ECSS Paris 2023: OP-MH06
INTRODUCTION: Cancer is the leading cause of death among children over the age of one in Europe, and more than 15,000 children and adolescents are diagnosed with cancer each year in Europe. Up to 80% of them can be cured with standard multidisciplinary care. Children, adolescents and young adults with cancer (CAYA-c) suffer from acute and chronic disabilities. Precision-based exercise programmes and sports are a new therapeutic option to counteract the side effects of cancer treatment in hospital. Inter Campus uses the values of football as an educational tool and contributes to the development of local communities by supporting educational, social and health programmes and promotes social integration between different ethnic groups and cultures. The aim of this study was to test the effectiveness of implementing the Inter Campus method in a complex clinical setting. METHODS: CAYA-c participating in a precision training research programme from 1 September to 31 December 2023 were enrolled. They were referred to the programme by their oncologists. Both sexes, aged between 3 and 21 years, with a diagnosis of blood cancer in the previous 8 weeks were eligible. Between the 3 weekly sessions of combined training (cardiorespiratory, resistance, flexibility and balance), 1 session of football was provided by Inter Campus. The methodology is based on a global approach to football training that includes performance, but also cognitive, emotional-affective and social areas of the childrens and adolescents personalities. Each child received exercises tailored to their own resources and vulnerabilities. Football sessions have been offered on the wards, including the bone marrow transplant center. When followed up in the outpatient clinic, they were trained in small groups (3 to 9 CAYA-c) in the gym, including an outdoor area, in the hospital. The frailest were trained with other CAYA-c to emphasize the inclusion part of the project. RESULTS: A total of 31 consecutive CAYA-c were enrolled and 29 were trained. The average age was 11.3 ± 5.9 years (range 4-20), 44.8% were female. The diagnoses were acute lymphoblastic and myeloid leukemias (60% and 16%), lymphoma (24%). Adherence to training (number of sessions/expected sessions) was 33% (range 7-80%). CAYA-c satisfaction with the intervention was 9.2 out of 10 in general and 8.8 for Inter Campus activities; parents reported 9.8 and 9.1, respectively. There were no major events related to football activities. CONCLUSION: Close consultation between pediatricians and exercise professionals, including football coaches with a pedagogical profile, is essential when introducing sport in hospitals. The use of football could be safe even in complex clinical settings. Adherence to training can be low for the most medically fragile children, although their willingness to participate in sports activities remains throughout their care. The satisfaction of the families and of CAYA-c is high and the resulting impact on their inclusion could be enormous.
Read CV SILVIO GUARESCHIECSS Paris 2023: OP-MH06
INTRODUCTION: Cancer is the leading cause of death from non-communicable diseases in children, adolescents and young adults with cancer (CAYA-C) in Europe. Reduced exercise capacity in CAYA-C may reflect both bed rest and drug-induced side effects such as cardiopulmonary dysfunction and/or reduced skeletal muscle oxidative metabolism due to myopathy and peripheral nervous system impairment. The individuals reduced exercise capacity in complex clinical situations, i.e. during the intensive phases of CAYA-C treatment, can be assessed by cardiopulmonary exercise testing (CPET). During CPET, near-infrared spectroscopy (NIRS) measures muscle oxidative capacity in vivo at the vastus lateralis and physiological calibration using an ischaemic leg cuff manoeuvre is required to compare different individuals. The leg cuff maneuver is not an option in CAYA-C with cancer due to severe thrombocythemia. The aim of this pilot study was to test whether adapted NIRS physiological calibrations obtained by quadriceps isometric and isotonic exercise manoeuvres can be performed in CAYA-C instead of the classical leg-cuff ischaemia. METHODS: After CPET on a cyclergometer, ischaemia of the quadriceps was performed on 3 CAYA-C with blood cancer (age 16.0±3.0 years) by means of isometric and isotonic exercises on a leg extension machine (80% of 1 