Benefits of Intrahospital Exercise Training after Pediatric Bone Marrow Transplantation

 

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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.

References

• 1 American Academy of Pediatrics . Strength training, weight and power lifting and bodybuilding by children and adolescents.  Pediatrics. 1990;  86 801-803
  PubMedGoogle Scholar
• 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
  Google Scholar
• 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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Hickson R C, Marone R J. Exercise and inhibition of glucocorticoid-induced muscle atropy.  Exerc Sport Sci Rev. 1993;  21 135-167
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  Google Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  Google Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  Google Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  Article in Thieme ConnectPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 32 National Strength and Conditioning Association . Youth resistance training: position statement paper and literature review.  J Strength Cond Res. 1996;  18 62-76
  PubMedGoogle Scholar
• 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
  Google Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar

Prof. Alejandro Lucia

Department of Physiology
Universidad Europea de Madrid

Villaviciosa de Odón

28670 Madrid

Spain

Phone: + 34 9 16 64 78 00

Fax: + 34 9 16 16 82 65

Email: alejandro.lucia@uem.es