Effect of exercise on bone health in children and adolescents with cancer during and after oncological treatment: A systematic review and meta-analysis

Andres Marmol-Perez; Esther Ubago-Guisado; Andrea Rodriguez-Solana; Jose J Gil-Cosano; Vicente Martinez-Vizcaino; Ivan Cavero-Redondo; Jonatan R Ruiz; Luis Gracia-Marco

doi:10.3389/fphys.2023.1088740

Effect of exercise on bone health in children and adolescents with cancer during and after oncological treatment: A systematic review and meta-analysis

Front Physiol. 2023 Mar 14:14:1088740. doi: 10.3389/fphys.2023.1088740. eCollection 2023.

Authors

Andres Marmol-Perez¹, Esther Ubago-Guisado^{1

2}, Andrea Rodriguez-Solana¹, Jose J Gil-Cosano^{1

3}, Vicente Martinez-Vizcaino^{4

5}, Ivan Cavero-Redondo^{4

5}, Jonatan R Ruiz^{1

2

6}, Luis Gracia-Marco^{1

2

6}

Affiliations

¹ Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.
² Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain.
³ Department of Communication and Education, Universidad Loyola Andalucía, Sevilla, Spain.
⁴ Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain.
⁵ Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.
⁶ Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.

Abstract

Background: Although regular physical activity and exercise programs might improve bone health caused by oncological treatment and the disease itself, it remains unknown the pooled effect of exercise interventions following frequency, intensity, time and type prescriptions. Objective: This systematic review and meta-analysis aimed to synthesise evidence regarding the effectiveness of exercise interventions on bone health in children and adolescents with cancer during and after oncological treatment. Methods: A systematic search was conducted in the MEDLINE (via PubMed), Web of Science and Scopus databases from November 2021 to January 2022. Randomised controlled trials (RCTs) and non-RCTs reporting pre-post changes of the effectiveness of exercise interventions on DXA-measured bone parameters in young population (1-19 years) during or after oncological treatment were included. Pooled (ESs) and 95% confidence intervals (95%CIs) were calculated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results: A total of eight trials with 341 participants were included. The meta-analyses did not reveal a statistically significant increase in whole body areal bone mineral density (ES = 0.10; 95%CI: -0.14, 0.34), lumbar spine (ES = 0.03; 95%CI: -0.21, 0.26) or femoral neck (ES = 0.10; 95%CI: -0.37, 0.56). Similarly, during the oncological treatment phase the ES was 0.04 (95%CI: -0.17, 0.25) and after the ES was 0.07 (95%CI: -0.20, 0.33). Conclusion: To date, exercise interventions have been inappropriate and therefore, ineffective to illustrate any beneficial effect on bone health in children and adolescents with cancer during and after oncological treatment. Systematic Review Registration: PROSPERO registration number: CRD42022310876.

Keywords: bone mineral density; dual-energy x-ray absorptiometry; impact-loading exercise; paediatrics; physical activity; weight-bearing exercise.

Publication types

Systematic Review

Grants and funding

This study has been partially supported by the Spanish Ministry of Science and Innovation (ref: PID2020-117302RA-I00), La Caixa Foundation (ref: LCF/BQ/PR19/11700007), the University of Granada Plan Propio de Investigación 2021-Excellence actions: Unit of Excellence on Exercise, Nutrition and Health (UCEENS) and the CIBEROBN, Centro de Investigación Biomédica en Red (CB22/03/00058), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea – European Regional Development Fund. AM-P is recipient of a predoctoral fellowship (FPU20/05530) by the Spanish Ministry of Education, Culture and Sport. EU-G is supported by the Maria Zambrano fellowship by the Ministerio de Universidades y la Unión Europea—NextGenerationEU.