2016;38:2073–84. https://doi.org/10.3109/09638288.2015.1116619.

    Article  PubMed  Google Scholar 

  39. Tanir MK, Kuguoglu S. Impact of exercise on lower activity levels in children with acute lymphoblastic leukemia: a randomized controlled trial from Turkey. Rehabil Nurs. 2013;38:48–59. https://doi.org/10.1002/rnj.58.

    Article  PubMed  Google Scholar 

  40. Braam KI, van Dijk-Lokkart EM, Kaspers GJL, Takken T, Huisman J, Buffart LM, et al. Effects of a combined physical and psychosocial training for children with cancer: a randomized controlled trial. BMC Cancer. 2018;18:1289. https://doi.org/10.1186/s12885-018-5181-0.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Cox CL, Zhu L, Kaste SC, Srivastava K, Barnes L, Nathan PC, et al. Modifying bone mineral density, physical function, and quality of life in children with acute lymphoblastic leukemia. Pediatr Blood Cancer. 2018;65:e26929. https://doi.org/10.1002/pbc.26929.

    Article  Google Scholar 

  42. De Macedo TMF, Oliveira KMC, Melo J, De Medeiros MG, De Medeiros Filho WC, Ferreira GMH. Inspiratory muscle training in patients with acute leukemia: preliminary results. Rev Paul de Pediatr. 2010;28:352–8.

    Article  Google Scholar 

  43. Fiuza-Luces C, Padilla JR, Soares-Miranda L, Santana-Sosa E, Quiroga JV, Santos-Lozano A, et al. Exercise intervention in pediatric patients with solid tumors: the physical activity in pediatric cancer trial. Med Sci Sports Exerc. 2017;49:223–30. https://doi.org/10.1249/mss.0000000000001094.

    Article  PubMed  Google Scholar 

  44. Hartman A, Winkel MLT, Beek RDV, Keizer-Schrama SMPFDM, Kemper HCG, Hop WCJ, 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 

  45. Hinds PS, Hockenberry M, Rai SN. Clinical field testing of an enhanced-activity intervention in hospitalized children with cancer. J Pain Symptom Manag. 2007;33:686–97.

    Article  Google Scholar 

  46. Marchese VG, Chiarello LA, Lange BJ. Effects of physical therapy intervention for children with acute lymphoblastic leukemia. Pediatr Blood Cancer. 2004;42:127–33.

    Article  PubMed  Google Scholar 

  47. Moyer-Mileur LJPRD, Ransdell LPF, Bruggers CSMD. 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;31:259–66.

    Article  PubMed  Google Scholar 

  48. Speyer E, Herbinet A, Vuillemin A, Briancon S, Chastagner P. Effect of adapted physical activity sessions in the hospital on health-related quality of life for children with cancer: a cross-over randomized trial. Pediatr Blood Cancer. 2010;55:1160–6. https://doi.org/10.1002/pbc.22698.

    Article  PubMed  Google Scholar 

  49. Stössel S, Neu MA, Wingerter A, Bloch W, Zimmer P, Paret C, et al. Benefits of exercise training for children and adolescents undergoing cancer treatment: results from the randomized controlled MUCKI trial. Front Pediatrics. 2020;8:243–243. https://doi.org/10.3389/fped.2020.00243.

    Article  Google Scholar 

  50. Devine KA, Viola A, Levonyan-Radloff K, Mackowski N, Bozzini B, Chandler A, et al. Feasibility of FitSurvivor: a technology-enhanced group-based fitness intervention for adolescent and young adult survivors of childhood cancer. Pediatr Blood Cancer. 2020;67:e28530. https://doi.org/10.1002/pbc.28530.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Li WHC, Chan GCF, Lam MHS, Chung JOK, Chiu SY, Fong DYT. Integrated adventure-based training and health education programme in promoting regular physical activity among childhood cancer survivors. Hong Kong Med J. 2019;25:40–43.

    PubMed  Google Scholar 

  52. Manchola-González JD, Bagur-Calafat C, Girabent-Farrés M, Serra-Grima JR, Pérez RÁ, Garnacho-Castaño MV, et al. Effects of a home-exercise programme in childhood survivors of acute lymphoblastic leukaemia on physical fitness and physical functioning: results of a randomised clinical trial. Support Care Cancer. 2020;28:3171–8. https://doi.org/10.1007/s00520-019-05131-2.

