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Paeds Cancer – Improvement in musculoskeletal health

Evidence Summary
The evidence shows that increases in muscle strength can be seen in cancer patients who undergo a supervised muscle strength and flexibility programme (1-10). Moralles, Braam and Wollin et al all demonstrated a significant increase in muscle strength in cancer patients (6, 8, 10), furthermore this programme was feasible and tolerated by patients in a hospital setting. Importantly, Jarvela et al have shown an improvement in muscle strength and cardio-metabolic risk factors through physical activity in late cancer survivors (1, 2). Lower body muscle strength can be improved three months post treatment through an exercise intervention (5).

Physical activity can be increased through adventure-based training for children (7). There is some early suggestion that ankle mobility can be improved through an ankle flexibility training although evidence is weak .
Hartman et al. (11) investigated the effect of exercise on bone mineral density in children with cancer (ALL). Post-publication analyses by the Cochrane Collaboration (5) identified a significant positive intervention effect on the total body bone mineral density for the children in the exercise group.
Quality of Evidence
Strength of Recommendation
Muscle strength and flexibility training is well tolerated and shows improvements in musculoskeletal health in cancer patients.


  1. Järvelä, L.S., Niinikoski, H., Lähteenmäki, P.M. et al. J Cancer Surviv (2010) 4: 339
  2. Järvelä, L. S., Kemppainen, J. , Niinikoski, H. , Hannukainen, J. C., Lähteenmäki, P. M., Kapanen, J. , Arola, M. and Heinonen, O. J. (2012), Effects of a home‐based exercise program on metabolic risk factors and fitness in long‐term survivors of childhood acute lymphoblastic leukemia. Pediatr. Blood Cancer, 59: 155-160.
  3. West, Sarah & Gassas, Adam & Schechter-Finkelstein, Tal & Egeler, R & Nathan, Paul & Wells, Greg. (2014). Exercise Intolerance and the Impact of Physical Activity in Children Treated With Hematopoietic Stem Cell Transplantation. Pediatric exercise science. 26.
  4. Wolin KY, Ruiz JR, Tuchman H, Lucia A. Exercise in adult and pediatric hematological cancer survivors: an intervention review. Leukemia 2010; 24(6): 1113-1120
  5. Braam KI, van der Torre P, Takken T, Veening MA, van Dulmen-den Broeder E, Kaspers GJL. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008796.
  6. Baumann, Freerk & Bloch, Wilhelm & Däggelmann (Beulertz), Julia. (2013). Clinical exercise interventions in pediatric oncology: A systematic review. Pediatric research. 74. 10.1038/pr.2013.123.
  7. Li, Ho & Chung, Oi & Ho, Ka & Chui, Sau & Lopez, Violeta. (2013). Effectiveness of an integrated adventure-based training and health education program in promoting regular physical activity among childhood cancer survivors. Psycho-oncology. 22. 10.1002/pon.3326.
  8. Braam, Katja & Dijk-Lokkart, Elisabeth & Kaspers, Gertjan & Takken, T. & Huisman, Jaap & Buffart, Laurien & Bierings, M.B. & Merks, Johannes & Heuvel-Eibrink, Marry & Veening, Margreet & Broeder, Eline. (2018). Effects of a combined physical and psychosocial training for children with cancer: A randomized controlled trial. BMC Cancer. 18. 1289.
  9. San Juan Ferrer, Alejandro & Chamorro Vina, Carolina & Moral, Susana & Fernandez del Valle, Maria & Madero, Luis & Ramirez, Manuel & Pérez, Margarita & Lucia, Alejandro. (2008). Benefits of Intrahospital Exercise Training after Pediatric Bone Marrow Transplantation. International journal of sports medicine. 29. 439-46.
  10. Morales Rojas, Javier Salvador & Valenzuela, Pedro L. & Rincon, Cecilia & Takken, T. & Fiuza-Luces, Carmen & Santos-Lozano, Alejandro & Lucia, Alejandro. (2018). Exercise training in childhood cancer: A systematic review and meta-analysis of randomized controlled trials. Cancer Treatment Reviews. 70.
  11. Hartman A., te Winkel M.L., van Beek R.D., de Muinck Keizer-Schrama S.M., Kemper H.C., Hop W.C., van den Heuvel-Eibrink M.M., Pieters R. A randomized trial investigating an exercise program to prevent reduction of bone mineral density and impairment of motor performance during treatment for childhood acute lymphoblastic leukemia. Pediatr. Blood Cancer. 2009;53:64–71.


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