Network Activeoncokids - Centralized Physical Activity Counseling for Children, adolescents, and Young Adults Across German-Speaking Countries Throughout All Oncological Treatment Phases.

Reaching age-appropriate physical activity levels is a significant challenge for many children, adolescents, and young adults (CAYAs) with and following an oncological disease. Many CAYAs require support in addressing physical activity-specific questions and need assistance in accessing sports and exercise offers in their local area. Since many clinics cannot provide such time-intensive counseling, the nationwide operating network ActiveOncoKids (NAOK), funded by the German Cancer Aid, offers individualized support to participate in physical activity (PA). This paper describes the NAOK-Physical-Activity-Counseling (-PAC) concept and evaluates the initial 200 consultations, focusing on recruitment, objectives, and oncology-specific parameters. Ultimately, dimensions of barriers and facilitators and intervention options are discussed.

Severely reduced physical performance is already present at the time of admission for stem cell transplantation.

Objectives: Paediatric patients with cancer undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) face a high risk for life-threatening infections and transplant-related complications. Therefore, these children should be in the best possible physical condition beforehand. The study aims to evaluate the fitness status before allo-HSCT and identify correlations between fitness, quality of life and fatigue, clinical data, and previous exercise sessions. Methods: Paediatric patients with cancer ≥4 years old, treated with allo-HSCT, were recruited for the ANIMAL trial ("Effects of a low vs. moderate intense exercise program on immune recovery during paediatric allo-HSCT.", DRKS ID:DRKS00019865). Assessed at admission for HSCT were (1) clinical and anthropometric data, (2) motor performance (strength, endurance and balance) and (3) psychological parameters. Values were compared with published reference values (normative data from the literature) of healthy children, and correlation analyses were conducted. Results: 22 paediatric patients undergoing pre-allo-HSCT (23% female, 9.4±4.5 years, 73% leukaemia) exhibited substantial reduced differences in all motor performance parameters, with up to -106%±98 (mean difference to reference value) in static stance, -37%±45 in sit-to-stand, -52%±16 in leg extension and -48%±22 in hand grip strength compared with reference values. Correlations were observed among age and fitness parameters, the number of inpatient days and fatigue, and many previous exercise sessions correlated with better hand grip strength. Conclusion: These results indicate a poorer fitness status in children before HSCT compared with healthy children, recommending the need for structured exercise programmes for children undergoing HSCT. Differently directed correlations between age/body mass index and endurance/strength and between exercise sessions and strength show the importance of individualised training recommendations and the effect of training.

Availability and adaption of exercise programs in pediatric oncology during the COVID-19 pandemic and beyond: a nationwide follow-up survey of providers in Germany.

Background: The COVID-19 pandemic has presented major challenges to clinical practice and delivery of care programs throughout all health care systems. Exercise programs, that are implemented in most centers for pediatric oncology in Germany, are a relatively new care program however with high clinical impact and health benefits. Objective: The impact and consequences of the pandemic on the delivery and availability of exercise programs in Germany for pediatric cancer patients and survivors are unknown. A national survey analyzed restrictions, challenges and novel approaches of exercise program delivery and scientific research. Method: A two-stage online survey was distributed to providers of exercise programs (acute clinics, non-clinical institutions, rehabilitation facilities) via the established Network ActiveOncoKids. Data was collected during the pandemic in 2022 and 2023 using a combination of open and closed questions. Results: In total, n = 27 (response rate: 82%) and n = 17 (response rate: 63%) providers participated in the first and second survey, respectively. Findings pointed out restrictions in 85% of all exercise programs in 2020 and 2021, with slight reductions in 2022. During pandemic, restrictions with major impact arose within exercise offers during follow-up and declined gradually. Whereas restrictions within the setting of acute therapy had medium or minor impact but persisted beyond. Delivery of provided exercise programs necessitated adaptions, including digital methods, supervised interventions from a distance and change of locations. Discussion: The findings highlight the adaptability, the demand and the potential of exercise programs in pediatric oncology. We assume that exercise professionals have used the pandemic-related challenges to review and modify existing concepts and made adaptations according to local conditions and novel tools for the provision of exercise programs. Nevertheless, a conspicuous lack of exercise-related care has become evident in certain patients and survivors. Further expansion of programs is imperative to address and accommodate all pertinent needs.