    Article  PubMed  Google Scholar 

  53. Ruble K, Scarvalone S, Gallicchio L, Davis C, Wells D. Group physical activity intervention for childhood cancer survivors: a pilot study. J Phys Act Health. 2016;13:352–9. https://doi.org/10.1123/jpah.2015-0050.

    Article  PubMed  Google Scholar 

  54. Stern M, Bleck J, Ewing LJ, Davila E, Lynn C, Hale G, et al. NOURISH-T: targeting caregivers to improve health behaviors in pediatric cancer survivors with obesity. Pediatr Blood Cancer. 2018. https://doi.org/10.1002/pbc.26941.

  55. Rueegg CS, Gianinazzi ME, Michel G, von der Weid NX, Bergstraesser E, Kuehni CE. Do childhood cancer survivors with physical performance limitations reach healthy activity levels? Pediatr Blood Cancer. 2013;60:1714–20. https://doi.org/10.1002/pbc.24595.

    Article  PubMed  Google Scholar 

  56. Mizrahi D, Wakefield CE, Simar D, Ha L, McBride J, Field P, et al. Barriers and enablers to physical activity and aerobic fitness deficits among childhood cancer survivors. Pediatr Blood Cancer. 2020;67:e28339. https://doi.org/10.1002/pbc.28339.

    Article  PubMed  Google Scholar 

  57. Ross WL, Le A, Zheng DJ, Mitchell HR, Rotatori J, Li F, et al. Physical activity barriers, preferences, and beliefs in childhood cancer patients. Support Care Cancer. 2018;26:2177–84. https://doi.org/10.1007/s00520-017-4041-9.

    Article  PubMed  Google Scholar 

  58. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health: a systematic review. J Am Med Assoc. 2007;298:2296–304. https://doi.org/10.1001/jama.298.19.2296.

    Article  CAS  Google Scholar 

  59. Miller WR, Rollnick S. The effectiveness and ineffectiveness of complex behavioral interventions: impact of treatment fidelity. Contemp Clin Trials. 2014;37:234–41. https://doi.org/10.1016/j.cct.2014.01.005.

    Article  PubMed  Google Scholar 

  60. Morgan F, Battersby A, Weightman AL, Searchfield L, Turley R, Morgan H, et al. Adherence to exercise referral schemes by participants—what do providers and commissioners need to know? A systematic review of barriers and facilitators. BMC Public Health. 2016;16:227. https://doi.org/10.1186/s12889-016-2882-7.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Kettle VE, Madigan CD, Coombe A, Graham H, Thomas JJC, Chalkley AE, et al. Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials. BMJ. 2022;376:e068465. https://doi.org/10.1136/bmj-2021-068465.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Rueegg CS, Kriemler S, Zuercher SJ, Schindera C, Renner A, Hebestreit H, et al. A partially supervised physical activity program for adult and adolescent survivors of childhood cancer (SURfit): study design of a randomized controlled trial [NCT02730767]. BMC Cancer. 2017;17:822. https://doi.org/10.1186/s12885-017-3801-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Steliarova-Foucher E, Stiller C, Lacour B, Kaatsch P. International Classification of Childhood Cancer, third edition. Cancer. 2005;103:1457–67. https://doi.org/10.1002/cncr.20910.

    Article  PubMed  Google Scholar 

  64. Michel G, von der Weid NX, Zwahlen M, Adam M, Rebholz CE, Kuehni CE. The Swiss Childhood Cancer Registry: rationale, organisation and results for the years 2001–2005. Swiss Med Wkly. 2007;137:502–9.

    PubMed  Google Scholar 

  65. Schindera C, Zürcher SJ, Jung R, Boehringer S, Balder JW, Rueegg CS, et al. Physical fitness and modifiable cardiovascular disease risk factors in survivors of childhood cancer: a report from the SURfit study. Cancer. 2021. https://doi.org/10.1002/cncr.33351.

  66. Jung R, Zürcher SJ, Schindera C, Eser P, Meier C, Schai A, et al. Effect of a physical activity intervention on lower body bone health in childhood cancer survivors: a randomized controlled trial (SURfit). Int J Cancer. 2023;152:162–71. https://doi.org/10.1002/ijc.34234.

