JMIR Publications

ABSTRACT

Background:

Acute Lymphoblastic Leukemia (ALL) is the most common type of pediatric cancer. ALL causes altered bone-mineral homeostasis state, which can contribute to osteopenia, and bone fractures, most commonly vertebral fractures. With the increasing number of childhood cancer survivors, late adverse effects (LAEs) such as musculoskeletal comorbidities are often reported, and are further influenced by inactive lifestyle habits. Physical activity has been shown to increase mechanical workload to the bone, mitigating the bone impairment in other cancer-specific populations.

Objective:

This interventional study proposes to investigate (1) the use of telehealth to deliver home-based exercise program for early-on survivors of bone marrow-related hematological malignancies, further (2) assessing its impact on survivors’ musculoskeletal and functional health.

Methods:

Survivors of ALL (n=12); 75% girls; 7.9 to 14.7 years old) within 6 months to 5 years off treatment were recruited to participate in the proposed study with a parent. The 16-week program included 40 potential home-based physical activity interventions supervised by a kinesiologist through a telehealth internet platform, with monthly progression. Patients could be recruited for the cohort if they were able to join the program during the first month (minimum 12 weeks of intervention). Evaluation before and after the intervention protocol highlighted differences in functional capacities and musculoskeletal health of patients using Mechanography, pQCT, six-minute walk test (6MWT), and grip force test.

Results:

Of the 12 patients recruited, 3 were excluded (1=relapse; 1=failure to meet technical requirements, and 1 abandoned). The 9 patients that completed the program (6 girls; 10.93±2.83 years; BMI: 21.58±6.55; CR: 36.67±16.37months) had a mean adherence of 89%, representing a completion rate of 75%. Additionally, these patients showed functional improvements in absolute and relative lower-limbs muscle power, relative muscle force, and 6MWT. Participants also showed improved bone health post-intervention on the following parameters: BMC, SSI, total and cortical CSA at the 14% and 38% sites of the tibia.

Conclusions:

Telehealth might be a feasible way of delivering exercise interventions to ALL early-on survivors, with high adherence, and might bring benefits to patients’ functional performance in addition to bone health parameters. A longer intervention is needed to truly assess the impact of such program on bone health.