Background As balance training seems to be a promising training method to improve physical limitations of the lower limbs, this study aims to evaluate feasibility, subjective benefits and preliminary effects on physical abilities of balance training in pediatric cancer patients. Patients 11 pediatric cancer patients (5-21 years) undergoing acute medical treatment were included in the study. Method Participants took part in a 4-week balance training intervention. 3 trainings/week were conducted either supervised or self-administered. Subjective benefits were evaluated using a questionnaire, effects on selected physical abilities were assessed using functional-motor assessments. Results Participants completed 71.21+37.34% of balance training sessions, no adverse events occurred. Participants were satisfied with the intervention and described various subjective benefits. Significant improvements were found in functional strength of the lower limbs as well as positive trends in balance. Discussion Balance training seems feasible with pediatric cancer patients undergoing acute medical treatment potentially improving functions of the lower limbs relevant for daily physical activity. Conclusion Balance training can be a valuable conjunct to general exercise programs in pediatric oncology.

Whole-body vibration (WBV) is a feasible and potentially beneficial exercise strategy for managing neuromuscular impairments like decreased strength or flexibility, mobility limitations and bone health in pediatric cancer survivors. However, as starting rehabilitation as early as possible is recommended to preserve physical function, this study investigated the feasibility of WBV for patients receiving cancer treatment for first cancer diagnosis. Eleven patients (various types of cancer, ages 7–17) participated in the supervised WBV intervention concomitant to acute cancer treatment, which involved chemotherapy. Training was implemented as part of a general exercise program and offered 3 days per week during hospitalization (warm-up, four progressive training exercises comprising 60–120 s, 21–27 Hz, 2 mm peak-to-peak-displacement). Feasibility, which was defined as the absence of WBV-related serious adverse events leading to study dropout, was primarily evaluated. Training documentation was additionally analyzed. As a main result, no serious adverse events leading to study dropout were reported. However, two incidents of bleeding (adverse events) were observed in patients with bleeding tendencies and low platelets (thrombocytes < 30,000/μL). After adjusting the platelet count threshold for WBV participation to 30,000/μL, no further incidents occurred. Moreover, due to WBV-related side effects like physical exhaustion, 11% of all training sessions had to be stopped and another 11% required reductions in the vibration load. Patients participated in 48% of the planned sessions. While main reasons for non-attendance were medical issues (35%), only few WBV sessions were missed, not completed or needed modifications due to motivational issues. Consequently, WBV seems to be feasible for inpatient pediatric patients receiving chemotherapy for first cancer diagnosis, given a sufficiently high platelet count of at least 30,000/μL. Although WBV tolerance and training motivation appear high, patient’s reduced medical condition during hospitalization can negatively impact training progression and attendance. Future research is required to confirm our findings on feasibility and to assess efficiency of WBV training for pediatric cancer patients receiving cancer treatment.

Zusammenfassung Bei einem Sensomotoriktraining (SMT), hier konkret einem Gleichgewichtstraining als Unterform des SMT, werden Übungen auf unterschiedlich stabilen Untergründen und in verschiedenen Standpositionen durchgeführt. Es hat das Potenzial, Regenerations- und Anpassungsmechanismen anzuregen und so zur Plastizität des Nervensystems beizutragen. Das Training ermöglicht eine individuelle und an die Tagesform angepasste Umsetzung und zeichnet sich durch einen geringen Material- und Zeitaufwand sowie eine gute Reproduzierbarkeit aus. Das SMT findet schon lange Anklang in der Rehabilitation sowie der Verletzungs- und Sturzprophylaxe. In den vergangenen Jahren wurde es auch vermehrt im Bereich der Erwachsenenonkologie zur Verbesserung der oftmals weitreichenden therapiebedingten Beeinträchtigungen der unteren Extremitäten, wie z. B. eine verminderte Gleichgewichtsfähigkeit, umgesetzt. Auch an Krebs erkrankte Kinder und Jugendliche sind häufig, u. a. infolge einer Chemotherapie-induzierten Polyneuropathie (CIPN), von den genannten Beeinträchtigungen in der unteren Extremität betroffen. Diese können sie auch noch lange nach der medizinischen Therapie daran hindern, ausreichend körperlich aktiv zu sein. SMT hat in diesem Kontext das Potenzial, adäquate sensorische und motorische Voraussetzungen für ein ausreichendes Aktivitätsniveau zu schaffen. Mit dem Ziel einer kindgerechten, motivierenden und individuellen Umsetzung des SMT wurde am Departement für Sport, Bewegung und Gesundheit der Universität Basel ein spezielles Trainingskonzept für die Kinderonkologie entwickelt. Mit einer Drehscheibe können die Kinder die Übungen kreativ und spielerisch zusammensetzen und so die Schwierigkeit individuell an ihre Tagesform nach der Therapie anpassen. Die Umsetzbarkeit des Trainingskonzepts wurde in einer 4-wöchigen Pilotstudie im Rahmen eines etablierten pädiatrisch-onkologischen Nachsorgesportprogramms der Deutschen Sporthochschule Köln im Kinderkrankenhaus Amsterdamer Straße Köln erprobt. Es nahmen 6 Kinder und Jugendliche teil. Die vorläufigen Ergebnisse der Pilotstudie und ein Fallbeispiel zeigen, dass das kindgerechte und spielerische SMT nach einer Krebserkrankung im Kindesalter ohne Zwischenfälle umsetzbar ist und eine spezifische und wertvolle Ergänzung der pädiatrisch-onkologischen Bewegungstherapie darstellen kann.

