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Effects of Exercise Interventions on Immune Function in Children and Adolescents With Cancer and HSCT Recipients - A
Ronja Beller1, Sabrina Bianca Bennstein2, Miriam Götte1
1Department of Pediatric Hematology/Oncology, Center for Child and Adolescent Medicine, Clinic for Pediatrics III, West German Cancer Centre, University Hospital Essen, Essen, Germany.
Insights
Exercise interventions show promising benefits for pediatric cancer patients, enhancing immune system cytotoxicity and reducing infection risk without adverse effects. Further research is needed to explore optimal exercise protocols for different cancer types and treatment phases.
Area of Science:
- Immunology
- Pediatric Oncology
- Exercise Science
Background:
- Pediatric cancer patients face high risks of infection and treatment complications.
- Exercise is a potential strategy to bolster the immune system and mitigate inflammation in this population.
- This systematic review aimed to assess exercise intervention effects on the immune system of pediatric cancer patients and survivors.
Approach:
- A systematic review was conducted, searching four major databases (MEDLINE, Cochrane Library, ClinicalTrials.gov, SPORTDiscus).
- Studies involving pediatric oncology patients were included, with data extraction and risk of bias assessment performed by two independent authors.
- Direction ratios were calculated for immune cell parameters to evaluate intervention effects.
Key Points:
- Eight studies with 400 pediatric cancer patients and 17 healthy controls (aged 4-19) were analyzed.
- Exercise interventions demonstrated no negative impact on the immune system and enhanced cytotoxicity.
- Significant reductions in hospitalization days and infection risk were observed, with beneficial immune parameter shifts.
Conclusions:
- Exercise interventions offer promising, non-adverse effects on the pediatric cancer patient immune system, particularly enhancing cytotoxicity.
- Current data is limited, necessitating further research into varied exercise modalities, intensities, treatment phases, and cancer types.
- Direction ratio parameters can guide future clinical trials on exercise immunology in pediatric oncology.
Background:
Pediatric cancer patients are at high risk for life-threatening infections, therapy associated complications and cancer-related side effects. Exercise is a promising tool to support the immune system and reduce inflammation. The primary objective of this systematic review was to evaluate the effects of exercise interventions in pediatric cancer patients and survivors on the immune system.
Methods:
For this systematic review (PROSPERO ID: CRD42021194282) we searched four databases (MEDLINE, Cochrane Library, ClinicalTrials.gov, SPORTDiscus) in June 2021. Studies with pediatric patients with oncological disease were included as main criterion. Two authors independently performed data extraction, risk of bias assessment, descriptive analysis and a direction ratio was calculated for all immune cell parameters.
Findings:
Of the 1448 detected articles, eight studies with overall n = 400 children and adolescents with cancer and n = 17 healthy children as controls aged 4-19 years met the inclusion criteria. Three randomized, four non-randomized controlled trials and one case series were analyzed descriptively. The exercise interventions had no negative adverse effects on the immune system. Statistically significant results indicated enhanced cytotoxicity through exercise, while changes in immune cell numbers did not differ significantly. Interventions further reduced days of in-hospitalization and reduced the risk of infections. Several beneficial direction ratios in immune parameters were identified favoring the intervention group.
Interpretation:
Exercise interventions for pediatric cancer patients and survivors had no negative but promising beneficial effects on the immune system, especially regarding cytotoxicity, but data is very limited. Further research should be conducted on the immunological effects of different training modalities and intensities, during various treatment phases, and for different pediatric cancer types. The direction ratio parameters given here may provide useful guidance for future clinical trials.
Systemic Review Registration:
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021194282, Prospero ID: CRD42021194282.
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