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.