In sensorimotor training (SMT), in this case balance training as a sub-category of SMT, exercises are carried out on different surfaces and in different standing positions. SMT has the potential to induce regenerative and adaptive mechanisms, contributing to the plasticity of the nervous system. While the effort and material involved for this exercise modality is minimal, effects remain high and reproducibility is good. It can be adjusted individually to the participant's daily performance level. To date, SMT has been conducted in the context of rehabilitation as well as injury and fall prevention. In recent years, SMT has also been successfully implemented in adult oncology in order to improve common impairments of the lower extremities, such as reduced balance control. Children after inpatient oncological treatment also suffer from various mobility-related impairments of their lower extremities which can lead to further physical inactivity. These impairments may occur as a result of chemotherapy induced peripheral neuropathy (CIPN). SMT seems to have the potential to improve sensory and motor dysfunctions, contributing to higher physical activity in general. With the objective of implementing a child-friendly, motivating and individual SMT, a specific training concept for paediatric oncology was developed at the Department of Sport, Exercise and Health at the University of Basel. In this training concept, children use a turntable to compose the sensorimotor exercises based on their daily performance level. The feasibility of the training concept was tested in a 4-week pilot study, conducted within an established exercise program after cancer treatment of the German Sport University Cologne in the Children's Hospital Amsterdamer Strasse Cologne. 6 children and adolescents after oncological treatment took part. The preliminary results of the pilot study and a case example show that a child-friendly and playful SMT after paediatric oncological disease is feasible without occurrence of adverse events. Therefore, SMT might be a valuable and targeted training modality supplementing exercise therapy in paediatric oncology.

Zusammenfassung Hintergrund Obwohl Studien zeigen, dass Bewegungsinterventionen während der stationären kinderonkologischen Akuttherapie sicher durchführbar sind und positive Effekte haben, fehlt es an einer flächendeckenden sporttherapeutischen Versorgung. Ziel der Arbeit Die vorliegende Publikation analysiert Daten zur Teilnahme, zu Hindernissen und zur Gestaltung eines stationären Sportprogramms mit den Zielen, Hinweise für die Etablierung weiterer Sportangebote zu generieren und die Bewegungsförderung während der pädiatrisch-onkologischen Akuttherapie zu verbessern. Material und Methoden Die Daten wurden zwischen September 2015 und August 2019 im Rahmen eines stationären Sportprogramms für onkologisch erkrankte Kinder und Jugendliche im Alter zwischen 2 und 22 Jahren erhoben. Ergebnisse In das Sportprogramm wurden 63 Kinder und Jugendliche für durchschnittlich 26 Wochen eingebunden. Die Teilnehmer*innen absolvierten 14,83 ± 12,25 von 28,17 ± 20,05 angebotenen Einheiten (Teilnahmequote: 56 %). Medizinische Gründe waren die häufigste Ursache, weshalb eine Trainingseinheit nicht wahrgenommen wurde. Nur 10 % der Einheiten wurden aus mangelnder Motivation abgelehnt. Die Dauer der Trainingseinheiten betrug ca. 25 min. Die Intensität lag im leichten bis moderaten Bereich. Diskussion Die Ergebnisse belegen das Interesse der Betroffenen an einem stationären Bewegungsangebot. Die Vielfalt der Trainingsinhalte unterstreicht die Bedeutung einer individuellen Adaptation der Sporttherapie. Gleichzeitig wird die Notwendigkeit eines „Minimalprogramms“ mit sehr leichten Intensitäten hervorgehoben. Optimierungsmöglichkeiten bestehen u. a. in einer höheren zeitlichen Flexibilität des Angebotes sowie der Ergänzung um ein selbstständiges Training mithilfe eines Bewegungsplanes.

