Benefits of Intrahospital Exercise Training after Pediatric Bone Marrow Transplantation

Abstract

The purpose of this study was to determine if an eight-week intrahospital supervised, conditioning program improves functional capacity and quality of life (QOL) in children (4 boys, 4 girls) (mean [SD] age: 10.9 [2.8] years [range: 8 - 16]) who have undergone bone marrow transplantation (BMT) for leukemia treatment within the last 12 months. A group of 8 age and gender-matched healthy children served as controls. The experimental group performed 3 weekly sessions of resistance and aerobic training inside an intra-hospital gymnasium. A significant combined effect of group and time (p < 0.05) was observed for muscle functional capacity (Timed Up and Down Stairs [TUDS] test) and peak oxygen uptake (V·O_2peak), i.e., with BMT children showing greater improvements than controls (V·O_2peak at pre- and post-training of 25.9 (8.2) and 31.1 (7.6) mL/kg/min in diseased children). Muscle strength (6 RM test for bench and leg press and seated row) also improved after training (p < 0.05) in the BMT group. Concerning QOL, a significant combined effect of group and time (p < 0.05) was also observed for children's self-report of comfort and resilience and for parents' report of their children's satisfaction and achievement. In summary, children who have received BMT experience physical and overall health benefits after a relatively short-term (8 weeks) supervised exercise training program.

Key words

cancer - children - quality of life - graft‐versus‐host disease - resistance training - V·O_2peak

