INTRODUCTION
Children and adolescents with cancer are generally treated with
chemotherapy, sometimes combined with radiotherapy and/or surgery. Their
disease and its treatments can cause a variety of early and late
morbidities, including fatigue, neuropathy, sleep disruption, chronic
pain, depression, anxiety, cognitive impairment, and a worse quality of
life (QoL).1–3 Overall, the physical functioning of
children and adolescents with cancer declines during their treatment,
and this can interfere with their QoL,4–6 as well as
increasing the risk of certain chronic diseases.2
There has been growing interest in studying the value of exercise in
oncology, albeit more in adults than in pediatric patients so
far.7–11 Regular exercise can help patients receiving
therapy and cancer survivors to avoid becoming trapped in a
self-perpetuating cycle of deteriorating physical functioning that can
exacerbate the negative consequences of fatigue and a sedentary
lifestyle.5,11-13
Health-related QoL (HRQoL) is a construct that describes a person’s
perception of their own physical, mental and social
wellbeing.14–17 Positive associations have been
reported between HRQoL and fitness levels in childhood cancer
survivors.18,19 Cancer-related fatigue is a common and
distressing condition that significantly lowers the HRQoL of adults and
children with cancer,20,21 and higher levels of
physical activity have been associated with lower levels of
cancer-related fatigue.22 It is worth also to consider
that in children the routine use of systemic pharmacological approaches
to manage fatigue is not generally recommended.23
Physical vitality is an important marker of any teenager’s physical and
psychosocial health, be they healthy or ill, and higher levels of
physical activity have been found to correlate with better cognitive
outcomes.24–27 Despite a wider acknowledgement of the
value of movement for patients with cancer, the prescription of exercise
in oncology has remained somewhat basic, particularly in the case of
children. With the aim of improving the opportunities for children and
adolescents with cancer to exercise, we have implemented an in-hospital
training program at the pediatric department of our institution. In an
effort to identify optimal approaches (or barriers) to organized
exercise programs in clinical cancer practice, this study aimed: (i) to
identify any improvement in physical, psychosocial and emotional
functioning in children and adolescents with various solid cancers after
the introduction of supervised controlled exercising programs; (ii) to
compare HRQoL scores between patients who attended the workouts and
those who did not; and (iii) to investigate barriers to physical
activity and participation in sport for young people diagnosed with
cancer.