01 Apr Exercise for Children with Cancer
By Nistha Shrestha, Pediatric Physiotherapist
Physical Activity for
Why are sport and exercise important for children with cancer?
The ability to participate in exercise and sports is something we take for granted; it is very much part of normal life for children. This includes group or individual, at a competitive level, either through school or something as simple as kicking a ball with friends or just riding a bicycle.
Exercise and sport are important because:
• they can increase and maintain our level of fitness
• they help us maintain a healthy weight (your child may gain or lose weight during treatment)
• they improve our sense of well-being and self-confidence
• particularly with team sports, they improve our sense of belonging.
Figuring a way to continue with an activity that your child has always enjoyed may require some adjustment as they go through treatment, or even thereafter.
The benefits of exercise and sport
There are many known benefits to integrating general exercise into the form of day by day life. Daily exercise discharges hormones called endorphins, which add to a sense of ‘feeling good’. For children with cancer, whose lives have been flipped around by their diagnosis, and who may have spent extensive time in hospital, this can be very helpful. Some exercise is also known to enhance good patterns of sleep, has been shown to decrease pain, and also to increase appetite and ease the problems of constipation, both of which may be related to the treatment being given. Weight bearing exercise can benefit a child’s bone density – as reduced bone density is a known side effect of some treatments.
A healthy lifestyle, with regular exercise, can help prevent illness, though this cannot be guaranteed.
Does a diagnosis of cancer mean the end of sport and exercise for my child?
No, it doesn’t, a diagnosis of cancer may bring up a wide range of issues and questions, including whether or not your child will be able to take part in sport, now or in the future.
There will be practical issues that you will need to consider. There may be some limitations, or adaptations required, either temporary or longer-term, depending on the type of cancer that your child has, what stage they are at in their treatment and, of course, the type of sport in question.
Not all children are sports-mad. Your child may not have been particularly interested in sport prior to being diagnosed with cancer. Exercise may, however, be considered an important part of their rehabilitation in terms of general health and well-being.
Am I being over-protective?
Inevitably, following a diagnosis of cancer, most parents feel a need to protect their child. Parents may feel overly anxious about their child taking part in sports which can lead to injury. The desire to wrap your child in cotton wool may be a strong one. There may be concerns that by allowing your child to take part in the sport you make matters worse. In some circumstances, this can lead to parents adopting an overly cautious approach.
Equally, there may be some parents who are so determined that their child should carry on with normal activities that they fail to take reasonable precautions to reflect their changed circumstances.
Others will take a sensible and more balanced approach, and need to be supported in doing this. It may be that sport and exercise was something the whole family used to do together – perhaps family cycling or walking trips; there really is no reason why that can’t continue, although maybe with some adaptation.
There needs to be a balance. There will be days when your child may feel more or less able to undertake sport or exercise. It will be important that you provide encouragement when they can, and support when they can’t.
If you are in any doubt about whether or not your child should take part in sport and exercise, then do discuss it with the team treating your child. There may be occasions, for example, when the child is at high risk of infection, when contact with other children may need to be avoided.
If your child has been treated for a brain tumor swimming may be appropriate, but no diving or jumping in for a number of weeks after surgery, and this can only be started when your child’s wound is fully healed. If you have any concerns, make sure you discuss them with your child’s medical team.
How can I help and support my child?
While taking part in sporting activities may be out of the question for a while, parents can still help by encouraging their child’s friends to provide updates on team progress, for example. In that way, they are not totally out of the loop. Watching sport and participation on the sidelines, without necessarily playing, is a good way to keep in touch, both with the game and with team-mates. If you have concerns about whether your child should avoid crowds while on treatment or neutropenic (low white cell count), do discuss this with the medical team.
Setting and achieving goals
For parents, and for the child with cancer, having goals to aim for as you go through treatment or embark on life beyond treatment, will be important.
This will include setting personal goals and achieving targets, even if the goals and targets are very different to ones you might have originally thought of before diagnosis.
• They do not have to be about climbing the highest mountain or doing the longest walk, or the fastest swim.
• It may be about just taking the first steps again.
• While it is important to have a final goal in mind, and to know how the bigger picture looks, it is essential that this is broken down into bite-sized goals, which are more likely to be achievable.
• This process will require constant evaluation: goal posts can shift, sometimes as a result of the cancer treatment or other cancer-related issues, and sometimes because of dips along the path, which may be totally unrelated to cancer.
• It may sometimes be a question of two steps forward, and one step back.
• A step back should not be seen as a failure. If it does happen it is still important to focus on the end goal and to look back at the progress that has been achieved in striving for that goal.
• By setting realistic goals, which are achievable, the whole family can benefit from a real sense of satisfaction. It may help to write your goals down so that you can make a note when you have achieved them.
• After the devastation of diagnosis and treatment, there will be a real sense of pride for parents, watching their child’s achievements, whatever they may be, and however big or small.
Who else can help?
The physiotherapist will be an important member of the multidisciplinary team treating your child. They are autonomous professionals concerned with care, management and rehabilitation of your child from the time of diagnosis. They conduct ongoing assessment of the needs of your child in order to apply skilled interventions which are vital for independence, functional capacity and quality of life.
A common problem experienced by the majority of children diagnosed with cancer at some point are pain, muscle wasting or weakness and reduced daily activities. This may be the result of long periods in bed, inactivity, the effect of steroids or other chemotherapy drugs, or be related to the particular type of tumor. Physiotherapists will be able to provide support in terms of reducing the pain, increasing the range of motion of the joint, improving bone mineral density and the strength of muscles which leads to increase in the functional status and level of physical activity of your child. They may also be able to give you a programme of exercises that your child can do at home. Physiotherapists will also help with any coordination and balance issues that your child may have which as a whole improve the quality of life of a child.
Your physiotherapist, or other members of the medical team, may have details of organisations locally, such as gyms or swimming pools, that offer facilities or special programmes for those returning to exercise after a period of illness.
• Make sure that your child’s calorie intake is appropriate for their level of activity
• Ensure that your child has appropriate, and suitably protective, footwear or other clothing, for the activity being undertaken.
• For children who have had brain tumors, it is important to ensure that the child does not fall over or bump their head.
• After treatment is finished, some children will have no long-term problems and may quickly be able to resume their previous activities. Parents should be aware, however, that this may not always be the case. Progress post-treatment may depend on the type of tumor, and how much the child was able to maintain a good level of fitness while on treatment.
• Those children with continuing difficulties or disabilities post-treatment, may still be able to undertake general exercise. It might be necessary, however, to explore alternatives to actually taking part in sport.
About Nistha Shrestha
Nistha Shrestha is a Lecturer and Consultant Pediatric Physiotherapist at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel Hospital. She is passionate about working with children to provide the highest quality physiotherapy service with a great multidisciplinary team, specially emphasizing on early childhood rehabilitation, inpatient physiotherapy service and preventing the non-communicable disease in children.