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Therapeutic Exercise Protocol During Hospitalization in Pediatric Oncohematological Patients: Randomized Clinical
Cintia Freire Carniel1, Bruna Cunha de Souza1, Henrique Ferreira Leite1
1Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário FMABC, Santo André, São Paulo, Brazil.
Insights
A structured exercise program for hospitalized pediatric cancer patients did not significantly improve quality of life, strength, or fatigue compared to minimal physiotherapy. The intervention was safe but showed no superiority in this small study.
Area of Science:
- Pediatric Oncology
- Rehabilitation Medicine
- Clinical Trials
Background:
- Pediatric cancers like leukemias, lymphomas, and CNS tumors can cause significant functional impairments.
- Early physiotherapy during hospitalization is crucial for preventing inactivity and preserving function in these young patients.
Purpose of the Study:
- To assess the impact of a therapeutic exercise program on quality of life, muscle strength, fatigue, and functional capacity in hospitalized pediatric oncohematological patients.
Main Methods:
- Thirty pediatric patients (8-17 years) with oncohematological diseases were randomized into an intervention group (IG) or a minimal active physiotherapy comparator group (CG).
- The IG received daily supervised aerobic, resistance, and breathing exercises, while the CG received breathing exercises and ambulation guidance.
- Assessments included the 6-minute walk test, handgrip dynamometry, and PedsQL scales for fatigue and quality of life at admission and discharge.
Main Results:
- No significant differences were found between the groups in fatigue, quality of life, muscle strength, or functional capacity.
- Observed time-related changes in outcomes were not attributable to the structured exercise protocol.
- The therapeutic exercise protocol was delivered safely without adverse events requiring permanent discontinuation.
Conclusions:
- The in-hospital therapeutic exercise protocol is safe and deliverable under supervision for pediatric cancer patients.
- The study did not demonstrate the superiority of the structured exercise protocol over minimal physiotherapy for improving key functional outcomes.
- Findings should be interpreted cautiously due to limitations including small sample size and clinical heterogeneity.
Background:
Leukemias, lymphomas, and central nervous system tumors are among the most common pediatric cancers and may lead to motor deficits, impaired balance, reduced muscle strength, fatigue, and decreased functional capacity. Early physiotherapy during hospitalization may help prevent inactivity and support functional preservation in this population.
Objective:
To evaluate the effects of a therapeutic exercise program on quality of life, muscle strength, fatigue, and functional capacity in hospitalized pediatric oncohematological patients.
Methods:
Thirty participants aged 8-17 years with oncohematological diseases were randomized to an intervention group (IG) or a minimal active physiotherapy comparator group (CG). Assessments included the 6-min walk test, handgrip dynamometry, the PedsQL Multidimensional Fatigue Scale, and the PedsQL Cancer Module at admission and discharge. The IG performed daily 25-min supervised sessions including aerobic, resistance, and breathing exercises with ambulation guidance, whereas the CG received breathing exercises and ambulation guidance.
Results:
No significant group × time interactions were observed for total fatigue or its domains, overall quality of life or its assessed domains, handgrip strength, or six-minute walk test distance. Time-related changes were observed for some outcomes, but these occurred without evidence of differential change between groups and were not interpreted as effects of the structured exercise protocol. No intervention-related adverse events requiring permanent protocol discontinuation were recorded.
Conclusion:
The structured in-hospital therapeutic exercise protocol could be delivered under close clinical supervision without recorded intervention-related adverse events requiring permanent discontinuation. However, the structured protocol did not demonstrate superiority over the minimal active physiotherapy comparator for fatigue, quality of life, muscle strength, or functional capacity. These findings should be interpreted cautiously because of the small sample size, clinical heterogeneity, variable intervention exposure, and limited intervention-fidelity data.
Trial Registration:
Brazilian Registry of Clinical Trials (ReBEC), RBR-8sxnfyd.
