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 journalArticle

38 Citations (Scopus)

Abstract

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
Pages (from-to)663-668
Number of pages6
JournalPediatric Blood and Cancer
Volume60
Issue number4
DOIs
StatePublished - Apr 1 2013

Fingerprint

Survivors
Exercise
Pediatrics
Neoplasms
Siblings
Methotrexate
Adipose Tissue
Left Ventricular Function
Oxygen Consumption
Biomarkers

Keywords

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

ASJC Scopus subject areas

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

Cite this

Miller, A. M., Lopez-Mitnik, G., Somarriba, G., Lipsitz, S. R., Hinkle, A. S., Constine, L. S., ... Miller, T. L. (2013). Exercise capacity in long-term survivors of pediatric cancer: An analysis from the cardiac risk factors in childhood cancer survivors study. Pediatric Blood and Cancer, 60(4), 663-668. https://doi.org/10.1002/pbc.24410

Exercise capacity in long-term survivors of pediatric cancer : An analysis from the cardiac risk factors in childhood cancer survivors study. / Miller, Angela M.; Lopez-Mitnik, Gabriela; Somarriba, Gabriel; Lipsitz, Stuart R.; Hinkle, Andrea S.; Constine, Louis S.; Lipshultz, Steven E; Miller, Tracie L.

In: Pediatric Blood and Cancer, Vol. 60, No. 4, 01.04.2013, p. 663-668.

Research output: Contribution to journalArticle

Miller, AM, Lopez-Mitnik, G, Somarriba, G, Lipsitz, SR, Hinkle, AS, Constine, LS, Lipshultz, SE & Miller, TL 2013, 'Exercise capacity in long-term survivors of pediatric cancer: An analysis from the cardiac risk factors in childhood cancer survivors study', Pediatric Blood and Cancer, vol. 60, no. 4, pp. 663-668. https://doi.org/10.1002/pbc.24410
Miller, Angela M. ; Lopez-Mitnik, Gabriela ; Somarriba, Gabriel ; Lipsitz, Stuart R. ; Hinkle, Andrea S. ; Constine, Louis S. ; Lipshultz, Steven E ; Miller, Tracie L. / Exercise capacity in long-term survivors of pediatric cancer : An analysis from the cardiac risk factors in childhood cancer survivors study. In: Pediatric Blood and Cancer. 2013 ; Vol. 60, No. 4. pp. 663-668.
@article{20db8def71524214b6b148be5d73b3c7,
title = "Exercise capacity in long-term survivors of pediatric cancer: An analysis from the cardiac risk factors in childhood cancer survivors study",
abstract = "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.",
keywords = "Cancer survivor, Cardiotoxicity, Child, Exercise capacity, Fitness",
author = "Miller, {Angela M.} and Gabriela Lopez-Mitnik and Gabriel Somarriba and Lipsitz, {Stuart R.} and Hinkle, {Andrea S.} and Constine, {Louis S.} and Lipshultz, {Steven E} and Miller, {Tracie L}",
year = "2013",
month = "4",
day = "1",
doi = "10.1002/pbc.24410",
language = "English",
volume = "60",
pages = "663--668",
journal = "Pediatric Blood and Cancer",
issn = "1545-5009",
publisher = "Wiley-Liss Inc.",
number = "4",

}

TY - JOUR

T1 - Exercise capacity in long-term survivors of pediatric cancer

T2 - An analysis from the cardiac risk factors in childhood cancer survivors study

AU - Miller, Angela M.

AU - Lopez-Mitnik, Gabriela

AU - Somarriba, Gabriel

AU - Lipsitz, Stuart R.

AU - Hinkle, Andrea S.

AU - Constine, Louis S.

AU - Lipshultz, Steven E

AU - Miller, Tracie L

PY - 2013/4/1

Y1 - 2013/4/1

N2 - 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.

AB - 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.

KW - Cancer survivor

KW - Cardiotoxicity

KW - Child

KW - Exercise capacity

KW - Fitness

UR - http://www.scopus.com/inward/record.url?scp=84873714954&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84873714954&partnerID=8YFLogxK

U2 - 10.1002/pbc.24410

DO - 10.1002/pbc.24410

M3 - Article

VL - 60

SP - 663

EP - 668

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

SN - 1545-5009

IS - 4

ER -