Is an Exercise Program for Pediatric Cancer Patients in Palliative Care Feasible and Supportive?-A Case Series.

(1) Background: Growing evidence indicates benefits through exercise programs in pediatric oncology throughout the whole cancer trajectory. This should include palliative care, too. This project analyzes the feasibility of a supervised exercise program offered during hospital and home-based care for children with advanced cancer diagnoses. (2) Methods: Four children (7-13 years old) with advanced cancer diagnoses participated in this project. It consisted of supervised exercise sessions offered once a week (30-90 min), mainly home-based, but also on an in- and outpatient basis. Regular data assessments included psychological and physical capacity-related endpoints and body composition. Details and contents of exercise sessions and adverse events were recorded. (3) Results: Exercise was feasible with 73 ± 9% adherence to the minimum number of planned sessions. The exercise offer was accepted until shortly before death. Effects on fatigue, quality of life and muscular endurance were noted. Participants showed major deviations from age-specific reference values. No exercise-related adverse events occurred. (4) Conclusions: The exercise program was safe, feasible, and might have served as a supportive tool to reduce overall burden. Evaluation of exercise as usual palliative care should be assessed by further studies.

Physical activity in 9-15 year-old pediatric cancer survivors compared to a nationwide sample.

INTRODUCTION: Sufficient physical activity (PA) has the potential to mitigate late effects of cancer, but objective data of PA levels in adolescents are scarce. The aim of this study was to investigate differences in PA behavior between childhood cancer survivors (CCS) and healthy peers. METHODS: PA levels of n = 74 CCS and n = 1304 healthy peers from the MoMo study aged 9-15 years were assessed with validated objective accelerometry and group means were compared. A binary multiple logistic regression was performed to investigate the potential predictors of PA. RESULTS: CCS spent significantly more time sedentary (p < 0.001) and less time in moderate-to-vigorous physical activity (p = 0.002) compared to the healthy cohort. Subgroup analysis revealed the largest deviations of PA levels for CCS aged 9-11 years who fulfilled international PA recommendations on significantly fewer days than MoMo (p < 0.01). Health conditions seem to be a predictor concerning the fulfillment of international PA recommendations by the WHO (p = 0.015). CONCLUSIONS: Our study identified vulnerable groups which seem to require targeted exercise and health behavior change programs to increase physical activity and reduce sedentary time. The presence of treatment sequelae as a significant predictor of insufficient physical activity underlines the need of multidisciplinary supportive care approaches.

Multidisciplinary Network ActiveOncoKids guidelines for providing movement and exercise in pediatric oncology: Consensus-based recommendations.

BACKGROUND: Pediatric cancer leads to reduced participation in exercise and only few patients comply with national physical activity recommendations. Physically inactive behavior hinders motor development and increases physical and psychological adverse effects of therapy and incidence of sequelae. Currently, there is neither nationwide coverage nor uniform level of knowledge regarding exercise promotion. The objective of the guideline is to facilitate qualified exercise interventions through standardized procedures in addition to regular physiotherapy and overall avoid physical inactivity in pediatric cancer patients. METHODS: This guideline addresses the multidisciplinary treatment team and informs physiotherapists and decision-makers in tertiary care hospitals and health insurance companies. The requirements of the Association of the Scientific Medical Societies in Germany were followed. Contents were based on best practice experience of experts, patient advocates, as well as on scientific evidence. RESULTS: The guideline includes 11 recommendations. Recommendations 1-4 declare the relevance of implementing exercise interventions and address general framework conditions. Recommendations 5-11 focus on the design of exercise programs, prevention and safety issues, relative contraindications for specific training loads, and options to overcome barriers to exercise. CONCLUSION: This guideline summarizes existing and established structures and evidence in the context of movement and exercise in pediatric oncology. It takes into consideration the rights, varying needs, and characteristics of children and adolescents as well as national and international experience in this field. In the future, relevant research gaps need to be addressed by high-quality intervention studies to provide the scientific background for a stronger evidence-based guideline.

Design and Evaluation of an Outdoor Exercise Program for Pediatric Cancer Survivors.