    Article  CAS  PubMed  Google Scholar 

  67. Rueegg CS, Kriemler S, von der Weid NX, Zürcher SJ, Schindera C, Jung R. The SURfit study — an RCT to investigate the effects of a one-year physical activity intervention in long-term survivors of childhood cancer. (2021, October 19) Retrieved from osf.io/w6j4y. https://doi.org/10.17605/OSF.IO/W6J4Y.

  68. Andersen LB, Lauersen JB, Brond JC, Anderssen SA, Sardinha LB, Steene-Johannessen J, et al. A new approach to define and diagnose cardiometabolic disorder in children. J Diabetes Res. 2015;2015:539835. https://doi.org/10.1155/2015/539835.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Slagter SN, van Waateringe RP, van Beek AP, van der Klauw MM, Wolffenbuttel BHR, van Vliet-Ostaptchouk JV. Sex, BMI and age differences in metabolic syndrome: the Dutch Lifelines Cohort Study. Endocr Connect. 2017;6:278–88. https://doi.org/10.1530/ec-17-0011.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Van de Poppe DJ, Hulzebos E, Takken T. Reference values for maximum work rate in apparently healthy Dutch/Flemish adults: data from the LowLands fitness registry. Acta Cardiol. 2019;74:223–30. https://doi.org/10.1080/00015385.2018.1478763.

    Article  CAS  PubMed  Google Scholar 

  71. Kelly AS, Steinberger J, Jacobs DR, Hong CP, Moran A, Sinaiko AR. Predicting cardiovascular risk in young adulthood from the metabolic syndrome, its component risk factors, and a cluster score in childhood. Int J Pediatr Obes. 2011;6:e283–289. https://doi.org/10.3109/17477166.2010.528765.

    Article  PubMed  Google Scholar 

  72. Kriemler S, Zahner L, Schindler C, Meyer U, Hartmann T, Hebestreit H, et al. Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. BMJ. 2010;340:c785.

    Article  PubMed  PubMed Central  Google Scholar 

  73. CTCAE. The Common Terminology Criteria for Adverse Events (CTCAE). November 2017. Retrieved from https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pdf

  74. Pencina MJ, D’Agostino RB, Larson MG, Massaro JM, Vasan RS. Predicting the 30-year risk of cardiovascular disease. Circulation. 2009;119:3078–84. https://doi.org/10.1161/CIRCULATIONAHA.108.816694.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Andersen LB, Hasselstrøm H, Grønfeldt V, Hansen SE, Karsten F. The relationship between physical fitness and clustered risk, and tracking of clustered risk from adolescence to young adulthood: eight years follow-up in the Danish Youth and Sport Study. Int J Behav Nutr Phys Act. 2004;1:6. https://doi.org/10.1186/1479-5868-1-6.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Koller A, Laughlin MH, Cenko E, de Wit C, Tóth K, Bugiardini R, et al. Functional and structural adaptations of the coronary macro- and micro-vasculature to regular aerobic exercise by activation of physiological, cellular and molecular mechanisms: Esc Working Group on Coronary Pathophysiology & Microcirculation Position Paper. Cardiovasc Res. 2021. https://doi.org/10.1093/cvr/cvab246.

    Article  PubMed Central  Google Scholar 

  77. Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, et al. Beyond medications and diet: alternative approaches to lowering blood pressure. Hypertension. 2013;61:1360–83. https://doi.org/10.1161/HYP.0b013e318293645f.

    Article  CAS  PubMed  Google Scholar 

  78. Nordengen S, Andersen LB, Solbraa AK, Riiser A. Cycling and cardiovascular disease risk factors including body composition, blood lipids and cardiorespiratory fitness analysed as continuous variables: part 2—systematic review with meta-analysis. Br J Sports Med. 2019;53:879–85. https://doi.org/10.1136/bjsports-2018-099778.

    Article  PubMed  Google Scholar 

  79. Salchow J, Mann J, Koch B, von Grundherr J, Jensen W, Elmers S, et al. Comprehensive assessments and related interventions to enhance the long-term outcomes of child, adolescent and young adult cancer survivors—presentation of the CARE for CAYA-Program study protocol and associated literature review. BMC Cancer. 2020;20:16. https://doi.org/10.1186/s12885-019-6492-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Orrow G, Kinmonth A-L, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;344:e1389. https://doi.org/10.1136/bmj.e1389.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Evenson KR, Goto MM, Furberg RD. Systematic review of the validity and reliability of consumer-wearable activity trackers. Int J Behav Nutr Phys Act. 2015;12:159. https://doi.org/10.1186/s12966-015-0314-1.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Gauß G, Beller R, Boos J, Däggelmann J, Stalf H, Wiskemann J, et al. Adverse events during supervised exercise interventions in pediatric oncology—a nationwide survey. Front Pediatr. 2021;9. https://doi.org/10.3389/fped.2021.682496.