Background Physical activity interventions are feasible, safe and beneficial during inpatient pediatric anticancer treatment; however, exercise programs are still rare. Objective Data on attendance, barriers and content of an inpatient exercise program were analyzed in an effort to support the implementation of exercise options and improve physical activity promotion during pediatric oncological treatment. Material and methods Relevant data were obtained from September 2015 to August 2019 from an inpatient exercise program for childhood cancer patients aged between 2 years and 22 years. Results A total of 63 childhood cancer patients participated in the exercise program for an average of 26 weeks. They participated in 14.83 +/- 12.25 out of 28.17 +/- 20.05 possible exercise sessions (attendance rate 56%). Medical issues were the main reason for nonparticipation. Only 10% of the offered training sessions were refused due to motivational reasons. Average training duration was 25 min and the intensity was considered to be light to moderate. Conclusion Childhood cancer patients show a high interest in inpatient exercise opportunities. The variability of training content underlines the necessity of individualization. In addition, the availability of exercises with a very light intensity is essential. Higher flexibility in timing as well as an additional exercise plan that allows patients to exercise on their own would improve the program.

Objectives: Exercise interventions during and after treatment for pediatric cancer are associated with beneficial physical, psychological, and social effects. However, valid data about adverse events (AEs) of such interventions have rarely been evaluated. This retrospective study evaluates AEs that occurred during supervised oncological exercise programs for pediatric cancer patients and survivors. Methods: This Germany-wide study used a self-administered online survey focusing on general program characteristics and AEs retrospectively for 2019. The questionnaire included (a) basic data on the offered exercise program, (b) AEs with consequences (Grade 2–5) that occurred in 2019 during an exercise intervention, (c) number of Grade 1 AEs, (d) safety procedures as part of the exercise programs, and (e) possibility to give feedback and describe experience with AEs in free text. Results: Out of 26 eligible exercise programs, response rate of program leaders was 92.3% ( n = 24). Representatives working for Universities ( n = 6), rehabilitation clinics ( n = 3), acute cancer clinics ( n = 12), and activity camps ( n = 3) participated. In total, 35,110 exercise interventions with varying duration were recorded for 2019. Six AEs with consequences (Grade 2–3) occurred during exercise interventions after cancer treatment resulting in an incidence of 17 per 100,000 exercise interventions (0.017%). No life-threatening consequences or death were reported and no serious AE occurred during acute cancer treatment. Grade 1 AE occurred with a frequency of 983, corresponding to an incidence of 2,800 per 100,000 interventions (2.8%). Most frequent Grade 1 AE were muscle soreness, circulatory problems, and abdominal pain. The most frequent preventive safety procedures at the institutions were regular breaks, consultations with the medical treatment team, and material selection with low injury potential. Conclusions: Supervised exercise interventions for pediatric cancer patients and survivors seem to be safe and AEs with consequences comparatively rare when compared to general childhood population data. Occurrence of grade 1 AEs was common, however, causality was probably not evident between AEs and the exercise intervention. Future research should standardize assessment of AEs in clinical practice and research, and prospectively register and evaluate AEs that occur in the context of exercise interventions in pediatric cancer patients and survivors.