Exercise programs for young people after cancer are not part of regular oncological care. This study describes and evaluates a regional outdoor exercise program and presents data with regard to the promoting and inhibiting factors for participation among pediatric cancer survivors. Exercise options, number of participants, and the cohort were evaluated descriptively for one year. A self-developed questionnaire was used to evaluate satisfaction, mood, motivations, and barriers to exercise. Overall N = 26 survivors (14.6 ± 5.5 years) participated in at least one activity in 2019 including try-out days (N = 10) and active weekend camps (N = 2). No adverse events occurred in 302 physical activity hours. Twenty-one survivors participated in the survey. The largest motivational aspect to participate was "to try out a new sport" (83.9%). Survivors reported "good mood", and 'being happy' after exercising. The largest barrier was concern about 'not being able to keep up with others' (38.1%). Around one-third (try-out day) and 50% (active weekend camp) of survivors did not feel confident to continue exercising outside the supervised exercise oncology program. This survey shows high enthusiasm for this exercise program with different outdoor activities and suggests that similar interventions may be accepted by this population.

A National Implementation Approach for Exercise as Usual Care in Pediatric and Adolescent Oncology: Network ActiveOncoKids.

The diagnosis of cancer as well as accompanying acute and late effects of treatment are influencing physical activity behavior of patients with childhood cancer and survivors. Research has shown that a pediatric cancer diagnosis is associated with impairments of physical performance, and function, as well as reduced physical, and psychosocial, health conditions. From an ethical perspective, lack of knowledge of health care providers, lack of physical activity promotion, and environmental, and structural barriers to physical activity restrict children's right to move and actively engage in physical activities. Network ActiveOncoKids is a German-wide initiative with the main goal of enabling children, adolescents, and young adults with exercise opportunities during and after cancer treatment. Since the network's foundation in 2012, Network ActiveOncoKids focuses on: (1) physical activity support for patients and families, (2) policy change to establish structures and guidelines, and (3) generating evidence through scientific projects. The purpose of this paper is to present an overview of Network ActiveOncoKids structure, aims, and projects. This topical review will highlight the network's structural development, research work, and implementation progress of exercise programs for patients with pediatric cancer and survivors, link international collaborations, and discuss future directions.

Adverse Events During Supervised Exercise Interventions in Pediatric Oncology-A Nationwide Survey.

Objectives: Exercise interventions during and after treatment for pediatric cancer are associated with beneficial physical, psychological, and social effects. However, valid data about adverse events (AEs) of such interventions have rarely been evaluated. This retrospective study evaluates AEs that occurred during supervised oncological exercise programs for pediatric cancer patients and survivors. Methods: This Germany-wide study used a self-administered online survey focusing on general program characteristics and AEs retrospectively for 2019. The questionnaire included (a) basic data on the offered exercise program, (b) AEs with consequences (Grade 2-5) that occurred in 2019 during an exercise intervention, (c) number of Grade 1 AEs, (d) safety procedures as part of the exercise programs, and (e) possibility to give feedback and describe experience with AEs in free text. Results: Out of 26 eligible exercise programs, response rate of program leaders was 92.3% (n = 24). Representatives working for Universities (n = 6), rehabilitation clinics (n = 3), acute cancer clinics (n = 12), and activity camps (n = 3) participated. In total, 35,110 exercise interventions with varying duration were recorded for 2019. Six AEs with consequences (Grade 2-3) occurred during exercise interventions after cancer treatment resulting in an incidence of 17 per 100,000 exercise interventions (0.017%). No life-threatening consequences or death were reported and no serious AE occurred during acute cancer treatment. Grade 1 AE occurred with a frequency of 983, corresponding to an incidence of 2,800 per 100,000 interventions (2.8%). Most frequent Grade 1 AE were muscle soreness, circulatory problems, and abdominal pain. The most frequent preventive safety procedures at the institutions were regular breaks, consultations with the medical treatment team, and material selection with low injury potential. Conclusions: Supervised exercise interventions for pediatric cancer patients and survivors seem to be safe and AEs with consequences comparatively rare when compared to general childhood population data. Occurrence of grade 1 AEs was common, however, causality was probably not evident between AEs and the exercise intervention. Future research should standardize assessment of AEs in clinical practice and research, and prospectively register and evaluate AEs that occur in the context of exercise interventions in pediatric cancer patients and survivors.