  83. Balady GJ, Berra KA, Golding LA, Gordon NF, Mahler DA, Myers JN, Sheldahl LM. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription, 6th edition. Ed, Franklin BA. Philadelphia: Lippincott Williams & Wilkins; 2000.

  84. Detry MA, Ma Y. Analyzing repeated measurements using mixed models. J Am Med Assoc. 2016;315:407–8. https://doi.org/10.1001/jama.2015.19394.

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Acknowledgements

We thank all participants for taking part in our study. We thank the study nurses, assistants, master students and physiotherapists for their great work within the study.

Funding

This work was supported by the Swiss Cancer League (KLS-3175-02-2013), the “Stiftung für krebskranke Kinder, Regio Basiliensis”, “Gedächtnis-Stiftung Susy Rückert zur Krebsbekämpfung”, “Taecker-Stiftung für Krebsforschung”, “Stiftung Henriette & Hans-Rudolf Dubach-Bucher”, “Stiftung zur Krebsbekämpfung”, “Stiftung Krebs-Hilfe Zürich”, “Fondation Recherche sur le Cancer de l’Enfant (FORCE)”, and Fond’Action contre le Cancer. CSR has received funding from the European Union Seventh Framework Programme (FP7-PEOPLE-2013-COFUND) under grant agreement n°609020-Scientia Fellows. WHD is paid by a research grant from the South-Eastern Norway Regional Health Authority (grant number 2019039, to CSR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. These authors contributed equally: Nicolas X. von der Weid, Susi Kriemler.

Authors and Affiliations

  1. Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway

    Corina S. Rueegg & Wei H. Deng

  2. Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD) and University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland

    Simeon J. Zürcher

  3. Department of Pediatric Hematology and Oncology, University Children’s Hospital Basel (UKBB) and University of Basel, Basel, Switzerland

    Christina Schindera & Nicolas X. von der Weid

  4. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

    Christina Schindera

  5. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

    Ruedi Jung & Susi Kriemler

  6. Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

    Wei H. Deng

  7. Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland

    Iris Bänteli

  8. Pediatric Department, University Hospital Augsburg, Augsburg, Germany

    Jonathan Schaeff

  9. Pediatric Department, University Hospital, Julius-Maximilians University, Würzburg, Germany

    Helge Hebestreit

Authors
  1. Corina S. Rueegg
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  9. Nicolas X. von der Weid
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  10. Susi Kriemler
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Contributions

Conceptualisation: SK, NXvdW and CSR; data curation: CSR, RJ and SJZ; formal analysis: CSR; funding acquisition: SK, CSR and NXvdW; investigation: SJZ, CS, RJ, IB and SK; methodology: CSR, SK, SJZ, CS, RJ and NXvdW; project administration: CSR, SJZ, CS, RJ, IB, NXvdW and SK; resources: NXvdW; software: JS, RJ, CSR and SJZ; supervision: CSR, NXvdW and SK; validation: SK, CSR, IB and RJ; visualisation: CSR; writing—original draft: CSR; writing—review and editing: all authors.

Corresponding author

Correspondence to Corina S. Rueegg.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was performed in accordance with the Declaration of Helsinki and approved by the Swiss Ethics Committee on research involving humans (Ethikkommision Nordwest-und Zentralschweiz [EKNZ], EKNZ-2015-169). Informed consent as documented by signature, was obtained from each survivor prior to participation in the study. Data protection is assured by pseudonymization and secure storage of sensitive data.

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Not applicable.

Data access, responsibility and analysis

CSR had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Rueegg, C.S., Zürcher, S.J., Schindera, C. et al. Effect of a 1-year physical activity intervention on cardiovascular health in long-term childhood cancer survivors—a randomised controlled trial (SURfit). Br J Cancer 129, 1284–1297 (2023). https://doi.org/10.1038/s41416-023-02410-y

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