1. Fuerst, Mark L.

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ORLANDO, FL-Increasing physical activity may have positive effects on fitness, cognition, and quality of life in adolescent survivors of pediatric cancer, according to a new study.

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A web-based, interactive intervention that provides rewards for exercising motivated young cancer survivors to stay physically active. Moderate to vigorous physical activity increased by an average of nearly 5 minutes a week in a group of 11- to 15-year-olds who used the intervention and decreased by an average of over 24 minutes in the control group.


"Compared to the general population, childhood cancer survivors have an increased risk for obesity and metabolic syndrome, conditions that can lead to heart disease, stroke, and diabetes, so it is really important that they are physically active. By intervening in this young age group, we hope to help kids develop healthy exercise habits for life," said lead author Carrie R. Howell, PhD, Clinical Research Scientist at St. Jude Children's Research Hospital in Memphis, Tenn., at a press cast in advance of the 2018 Cancer Survivorship Symposium (Abstract 102).


Studying Adolescents & Fitness

Howell and colleagues conducted a pilot study to test if a web-delivered, interactive, rewards-based physical activity intervention among adolescent cancer survivors would increase moderate to vigorous physical activity and improve fitness, neurocognitive, and health-related quality of life over 24 weeks.


Researchers randomly assigned 97 survivors, ages 11-15, who were no longer receiving cancer treatment and were physically active less than 60 minutes a day to a web-based physical activity intervention or to a control group. The study was open to children with any type of cancer; about one-quarter of the patients had acute lymphoblastic leukemia (ALL).


Both groups received an educational handout with information about the importance of physical activity and examples of activities, along with a wearable activity monitor. The intervention group also had access to an interactive, age-appropriate website. These patients connected their monitor to a computer and logged in their activity through the website on at least a weekly basis. They received rewards, for example, T-shirts, stickers, and gift cards by mail, if they achieved certain thresholds of activity.


At the beginning and at the end of the study, the researchers assessed the participants physical fitness (strength, flexibility, and endurance) and neurocognitive measures (attention, memory), as well as health-related quality of life (assessed using the Pediatric Quality of Life Inventory questionnaire).


A total of 78 participants, mean age 12.7 years, included 53 patients in the intervention group and 25 patients among the controls, who completed the 24-week program. Time spent performing moderate-to-vigorous physical activity increased by an average of 4.7 minutes per week in the intervention group and decreased by an average of 24.3 minutes per week in the control group. In the intervention group, researchers also noted improvements in hand grip strength (from an average of 19.9 kg to 21.0 kg), number of push-ups (from an average of 15 to 18) and sit-ups completed (from an average of 11 to 14), verbal fluency, and health-related quality of life. No significant changes in any of those measures were seen in the control group.


"In this age group, it is common to see a decrease in physical activity over time, even among healthy kids. Therefore, we are encouraged that our intervention was successful at maintaining physical activity levels, but a longer program may be needed to create lasting exercise habits," said Howell.


Future Studies

Based on this pilot study, the researchers designed a larger clinical trial of a web-based physical activity intervention. The trial, ALTE1631, aims to enroll 384 survivors of childhood with ALL at institutions across the country. The intervention will last 1 year with follow-up at 18 months.


In the future, the researchers also plan to explore the relationship between physical activity and cognition. Many survivors of childhood cancer have treatment-related cognitive problems, and there is preliminary evidence suggesting that exercise may improve cognitive function.


ASCO Expert Timothy Gilligan, MD, MSc, FASCO, Associate Professor of Medicine at the Cleveland Clinic Taussig Cancer Institute, commented: "This study shows that online tools can be an excellent way to motivate young people with cancer to be more active. We know that exercise brings a wide range of benefits. It improves heart health, reduces fatigue, and helps control weight-all of which are important after cancer treatment.


"We need to engage young cancer survivors in physical activity. This is more evidence that benefits are derived from increased physical activity. We need to be creative to motivate people."


Mark L. Fuerst is a contributing writer.