A randomized trial investigating an exercise program to prevent reduction of bone mineral density and impairment of motor performance during treatment for childhood acute lymphoblastic leukemia

Authors

  • A. Hartman MSc,

    Corresponding author
    1. Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
    2. Department of Paediatric Physiotherapy, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
    • Department of Paediatric Physiotherapy, Erasmus MC-Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
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    • A. Hartman and M. L. te Winkel contributed equally to this work.

  • M.L. te Winkel MD,

    1. Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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    • A. Hartman and M. L. te Winkel contributed equally to this work.

  • R.D. van Beek MD,

    1. Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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  • S.M.P.F. de Muinck Keizer-Schrama MD, PhD,

    1. Department of Paediatric Endocrinology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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  • H.C.G. Kemper PhD,

    1. EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands
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  • W.C.J. Hop PhD,

    1. Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
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  • M.M. van den Heuvel-Eibrink MD, PhD,

    1. Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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  • R. Pieters MD, PhD

    1. Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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Abstract

Background

Reduced bone mineral density (BMD), altered body composition, impaired motor performance and passive ankle dorsiflexion are side effects of acute lymphoblastic leukemia (ALL) treatment. We performed a randomized study investigating whether an exercise program could prevent these side effects.

Procedure

At diagnosis we randomized 51 ALL patients (median age: 5.4 years) into a group receiving a 2-year exercise program or a control group receiving standard care. BMD of total body (BMDTB), lumbar spine (BMDLS) and body composition were measured using dual energy X-ray absorptiometry, motor performance with Bayley Scales of Infant Development or Movement-ABC, and passive ankle dorsiflexion with a goniometer. The investigator was blinded to the randomization.

Results

Body fat increased equally during treatment in both groups. One year after cessation of therapy more rapid decline of excessive body fat was observed in the intervention group than in the controls (P = 0.01). Lean body mass, BMDTB and BMDLS of both groups decreased equally during treatment and increased equally thereafter. Both groups showed a similar decrease in passive ankle dorsiflexion and motor performance during treatment. Adherence to the intervention program varied considerably. Adherence to intervention: 11% of children exercised daily, 37% > once a week, 16% once weekly, 36% < once a week.

Conclusions

The exercise program was not more beneficial than standard care in preventing reduction in BMD, motor performance and passive ankle dorsiflexion than standard care, most likely due to unsatisfactory compliance. Increased BMI and body fat in the intervention group normalized faster after cessation of chemotherapy. Pediatr Blood Cancer 2009;53:64–71. © 2009 Wiley-Liss, Inc.

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