Morales Javier S, Padilla Julio R, Valenzuela Pedro L, Santana-Sosa Elena, Rincón-Castanedo Cecilia, Santos-Lozano Alejandro, Herrera-Olivares Alba M, Madero Luis, San Juan Alejandro F, Fiuza-Luces Carmen, Lucia Alejandro
Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.
Systems Biology Department, University of Alcalá, Alcalá de Henares, Madrid, Spain.
Front Pediatr. 2018 Dec 19;6:404. doi: 10.3389/fped.2018.00404. eCollection 2018.
Physical exercise training might counteract the weakening effects of both pediatric cancer and anti-cancer treatment. We aimed to analyze the prevalence of "responders" and "non-responders" to inhospital exercise training in children with cancer and to identify the factors that could influence responsiveness, which might help personalize exercise interventions for this patient population. We performed an ancillary analysis of the randomized controlled trial "Physical activity in Pediatric Cancer" (NCT01645436), in which 49 children with solid tumors were allocated to an inhospital exercise intervention or control group. The present study focused on the children in the former group ( = 24, 10 ± 4 years), who performed 3 weekly training sessions (aerobic + strength exercises). The intervention lasted 19 ± 8 weeks (i.e., from the start to the end of neoadjuvant chemotherapy treatment). A responder-vs-non-responder analysis was performed for physical capacity-related endpoints (five-repetition maximum strength, functional mobility tests, and cardiorespiratory fitness [CRF]). Only those participants showing improvements in a given test of a magnitude greater than both the random error and the threshold for clinically meaningful changes were considered responders. Most participants improved their performance in the strength tests, with 80, 88, and 93% of total showing a positive response for seated bench press, lateral row, and leg press, respectively ( < 0.001). No significant improvements were observed for the functional mobility tests or CRF ( > 0.05, rate of responsiveness ≤ 50%). No differences between responders and non-responders were observed for sex, age, type of cancer, or treatment (i.e., including or not anthracyclines/radiotherapy). However, significant differences ( < 0.05) were observed between responders and non-responders for baseline performance in all the tests, and a significant ( < 0.05) inverse relationship was found between baseline performance and relative improvement for most endpoints. Although most children improved their muscle strength after the exercise intervention, a considerable individual variability was observed for the training responsiveness of functional mobility and CRF. A lower baseline performance was associated with a higher responsiveness for all the study endpoints, with the fittest children at the start of treatment showing the lowest responses. Efforts to individualize exercise prescription are needed to maximize responsiveness in pediatric cancer patients.
体育锻炼训练可能会抵消儿科癌症和抗癌治疗的削弱作用。我们旨在分析癌症患儿对住院锻炼训练的“反应者”和“无反应者”的患病率，并确定可能影响反应性的因素，这可能有助于为该患者群体制定个性化的运动干预措施。我们对随机对照试验“儿科癌症中的身体活动”（NCT01645436）进行了辅助分析，在该试验中，49名实体瘤患儿被分配到住院运动干预组或对照组。本研究重点关注前一组的儿童（n = 24，10±4岁），他们每周进行3次训练课程（有氧运动+力量训练）。干预持续19±8周（即从新辅助化疗治疗开始到结束）。对与身体能力相关的终点（五次重复最大力量、功能活动测试和心肺适能[CRF]）进行了反应者与无反应者分析。只有那些在给定测试中显示出的改善幅度大于随机误差和临床有意义变化阈值的参与者才被视为反应者。大多数参与者在力量测试中的表现有所改善，分别有80%、88%和93%的总体参与者在坐姿卧推、侧拉和腿举测试中呈阳性反应（P < 0.001）。功能活动测试或CRF未观察到显著改善（P > 0.05，反应率≤50%）。在性别、年龄、癌症类型或治疗（即是否包括蒽环类药物/放疗）方面，反应者和无反应者之间未观察到差异。然而，在所有测试中，反应者和无反应者在基线表现上存在显著差异（P < 0.05），并且在大多数终点上，基线表现与相对改善之间存在显著的（P < 0.05）负相关关系。尽管大多数儿童在运动干预后肌肉力量有所改善，但在功能活动和CRF的训练反应性方面观察到相当大的个体差异。较低的基线表现与所有研究终点的较高反应性相关，治疗开始时身体状况最佳的儿童反应最低。需要努力使运动处方个性化，以最大限度地提高儿科癌症患者的反应性。
