Key words: Paediatric oncology; Exercise; Supportive care.
Why is this study important?
For a long time, there has been uncertainty about the role of exercise in paediatric oncology. On the one hand, we know that physical activity is beneficial in almost all populations we study. On the other hand, when it comes to children and adolescents with cancer, uncertainty often prevails. Is it safe? Is it really helpful? Or are we simply assuming these benefits without solid evidence?
In recent years, there has been an increase in the number of studies analysing exercise during and after cancer treatment in young patients. However, the results have been inconsistent and, often, clinicians are left without clear guidance. This is where our study comes in. Rather than adding yet another isolated piece of evidence, we wanted to take a step back and look at the bigger picture: what does the evidence as a whole actually tell us?
How did the study go about this?
To answer this question, we conducted an umbrella review (i.e. a review of systematic reviews with meta-analyses) (1). This enabled us to synthesise the highest level of available evidence. We included 19 systematic reviews with meta-analyses, covering a total of 53 primary studies and more than 2,350 children and adolescents with cancer. Our aim was simple, but ambitious: to assess the effects of exercise interventions on a wide range of outcomes, from physical fitness to psychological health and clinical endpoints.
Notably, we did not just summarise the findings. We also assessed the certainty of the evidence using established grading criteria, which helped to distinguish between what we know for certain and what remains uncertain.
What did the study find?
The overall message is encouraging, but nuanced. Exercise interventions showed clear benefits in several areas. Children and adolescents who exercised improved their cardiorespiratory fitness, muscle strength, functional mobility and cancer-related fatigue. Positive effects were also observed in some aspects of cognitive function. In practice, this means that exercise can help young patients maintain their physical capacity and better cope with the demands of the disease and its treatment.
However, not all outcomes showed improvements. No consistent effects were observed on depression, bone mineral density, health-related quality of life, body composition or clinical outcomes, such as relapse and mortality. Another relevant point is that, despite these promising findings, the certainty of the evidence was, in general, low to moderate. This reflects the limitations of the available studies, such as small sample sizes and variability in exercise programmes.
What are the key take-home points?
Firstly, exercise in paediatric oncology is not only safe but also beneficial for a number of important physical and functional outcomes. Secondly, the notion that young patients should avoid physical activity during treatment is becoming increasingly difficult to justify. When properly supervised, exercise can and should form part of their medical care. Thirdly, we still need better research. Future studies should aim to identify the optimal type, intensity and timing of exercise, as well as to strengthen the evidence base for outcomes where these are not yet clear.
Finally, and perhaps most importantly, this is about changing perspective. Exercise in paediatric oncology should not be viewed as an optional extra, but as a significant component of supportive care.
Author: Javier S. Morales.
SPORT Research Group (CTS-1024); Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.
References:
- Ruiz-Campos S, Sanchez-Gomez J, Ruiz-González D, et al. Grading the evidence on the effects of exercise interventions in children and adolescents during and beyond cancer treatment: an umbrella review of systematic reviews with meta-analyses. British Journal of Sports Medicine 2026;60:738-747