Reduced Lower Body Muscular Strength and Endurance Among Adult Survivors of Childhood Cancer

Overview

Journal Med Sci Sports Exerc

Date 2025 Jan 14

PMID 39809246

Authors

Tomas Slama

Carina Nigg

Reto D Kurmann

Gabriela M Kuster

Nana K Poku

Eva Scheler

Claudia E Kuehni

Nicolas X VON DER Weid

Christina Schindera

Affiliations

Soon will be listed here.

Abstract

Introduction: Impaired physical fitness is a possible late effect among adult survivors of childhood cancer (ASCC). Our study describes lower body muscular strength and endurance among ASCC using the 1-min sit-to-stand (1-min STS) test, compares them with the general population, identifies risk factors, and describes changes over time.

Methods: In a prospective multicenter cohort study, we invited ASCC ≥18 yr of age at study who were diagnosed between ages 0 and 20 yr, treated in five pediatric oncology centers across Switzerland from 1976 to 2017, and survived ≥5 yr for a 1-min STS test. We collected information about lifestyle, medical history, and previous cancer treatment. Using population-based Swiss reference values, we calculated age- and sex-adjusted z -scores for 1-min STS performance and assessed the association between risk factors and 1-min STS test using multivariable linear regression. We fitted a multilevel linear model to describe the longitudinal course of 1-min STS performance.

Results: We included 338 CCS of 1048 invited ASCC (participation rate 32%) with a median age at study of 34 yr (interquartile range, 26-41 yr). Compared with the general population, mean 1-min STS z -score was half a standard deviation lower (-0.52; 95% confidence interval (CI), -0.64 to -0.40). Obesity ( B = -0.56; 95% CI, -0.97 to -0.16), cumulative cisplatin dose ( B = -0.12; 95% CI, -0.21 to -0.02), and cumulative cranial radiotherapy dose ( B = -0.10; 95% CI, -0.19 to -0.01) were associated with reduced 1-min STS performance. There was no change in 1-min STS z -scores over time ( B = 0.02; 95% CI, -0.05 to 0.09).

Conclusions: We found evidence for reduced lower body strength and endurance among ASCC, suggesting the need for counseling and effective training and rehabilitation programs for maintaining daily functioning, improving cardiovascular health, and reducing morbidity for ASCC.

References

Hortobagyi T, Mizelle C, Beam S, DeVita P . Old adults perform activities of daily living near their maximal capabilities. J Gerontol A Biol Sci Med Sci. 2003; 58(5):M453-60. DOI: 10.1093/gerona/58.5.m453. View

Strumberg D, Brugge S, Korn M, Koeppen S, Ranft J, Scheiber G . Evaluation of long-term toxicity in patients after cisplatin-based chemotherapy for non-seminomatous testicular cancer. Ann Oncol. 2002; 13(2):229-36. DOI: 10.1093/annonc/mdf058. View

Taskinen M, Kurimo M, Kanerva J, Hovi L . Physical performance of nontransplanted childhood ALL survivors is comparable to healthy controls. J Pediatr Hematol Oncol. 2013; 35(4):276-80. DOI: 10.1097/MPH.0b013e3182830ffa. View

Braam K, van der Torre P, Takken T, Veening M, van Dulmen-den Broeder E, Kaspers G . Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev. 2016; 3:CD008796. PMC: 6464400. DOI: 10.1002/14651858.CD008796.pub3. View

Ness K, Baker K, Dengel D, Youngren N, Sibley S, Mertens A . Body composition, muscle strength deficits and mobility limitations in adult survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2006; 49(7):975-81. DOI: 10.1002/pbc.21091. View

Gephine S, Bergeron S, Tremblay Labrecque P, Mucci P, Saey D, Maltais F . Cardiorespiratory Response during the 1-min Sit-to-Stand Test in Chronic Obstructive Pulmonary Disease. Med Sci Sports Exerc. 2020; 52(7):1441-1448. DOI: 10.1249/MSS.0000000000002276. View

Jones C, Rikli R, Beam W . A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999; 70(2):113-9. DOI: 10.1080/02701367.1999.10608028. View

Lenneman C, Sawyer D . Cardio-Oncology: An Update on Cardiotoxicity of Cancer-Related Treatment. Circ Res. 2016; 118(6):1008-20. DOI: 10.1161/CIRCRESAHA.115.303633. View

Goodenough C, Partin R, Ness K . Skeletal Muscle and Childhood Cancer: Where are we now and where we go from here. Aging Cancer. 2021; 2(1-2):13-35. PMC: 8445321. DOI: 10.1002/aac2.12027. View

10.

Strassmann A, Steurer-Stey C, Dalla Lana K, Zoller M, Turk A, Suter P . Population-based reference values for the 1-min sit-to-stand test. Int J Public Health. 2013; 58(6):949-53. DOI: 10.1007/s00038-013-0504-z. View

11.

Hovi L, Kurimo M, Taskinen M, Vettenranta J, Vettenranta K, Saarinen-Pihkala U . Suboptimal long-term physical performance in children and young adults after pediatric allo-SCT. Bone Marrow Transplant. 2009; 45(4):738-45. DOI: 10.1038/bmt.2009.221. View

12.

Sontgerath R, Eckert K . Impairments of Lower Extremity Muscle Strength and Balance in Childhood Cancer Patients and Survivors: A Systematic Review. Pediatr Hematol Oncol. 2015; 32(8):585-612. DOI: 10.3109/08880018.2015.1079756. View

13.

van Cappellen-van Maldegem S, Hoedjes M, Seidell J, van de Poll-Franse L, Buffart L, Mols F . Self-performed Five Times Sit-To-Stand test at home as (pre-)screening tool for frailty in cancer survivors: Reliability and agreement assessment. J Clin Nurs. 2022; 32(7-8):1370-1380. DOI: 10.1111/jocn.16299. View

14.

Arend M, Schafer T . Statistical power in two-level models: A tutorial based on Monte Carlo simulation. Psychol Methods. 2018; 24(1):1-19. DOI: 10.1037/met0000195. View

15.

Wilson C, Howell C, Partin R, Lu L, Kaste S, Mulrooney D . Influence of fitness on health status among survivors of acute lymphoblastic leukemia. Pediatr Blood Cancer. 2018; 65(11):e27286. PMC: 6150801. DOI: 10.1002/pbc.27286. View

16.

Ness K, Morris E, Nolan V, Howell C, Gilchrist L, Stovall M . Physical performance limitations among adult survivors of childhood brain tumors. Cancer. 2010; 116(12):3034-44. PMC: 3554250. DOI: 10.1002/cncr.25051. View

17.

Bohannon R, Hull D, Palmeri D . Muscle strength impairments and gait performance deficits in kidney transplantation candidates. Am J Kidney Dis. 1994; 24(3):480-5. DOI: 10.1016/s0272-6386(12)80905-x. View

18.

Hovi L, Era P, Rautonen J, Siimes M . Impaired muscle strength in female adolescents and young adults surviving leukemia in childhood. Cancer. 1993; 72(1):276-81. DOI: 10.1002/1097-0142(19930701)72:1<276::aid-cncr2820720148>3.0.co;2-2. View

19.

Wretenberg P, Arborelius U . Power and work produced in different leg muscle groups when rising from a chair. Eur J Appl Physiol Occup Physiol. 1994; 68(5):413-7. DOI: 10.1007/BF00843738. View

20.

Steliarova-Foucher E, Stiller C, Lacour B, Kaatsch P . International Classification of Childhood Cancer, third edition. Cancer. 2005; 103(7):1457-67. DOI: 10.1002/cncr.20910. View