Exercise capacity in long-term survivors of pediatric cancer: An analysis from the cardiac risk factors in childhood cancer survivors study

Angela M. Miller, Gabriela Lopez-Mitnik, Gabriel Somarriba, Stuart R. Lipsitz, Andrea S. Hinkle, Louis S. Constine, Steven E. Lipshultz, Tracie L. Miller

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Background: Childhood cancer survivors may have premature symptomatic cardiovascular and non-cardiovascular diseases that contribute to reduced capacity for physical activity. Studies of exercise capacity and identification of risk factors for reduced capacity in survivors are limited. Procedure: We assessed maximal myocardial oxygen consumption (VO2maxVO2max, a measure of exercise capacity) in survivors at least 4 years after cancer diagnosis and sibling controls. We evaluated associations between VO2max and age, sex, treatments, cardiac structure and function, biomarkers, endocrine function, and physical activity. Results: Of 72 survivors (mean age, 22 years; range, 8.0-40 years) and 32 siblings (mean age, 20.2 years; range, 8-46 years), about half were male. Mean time since diagnosis was 13.4 years (range, 4.5-31.6 years). In age- and sibling-pair adjusted analyses, VO2max was lower in survivors than siblings (males, 28.53 vs. 30.90ml/kg/minute, P=0.08; females, 19.81 vs. 23.40ml/kg/minute, P=0.03). In males, older age (P=0.01), higher percent body fat (P<0.001) and high or low left ventricular (LV) mass Z-scores (P=0.03) predicted lower VO2max. In females, older age (P<0.001), methotrexate exposure (P=0.01), and higher, but normal, LV load-dependent contractility (P=0.02) predicted lower VO2max. Conclusions: Fitness for most survivors and controls was poor and generally lower in survivors, particularly females. Older age, higher body fat, methotrexate exposure, and extremes of LV mass/function were associated with lower VO2max in survivors. Because physical activity can improve nutritional and cardiac conditions, survivors should be encouraged to exercise regularly with close monitoring.

Original languageEnglish (US)
Pages (from-to)663-668
Number of pages6
JournalPediatric Blood and Cancer
Issue number4
StatePublished - Apr 2013
Externally publishedYes


  • Cancer survivor
  • Cardiotoxicity
  • Child
  • Exercise capacity
  • Fitness

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology


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