Background Research indicates reduced physical performance from diagnosis into survivorship of pediatric cancer patients. However, there is no systematic information or guideline available on the methods to assess physical performance and function in this population. The purpose was to systematically compile and describe assessments of physical performance and function in patients and survivors of pediatric cancer, including cardiorespiratory fitness, muscle strength, speed, balance, flexibility, functional mobility, gait and motor performance test batteries. Methods We searched the databases PubMed, SPORTDiscus, and Cochrane Database and performed abstract and full-text selection of 2619 articles according to the Cochrane Handbook of Systematic Reviews. Information on patients characteristics, assessments, information on validity and reliability, and relevant references was extracted. Results In summary, 63 different assessments were found in 149 studies including 11639 participants. Most studies evaluated cardiorespiratory fitness and muscle strength with the majority conducted off treatment. Some outcomes (e.g. speed) and diagnoses (e.g. neuroblastoma) were severely underrepresented. With the exception of gait, leukemia patients represented the largest group of individuals tested. Conclusions Insufficient data and patient heterogeneity complicate uniform recommendations for assessments. Our results support researchers and practitioners in selecting appropriate assessment to meet their specific research questions or individual daily practice needs. Impact This systematic review includes 149 studies and provides a comprehensive summary of 63 assessments to evaluate cardiorespiratory fitness, muscle strength, speed, balance, flexibility, functional mobility, gait or motor performance test batteries in patients and survivors of pediatric cancer. We present the most studied fields within the pediatric cancer population, which are cardiorespiratory fitness and muscle strength, off treatment phase, and leukemia patients. We propose research priorities by identification of subgroups in terms of cancer type, phase of treatment, and outcome of interest that are underrepresented in studies currently available.

Background Exercise interventions in pediatric oncology include primarily traditional types of physical activity (PA) such as endurance and strength training, while there is a growing interest in recreational types of PA for pediatric cancer survivors, as well. One of these motivating and fun activities is indoor wall climbing. Therefore, this exploratory study aims to evaluate the feasibility and beneficial effects of a 10-week indoor wall climbing intervention in pediatric oncology. Patients Thirteen childhood cancer survivors aged 6-21 years were included after cessation of their inpatient medical treatment of whom eleven completed the study. Methods Study participants completed measurements of physical functioning at baseline (t0) and post-intervention (t1), as well as a questionnaire on program satisfaction at t1. Results Survivors participated in 57.43 +/- 31.77% of the climbing sessions and no adverse events occurred. Most study participants evaluated the climbing experience to be fun and motivational. One child stated that the climbing intervention was too exhausting/overstraining. Significant positive effects were found in terms of ankle DF-ROM and ankle DF strength. Discussion Indoor wall climbing seems feasible with childhood cancer survivors and suggests beneficial potentials on physical functioning. However, some preconditions (i. e. close supervision; slow increase of intensity; sufficient breaks) must be ensured. Conclusion Indoor wall climbing could be a motivational adjunct to traditional types of exercise in pediatric oncology.

Childhood cancer survivors show reduced physical activity (PA) levels which may considerably impact child development, quality of life, social participation and sequelae such as functional and cardiovascular health. This study aims to evaluate different aspects of PA behaviour in patients with childhood cancer (PaC) before (bT), during (dT) and after (aT) cancer treatment. In this cross-sectional, multicentre study, 114 PaC and 37 healthy controls between 4 and 20 years of age were enrolled. PA behaviour was assessed using an adapted questionnaire which included items asking about PA level, PA intensity and domains of PA. Patients reported lower PA levels and less minutes of PA at moderate-intensity dT than aT and bT (P ≤ 0.05). Healthy controls reported higher PA levels than patients aT (P ≤ 0.05). At school, 41.7% of PaC did not participate in physical education aT or bT. Lastly, 45.6% of PaC who were engaged in sport club activities bT did no more participate in sport club activities aT. Patients reported different PA behaviours dT and aT than bT. Therefore, monitoring of PA should be considered to increase PA levels in PaC. Future studies also need to examine how PA behaviour can be influenced in a positive way in PaC.