References

• 1 American Academy of Pediatrics . Strength training, weight and power lifting and bodybuilding by children and adolescents.  Pediatrics. 1990;  86 801-803
• 2 Bar-Or O, Rowland (eds) T W. Pediatric Exercise Medicine: From Physiologic Principles to Health Care Application. Champaign IL; Human Kinetics 2004: 5-7
• 3 Carlson K, Smedmyr B, Bäcklund L, Simonsson B. Subclinical disturbances in cardiac function at rest and in gas exchange during exercise are common findings after autologous bone marrow transplantation.  Bone Marrow Transplant. 1994;  14 949-954
• 4 Cooper D M, Weiler-Ravell D, Whipp B J, Wasserman K. Aerobic parameters of exercise as a function of body size during growth in children.  J Appl Physiol. 1984;  56 628-634
• 5 Cunningham B A, Morris G, Cheney C L, Buergel N, Aker S N, Lenssen P. Effects of resistive exercise on skeletal muscle in marrow transplant recipients receiving total parenteral nutrition.  J Parenter Enter Nutr. 1986;  10 558-563
• 6 De Caro E, Fioredda F, Calevo M G, Smeraldi A, Saitta M, Hanau G, Faraci M, Grisolia F, Dini G, Pongiglione G, Haupt R. Exercise capacity in apparently healthy survivors of cancer.  Arch Dis Child. 2006;  91 47-51
• 7 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
• 8 Dimeo F, Fetscher S, Lange W, Mertelsmann R, Keul J. Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high dose chemotherapy.  Blood. 1997;  90 3390-3394
• 9 Dimeo F, Tilmann M HM, 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
• 10 Earnes G M, Crosson J, Steinberger J, Steinbuch M, Krabill K, Bass J, Ramsay N K, Neglia J P. Cardiovascular function in children following bone marrow transplant: a cross-sectional study.  Bone Marrow Transplant. 1997;  19 61-66
• 11 Faigenbaum A D, Westcott W L, Micheli L J, Outerbridge A R, Long C J, La Rosa-Loud R L. The effects of strength training and detraining on children.  J Strength Cond Res. 1996;  10 109-114
• 12 Felder-Puig R, Di Gallo A, Waldenmair M, Norden P, Winter A, Gadner H, Topf R. 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
• 13 Fournier M, Ricci J, Taylor A W, Ferguson R J, Montpetit R R, Chaitman B R. Skeletal muscle adaptation in adolescent boys: sprint and endurance training and detraining.  Med Sci Sports Exerc. 1982;  14 453-456
• 14 Gandola L, Siena S, Bregni M, Sverzellati E, Piotti P, Stucchi C, Gianni A M, Lombardi F. et al . Prospective evaluation of pulmonary function in cancer patients treated with total body irradiation, high-dose melphalan and autologous hematopoietic ítem cell transplantation.  Int J Radiat Oncol Biol Phys. 1990;  19 743-749
• 15 Gocha Marchese V G, Chiarello L A, Lange B J. Strength and functional mobility in children with acute lymphoblastic leukemia.  Med Pediatr Oncol. 2003;  40 230-232
• 16 Hebestreit H, Staschen B, Hebestreit H. Ventilatory threshold: a useful method to determine aerobic fitness in children.  Med Sci Sports Exerc. 2000;  32 1964-1969
• 17 Herrero F, San Juan A F, Fleck S J, Balmer J, Perez M, Cañete S, Earnest C P, Foster C, Lucia A. Combined aerobic and resistance training in breast cancer survivors: a randomized, controlled pilot trial.  Int J Sports Med. 2006;  27 573-580
• 18 Hickson R C, Marone R J. Exercise and inhibition of glucocorticoid-induced muscle atropy.  Exerc Sport Sci Rev. 1993;  21 135-167
• 19 Hogarty A N, Leahey A, Zhao H, Hogarty M D, Bunin N, Cnaan A, Paridon S M. Longitudinal evaluation of cardiopulmonary performance during exercise after bone marrow transplantation in children.  J Pediatrics. 2000;  136 311-317
• 20 Jenney M E, Faragher E B, Jones P H, Woodcock A. Lung function and exercise capacity in survivors of childhood leukaemia.  Med Pediatr Oncol. 1995;  24 222-230
• 21 Kraemer W, Fry A. Strength testing development and evaluation of methodology. Mauch PJ, Foster C Physiological Assessment of Human Fitness. Champaign IL; Human Kinetics 1995: 115-138
• 22 Larsen R L, Barber G, Heise C T, August C S. Exercise assessment of cardiac function in children and young adults before and after bone marrow transplantation.  Pediatrics. 1992;  89 722-729
• 23 Lucia A, Ramirez M, San Juan A F, Fleck S J, García-Castro J, Madero L. Intrahospital supervised exercise training: a complementary tool in the therapeutic armamentarium against childhood leukaemia.  Leukemia. 2005;  19 1334-1337
• 24 Lund M B, Kongerud J, Brinch L, Evensen S A, Boe J. Decreased lung function in one year survivors of allogeneic bone marrow transplantation conditioned with high-dose busulphan and cyclophosphamide.  Eur Respir J. 1995;  8 1269-1274
• 25 Mahon A D, Gay J A, Stolen K Q. Differentiated ratings of perceived exertion at ventilatory threshold in children and adults.  Eur J Appl Physiol Occup Physiol. 1998;  78 115-120
• 26 Mahon A D, Marsh M L. Reliability of the rating of perceived exertion at ventilatory threshold in children.  Int J Sports Med. 1992;  13 567-571
• 27 Marchese V G, Chiarello L A, Lange B J. Effects of physical therapy intervention for children with acute lymphoblastic leukemia.  Pediatr Blood Cancer. 2004;  42 127-133
• 28 Mazzetti S A, Kraemer W J, Volek J S, Duncan N D, Ratamess N A, Gomez A L, Newton R U, Hakkinen K, Fleck S J. The influence of direct supervision of resistance training on strength performance.  Med Sci Sports Exerc. 2000;  32 1175-1184
• 29 Mello M, Tanaka C, Dulley F L. Effects of an exercise program on muscle performance in patients undergoing allogeneic bone marrow transplantation.  Bone Marrow Transplant. 2003;  32 723-728
• 30 Meyer T, Lucia A, Earnest C P, Kindermann W. A conceptual framework for performance diagnosis and training prescription from submaximal parameters - theory and application.  Int J Sports Med. 2005;  (Suppl 1) S38-S48
• 31 Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood J E. Exercise capacity and mortality among men referred for exercise testing.  N Engl J Med. 2002;  4 793-801
• 32 National Strength and Conditioning Association . Youth resistance training: position statement paper and literature review.  J Strength Cond Res. 1996;  18 62-76
• 33 Norkin C C, White (eds) D J. Measurement of Joint Motion: A Guide to Goniometry. 3rd edn. Philadelphia, PA; FA Davis Compan 2003: 256-259
• 34 Rajmil L, Serra-Sutton V, Alonso J, Starfield B, Riley A, Váquez J R. The Spanish version of the child health and illness profile-adolescent edition (CHIP‐AE).  Quality of Life Res. 2003;  12 303-313
• 35 Riley A W, Forrest C B, Rebok G W, Starfield B, Green B F, Robertson J A, Friello P. The child report form of CHIP-child edition: reliability and validity.  Med Care. 2004;  42 221-231
• 36 Riley A W, Forrest C B, Starfield B, Rebok G W, Robertson J A, Green B F. The parent report form of the CHIP-child edition: reliability and validity.  Med Care. 2004;  42 210-220
• 37 San Juan A F, Fleck S J, Chamorro-Viña C, Maté-Muñoz J L, Moral S, García-Castro J, Ramirez M, Madero L, Lucia A. Early-phase adaptations to intra-hospital training in strength and functional mobility of children with leukemia.  J Strength Cond Res. 2007;  21 173-177
• 38 San Juan A F, Fleck S J, Chamorro-Viña C, Maté-Muñoz J L, Moral S, Pérez M, Ramirez M, Madero L, Lucia A. Effects of an intra-hospital exercise program intervention for children with leukemia.  Med Sci Sports Exerc. 2007;  39 13-21
• 39 Stevens A M, Sullivan K M, Nelson J L. Polymyositis as a manifestation of chronic graft-versus-host disease.  Rheumatology. 2003;  42 34-39
• 40 Tsolaris C K, Vagenas G K, Dessypris A G. Strength adaptations and hormonal responses to resistance training and detraining in preadolescent males.  J Strength Cond Res. 2006;  18 625-629
• 41 van Brussel M, Takken T, Lucia A, van der Net J, Helders P J. Is physical fitness decreased in survivors of childhood leukemia? A systematic review.  Leukemia. 2005;  19 13-17
• 42 Wright M J, Hanna S E, Haltona J M, Barr R D. Maintenance of ankle range of motion in children treated for acute lymphoblastic leukaemia.  Ped Phys Ther. 2003;  15 146-152