Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, CEPSUM, 2100, boulevard Édouard Montpetit, Montréal, QC, H3C 3J7, Canada.
Sainte-Justine University Health Center, Research Center, Montreal, Canada.
Support Care Cancer. 2021 Feb;29(2):987-996. doi: 10.1007/s00520-020-05582-y. Epub 2020 Jun 17.
The purpose of this study was to demonstrate if childhood acute lymphoblastic leukemia (ALL) survivors exposed to chemotherapy (i.e., doxorubicin) are able to achieve a safe maximal cardiopulmonary exercise test (CPET).
A total of 250 childhood ALL survivors were eligible to undergo a CPET on ergocycle. Analyses were performed in 216 survivors and stratified in regard to their prognostic risk groups: 99 survivors (55 males and 44 females) at standard risk and 117 survivors (56 males and 61 females) at high risk.
Results showed that 100% (n = 216) of survivors completed a maximal CPET confirmed by the achievement of two out of three of the following criteria: 197 survivors (91.2%) reached a peak RER value of ≥ 1.15, 197 survivors (91.2%) reached a RPE score > 7, and 210 survivors (97.2%) reached a maximal heart rate ≥ 85% of the predicted value. Linear regression analysis showed a significant association between the survivors' cumulative dose of doxorubicin and their VO peak measured. Two non-fatal adverse events were observed and reported at the end of the maximal CPET, while non-fatal adverse events were reported in 5 survivors during the recovery period. None of these events resulted in a long-term complication.
Childhood ALL survivors with prior exposure to chemotherapy can achieve a safe maximal CPET. They were able of achieving a maximal exercise test without being limited by symptoms, potential overprotection, or musculoskeletal issues. Thus, it should be the norm to realize a CPET prior a physical activity program to propose an optimal prescription. This study provides important information regarding the maximal physiological parameters that childhood ALL survivors are able to reach and have important clinical implications in the exercise and oncology field for this population of survivors.
本研究旨在证明接受过化疗（如阿霉素）治疗的儿童急性淋巴细胞白血病（ALL）幸存者是否能够安全地进行最大心肺运动测试（CPET）。
共有 250 名儿童 ALL 幸存者有资格在跑步机上进行 CPET。在 216 名幸存者中进行了分析，并根据其预后风险组进行分层：99 名幸存者（55 名男性和 44 名女性）为低危组，117 名幸存者（56 名男性和 61 名女性）为高危组。
结果表明，100%（n=216）的幸存者完成了最大 CPET，通过以下三个标准中的两个标准来证实：197 名幸存者（91.2%）达到了峰值呼吸交换率（RER）值≥1.15，197 名幸存者（91.2%）达到了 RPE 评分>7，210 名幸存者（97.2%）达到了最大心率≥预测值的 85%。线性回归分析显示，幸存者累积阿霉素剂量与 VO 峰值之间存在显著关联。在最大 CPET 结束时观察到并报告了 2 例非致命性不良事件，而在恢复期报告了 5 例非致命性不良事件。这些事件均未导致长期并发症。
先前接受过化疗的儿童 ALL 幸存者可以进行安全的最大 CPET。他们能够进行最大运动测试，而不会受到症状、潜在过度保护或肌肉骨骼问题的限制。因此，在制定体力活动计划之前，应常规进行 CPET，以提出最佳的处方。本研究提供了有关儿童 ALL 幸存者能够达到的最大生理参数的重要信息，对该人群的运动和肿瘤学领域具有重要的临床意义。
