ESPE Abstracts

Background: Survivors of childhood cancer are at increased risk of cardiovascular morbidity and mortality in later life. Although the brain is known to be involved in control of metabolic functions including appetite regulation and energy expenditure (1), little data are available relating to the risk of metabolic dysfunction secondary to cerebral injury. Several studies have attempted to investigate the impact of exercise on physical and psychosocial parameters in survivors of childhood cancer, however most involved exercise durations of less than 12 weeks. It is therefore unknown whether intensive, prolonged exercise intervention is safe and tolerable for young adults and adolescents with cerebral injury due to tumours or cancer therapy or if it is beneficial from a metabolic perspective.

Aim: To expose 20 adolescent and young adult survivors of cerebral injury due to brain tumour or cancer therapy, to a supervised, tailored exercise program of 6 months duration in order to determine whether an intensive exercise regimen is safe and tolerable for this cohort. Further, to explore the impact on their metabolic profile and body composition.

Methods: Adolescents and young adults aged 15–23 with a past history of brain tumours or cranial irradiation, were recruited from the Princess Margaret Hospital Oncology database. Baseline testing included auxology, body composition using DXA, oral glucose tolerance testing and lipid and hormone profiling. Subjects were re-tested after a non-intervention control period of six months and then commenced the intervention program. All tests were repeated upon completion of the intervention, which consisted of thrice weekly small-group, tailored supervised exercise sessions over a six month period.

Results: Twenty out of 87 possible candidates were recruited from the PMH oncology database. All underwent testing at baseline and after the 6 month control period. Two dropped out prior to commencement of the intervention program, three decided to pursue a home-based program and three pulled out of the intervention early on due to other commitments. No significant variation occurred in body composition, BMI, lipid profile, insulin or glucose levels during the control period (n=20). Twelve participants completed the intervention phase; nine participated in more than 20 exercise sessions and three participated in more than 40 sessions. No difference (P>0.05) was seen in their BMI or metabolic profile after the intervention regardless of the extent of their compliance, however improvement in body composition was noted: total fat percentage decreased from 36.2% to 34.5% (P=0.024) and trunk: total mass ratio dropped from 0.51 to 0.48 (P=0.014) indicating reduction in central adiposity. During the intervention, there was one fall. No other adverse events were identified. Of those who completed the intervention, 91% indicated that they enjoyed it and would consider participating in further tailored programmes.

Conclusion: Small-group based exercise is acceptable, safe and enjoyable for young adult and adolescent survivors of childhood cancer. Although metabolic benefit was not evident in the small group who completed the intervention, body composition improved. Participant’s enthusiasm for the program and desire to continue exercising, indicate that this form of intervention may be sustainable in the long term and requires further, larger scale investigation.