Fitness consultations in oncology care motivate child cancer survivors to be more active

Just one exercise physiology consultation is enough to improve motivation and exercise levels among most child cancer survivors, a UNSW Sydney study has found.

Almost three quarters of child cancer survivors increased their general exercise after just one consultation with an exercise physiologist, a UNSW Sydney study has found. The sessions were also motivational, with nine out of 10 kids reporting they wanted to increase their fitness levels.

"Currently, less than one-third of survivors are achieving recommended exercise guidelines, but they are ten times more likely to develop cardiovascular disease than the general population," says Dr. David Mizrahi, lead author of the study and Clinical Research Officer at UNSW Medicine's Prince of Wales Clinical School.

Published this week in Heart and Mind, the study assessed the response of child cancer survivors and their parents to a fitness consultation from an exercise physiologist. The research involved 102 cancer survivors aged between eight and 18 years old, with 70 families of these survivors surveyed on their satisfaction with the consultation.

96% of parents and survivors found the consultation an acceptable part of oncology care and would recommend it to other survivors. While some were eager for a consultation during cancer treatment, four out of five would prefer the consultation after treatment or in a follow-up session.

Parents were also twice as happy with the exercise information provided when compared to routine treatment.

In each consultation, the exercise physiologist assessed the child's cardiorespiratory fitness and body composition before creating a personalized exercise plan. Together, they set short and long term fitness goals and discussed ways to safely increase the child's exercise abilities to their needs and preferences.

"The kids found the individualized lifestyle support really important and helpful in their recovery," says Dr. Mizrahi.

Survivors are already at a higher risk of developing health conditions later in life, such as cardiovascular disease and diabetes—regular exercise could help minimize this risk, while also providing other physical and psychological benefits.

"Individualised and tailored guidance from an exercise professional will help mitigate the risk of developing future health problems," says Dr. Mizrahi.

Exercise and survivorship

Despite the well-known benefits of exercise to physical and psychological health, fitness consultations are not currently part of standard oncology care in Australia.

Post cancer treatment, patients will usually have a consultation with their doctor about survivorship. This conversation may include exercise guidelines, but it really depends on the doctor, explains Dr. Mizrahi.

"The doctor won't be trained specifically in exercise science, and they have so many other things to worry about. They might mention exercise in general terms, but not exactly what and how much the patient should be doing."

In some cases, the lack of information surrounding exercise after cancer can lead parents to be hesitant of their child moving back into higher-intensity sport—which is why Dr. Mizrahi thinks it's crucial to keep parents informed and assured that the exercise plan is tailored to their child's needs.

"Childhood cancer is often called a family disease as well, because it doesn't just affect the child—it affects everyone around them.

"When the child is young, they will need support and encouragement from the parents to be active. It can even be something they do together, like going to the park.

"If we can make a child active, they are more likely to be an active adolescent, and in turn an active adult."

Regular exercise isn't just something to help the children with their physical health, but also their mental health.

"Children didn't do anything to get cancer, but they have to live with the consequences of it for their whole lives—like being at high-risk for developing other health issues later in life.

"Exercise is something that's in their control, and they can also get enjoyment out of."

An opportunity for change

Dr. Mizrahi hopes the findings will help build the case for government to fund exercise physiology programs in oncology departments across Australia. He sees this move as not only the right thing to do, but the smart thing.

"We have this evidence that parents and kids want this to happen—they enjoy this type of service—but it's not standard of care. Why is that the case in Australia?

"When kids are more active after cancer treatment, they may be less likely to develop chronic diseases later in life. In terms of cost-benefit ratio, the government will save a lot of money in the long run by providing hospitals with exercise physiologists."

The use of exercise in cancer treatment is already common in some American hospitals, and Dr. Mizrahi hopes to make this a reality in Australia.

Next year, he will be traveling to St. Jude's Children's Research Hospital in Tennessee, a leading institution in pediatric oncology and exercise research, as part of his Australian-American Fulbright Postdoctoral Scholarship.

"St. Jude's has all sorts of interventions during and after treatment, including technology such as fitness trackers and mobile apps.

"I have a lot to learn and bring back to try and improve the health outcomes for Australian cancer survivors," says Dr. Mizrahi.