maximum repetition). Each manoeuvre was separated by 2 minutes of rest and the difference between the values at rest and at the end of the manoeuvres was calculated, until a plateau of deoxygenated hemoglobin values was reached (D[HHb], A.U.). In 3 healthy young adults (HEAL) the 2 methods were compared with a 300 mmHg leg cuff tourniquet and the D[HHb] kinetic time (τ, sec) was measured. The D[HHb] values obtained during CPET were expressed as a percentage of the different ischaemias (D[HHb]/D[HHb]isch). RESULTS: None of the CAYA-C patients complained of pain during the manoeuvres, although the HEAL patients experienced discomfort during the leg-cuff. The 3 CAYA-C showed D[HHb] 19.1±2.8 and 16.8±2.7 in relation to isometric and isotonic conditions respectively, without any statistical difference. The D[HHb]/D[HHb]isch were 0.38±0.08 and 0.34±0.07 in relation to isometric and isotonic conditions, respectively. The 3 HEAL showed D[HHb] 10,1±6,5, 9,3±9,8 and 11,7±9,0 in relation to isometric, isotonic and leg cuff conditions respectively without any statistical difference. The τ of the 3 procedures were 36,8±21,0, 23,1±22,9 and 249,8±133,7 respectively with a significant statistical difference (p<0,006) CONCLUSION: The adapted physiological NIRS calibrations were well tolerated in both CAYA-C and HEAL. Reduced oxidative metabolism was observed in CAYA-C and comparable D[HHb] values were found between isometric and isotonic manoeuvres. HEAL showed that the kinetics of the leg cuff is slower than other manoeuvres and give reasons for the pain experienced during the manoeuvres, adding concern in performing the manoeuvre in CAYA-C.
Read CV William ZardoECSS Paris 2023: OP-MH06
INTRODUCTION: Cardiopulmonary exercise testing is frequently utilised in the United Kingdom to assess patients’ functional capacity prior to elective surgery. Both peak oxygen (VO2Peak) and the amount of oxygen consumed at the 1st ventilatory threshold have been used as markers of functional capacity with low values linked to morbidity and mortality in the postoperative period. Surgical prehabilitation (PREHAB) is an intervention including one or more lifestyle components (e.g., exercise) implemented to enhance functional capacity in patients awaiting surgery. We aimed to systematically summarize the effects of PREHAB on VO2Peak in patients awaiting oncologic resection. METHODS: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist and registered with the International Prospective Register of Systematic Reviews, PROSPERO (CRD42023428676). The search of the literature was conducted using Cochrane Library, EBSCOhost, Google Scholar, MEDLINE PubMed, and Web of Science from March 2023 to October 2023. Inclusion criteria were randomized controlled trials (RCT), including adult patients (≥18 years old), diagnosed with any type of cancer, who could be undergoing or not neo-adjuvant chemotherapy, implementing any type of PREHAB modality (i.e., unimodal or multimodal), delivered at any venue (i.e., home, hospital or in the community), by any means (i.e., telehealth or face-to-face) and including at least an intervention group (PREHAB) and one control group (standard care). Continuous data on VO2Peak as a marker of functional capacity were pooled using a random-effects model. The Comprehensive Meta-Analysis Software, v. 4.0.000 (Biostat Inc., Englewood, New York, USA) was used for the analysis. RESULTS: Seven RCTs reporting VO2Peak met the inclusion criteria. The overall quality of the included studies was high, with a low risk of bias, scoring from 2 to 5 points in the Cochrane collaboration tool. All the studies included an exercise component. Two studies implemented multimodal prehabilitation and five implemented unimodal exercise-based prehabilitation. The mean effect size (Hedges’ g) of PREHAB vs. standard care on VO2Peak was medium (n = 7, g= 0.615, 95% CI 0.243 to 0.987), and statistically significant (Z = 3.240, p = 0.001). The prediction interval was calculated from -0.562 to 1.793 (95% CI). The sensitivity analysis showed that none of the studies contributed disproportionately to the results of the meta-analysis and no outliers were identified amongst the analysed studies. CONCLUSION: Considering the overall findings and the estimated prediction interval from the seven meta-analysed RCTs, we are unable to support the claim that PREHAB improves VO2Peak.
Read CV Roberto Laza CagigasECSS Paris 2023: OP-MH06