09 Apr Physical Activity in Children with Cancer
By Nistha Shrestha, Pediatric Physiotherapist
Physical activity (PA) is a key factor in the development of healthy children and this applies to children with cancer as well. It is any bodily movement produced by skeletal muscles that require energy expenditure which includes play, games, sports, transportation, chores, recreation, physical education, or planned exercise, in the context of family, school, and community activities.
In healthy children, regular and adequate levels of physical activity are fundamental to everyday life but a child with cancer shows a high level of physical inactivity due to the disease itself and its treatment and isolation practiced during the treatment that can last for months or years. In addition to the negative side effects of medication, physical inactivity leads to physical, psychosocial side effects and is also a risk factor for chronic diseases like obesity, diabetes, and cardiovascular diseases. The Childhood Cancer Survivor Study found that 62% of childhood cancer survivors had at least one chronic condition and 27.5% have a severe or life-threatening condition by 29.2 years of age.
Physical activity has emerged as a promising intervention to mitigate the negative effects of medication and physical inactivity. Physical activity improves energy balance and weight control, muscular and cardiorespiratory fitness, functional lung capacity, bone, and functional health, mental health, and reduces the fatigue level and risk of non-communicable disease. Moreover, physical activity also improves psychosocial effects by reducing the levels of fear and anxiety, providing possibilities for self-expression, building self-confidence, feelings of relatedness, and improving social interaction and integration leading to optimal quality of life of children.
In order to improve overall health, WHO has recommended moderate to vigorous intensity of physical activity daily for at least 60 minutes (which can be in multiple short sessions separated throughout the day e.g. 2 sessions of 30 minutes) for children and youth aged 5-17 years. Most of the daily activities should be aerobic. However, the evidence to date suggests promoting an active lifestyle and performing mild to moderate intensity of physical activity is safe, beneficial, and feasible in children with cancer. Additionally, in order to prevent cancer in children and adolescents, The American Cancer Society recommended 60 minutes of moderate to vigorous exercise for 5 days/week.
There are evidence-based PA programs and exercise manuals developed for children with cancers and cancer survivors 1. Pediatric Survivors Engaging in Exercise Recovery (PEER) and 2. Pediatric Oncology Exercise Manual (POEM) developed at the University of Calgary, 3. Play Strong – A Pediatric Cancer Exercise Program, developed in Nationwide Children’s Hospital in Ohio, USA, and few other manuals have been developed at the University of South Australia’s School of Health Science in partnership with the Little Heroes Foundation Child Family Care Project and Leukemia Foundation. In most cases, the advantage of PA outweighs the risks, but it is essential to individualize the PA program by Physiotherapists or specialized health professionals according to the need of the child to optimize long term compliance.
Barriers to PA are physical (fatigue, concern for increased risk of infection, side effects of treatment, gastrointestinal problems, pain, dizziness, and weakness), psychological (lack of energy, bad moods/not feeling like it, preference for other things like staying in bed, concern for injury, fear of soreness and sweating, falling behind academically, and preference for sleeping to not feel side effects), and organizational factors (lack of time, lack of sports equipment, bad weather, lack of ideas, lack of space for physical activities and no one to play with).
Studies have shown family and peer support are associated with increased self-efficacy and increased activity levels with child preference for mother as an exercise partner. Above all, there is an immense need to build an infrastructure in which the PA habit can be developed.
Awareness and counseling about the benefits of PA throughout the childhood cancer experience must be provided by Pediatric oncologists, Physicians, and the concerned health care professional which is the step to promote PA.
1. WHO. Physical activity and young people. 2011 [Link]
2. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med (2006) 355:1572–82. [Link]
3. C Chamorro Vina, AJ Wurz, SN Culos-Reed. Promoting physical activity in pediatric oncology. Where do we go from here? Frontiers in oncology, 2013, 3:173. [Link]
4. Y Larrilyn, S Forbis. Influences and Barriers on Physical Activity in Pediatrics Oncology Patients. Front. Pediatr. 2016. [Link]
About Nistha Shrestha
Nistha Shrestha is a Lecture and Consultant Pediatric Physiotherapist at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel Hospital (DH)-Kathmandu University Hospital. She is passionate about working with children to provide the highest quality of physiotherapy service with a great multidisciplinary team, specially emphasizing on early childhood rehabilitation, inpatient physiotherapy service and preventing the non-communicable disease in children of Nepal.