PurposeLow levels of physical activity often observed in pediatric oncology might be attributed to various functional deficits, especially those of the lower limbs as these affect gait, mobility, and, consequently, physical activity. In the past few years, whole-body vibration (WBV) has emerged as a new therapy modality for improving physical functioning. Although WBV is increasingly applied in children with disabilities, its impact on lower limb function in pediatric cancer patients and survivors has not yet been investigated.MethodsTo establish whether there is evidence that WBV may be beneficial for pediatric cancer patients and survivors, this review summarizes current data on WBV studies among children with disabilities and extracts relevant information for the pediatric cancer population. Two independent reviewers performed a systematic literature search following the PRISMA guidelines.ResultsNine studies were included in the analysis. Results demonstrate that WBV is a safe, highly compliant, and effective approach in cohorts of children with disabilities. The largest effects of WBV were observed in lower extremity muscle mass and strength, balance control, gait, and walking ability. Furthermore, we were able to develop first recommendations for WBV protocols.ConclusionsWBV seems to be feasible and effective for improving parameters that may be relevant to the pediatric cancer population. Efforts are needed to conduct first WBV interventions in children with cancer proving the effects. The developed recommendations for WBV protocols might help to implement these intervention studies.

Most research-based physical activity (PA) interventions show that children diagnosed with cancer experience healthrelated benefits during the intervention period. However, translating these interventions into practice is uncommon. To better understand if/how researchers translate their PA interventions to practice, we identified 65 researchers who had published research manuscripts/conference abstracts detailing PA interventions for children with cancer. Most authors reported their PA intervention was not translated into practice due to financing constraints and low adherence rates during the study period. Of those who did translate, strategies to overcome commonly cited barriers were provided. We can conclude that PA interventions are rarely translated to practice, as doing so is resource-intensive and requires concerted efforts from multiple stakeholders. Findings underscore the complicated nature of knowledge translation and raise questions about whose responsibility it is to move evidence to practice.

BackgroundPhysical activity programs for children diagnosed with cancer may enhance health and quality of life. However, it is unknown where and in what capacity such programs are being offered internationally.PurposeTo identify physical activity programs for children diagnosed with cancer and summarize program characteristics.MethodsFive data sources were searched to identify physical activity programs offered to children diagnosed with cancer. Following confirmation of eligibility, correspondents were sent a series of open-ended questions via email. Data were extracted from responses and summarized descriptively and narratively.ResultsOf the 140 unique correspondents contacted, 46 programs, in 10 countries, met eligibility criteria. Responses to open-ended follow-up questions were obtained from 36 programs and were subsequently included in the content analysis. Internationally, the majority of programs are being offered to children in Europe, with mixed cancer types, at different stages of the cancer trajectory. There is relatively equal distribution with regard to the setting in which programs are offered (i.e., community, hospital, combination). All correspondents reported that their program is professionally supervised, and most require that children obtain medical clearance prior to participating. There is considerable variability in terms of other key program (e.g., funding) and physical activity characteristics (e.g., frequency).ConclusionsFindings from this environmental scan highlight where and in what capacity physical activity programs are being offered, providing guidance for those seeking to develop/implement physical activity programs themselves. Moreover, results highlight the current state of practice, underscoring the necessity of international networks, multi-site collaborations, and public relations to ensure all children diagnosed with cancer have access to physical activity programs.

BACKGROUND:With improved survival rates in pediatric oncology, the detection of adverse side- and late-effects is gaining increased interest. This cross-sectional study investigated walking abilities and ankle dorsiflexion function in children with cancer. PATIENTS:Study participants included 16 children with various cancers (4-20 years, patient group) after completion of the intense treatment and 16 age- and gender-matched healthy peers (comparison group). METHOD:Walking speed (10-meter-walking-test, treadmill test assessing preferred transition speed), walking capacity (2-minute-walk-test), walking balance (Timed-Up-And-Go-Test), active/passive ankle dorsiflexion range of motion (ROM) (goniometer) and ankle dorsiflexion strength (hand-held dynamometer) were comprehensively assessed. RESULTS:Significant lower values in the patient group were found for walking capacity, maximum walking speed, ankle dorsiflexion ROM and strength. No significant differences between the groups were found for preferred walking speed and walking balance. DISCUSSION:Limited walking abilities and ankle dorsiflexion dysfunctions are prominent in children with cancer; having the potential to impact children's community mobility and physical activity. CONCLUSIONS:To provide holistic care, the development of specific supportive strategies such as exercise interventions and its translation into clinical practice needs to be accelerated.