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Background: The COVID-19 pandemic has presented major challenges to clinical practice and delivery of care programs throughout all health care systems. Exercise programs, that are implemented in most centers for pediatric oncology in Germany, are a relatively new care program however with high clinical impact and health benefits. Objective: The impact and consequences of the pandemic on the delivery and availability of exercise programs in Germany for pediatric cancer patients and survivors are unknown. A national survey analyzed restrictions, challenges and novel approaches of exercise program delivery and scientific research. Method: A two-stage online survey was distributed to providers of exercise programs (acute clinics, non-clinical institutions, rehabilitation facilities) via the established Network ActiveOncoKids. Data was collected during the pandemic in 2022 and 2023 using a combination of open and closed questions. Results: In total, n = 27 (response rate: 82%) and n = 17 (response rate: 63%) providers participated in the first and second survey, respectively. Findings pointed out restrictions in 85% of all exercise programs in 2020 and 2021, with slight reductions in 2022. During pandemic, restrictions with major impact arose within exercise offers during follow-up and declined gradually. Whereas restrictions within the setting of acute therapy had medium or minor impact but persisted beyond. Delivery of provided exercise programs necessitated adaptions, including digital methods, supervised interventions from a distance and change of locations. Discussion: The findings highlight the adaptability, the demand and the potential of exercise programs in pediatric oncology. We assume that exercise professionals have used the pandemic-related challenges to review and modify existing concepts and made adaptations according to local conditions and novel tools for the provision of exercise programs. Nevertheless, a conspicuous lack of exercise-related care has become evident in certain patients and survivors. Further expansion of programs is imperative to address and accommodate all pertinent needs.

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Objectives: Pediatric patients with cancer experience impairments in muscle strength and physical activity (PA) that may reduce autonomy during hospitalization. To determine the effects of strength exercise interventions on the accomplishment of activities of daily living (ADLs), motor performance, and PA in children with leukemia or non-Hodgkin lymphoma, we randomly allocated patients (4-18 years) immediately after diagnosis into two exercise groups. Methods: The intervention group (IG; n = 21) received a specific strength training combined with a standard care exercise program, whereas the control group (CG; n = 20) was provided standard care exercise program without any targeted muscle strengthening. After the baseline visit, participants were followed-up three times until intensive treatment cessation. We assessed physical function limitations using the Activities Scale for Kids© (ASK) and Functional ADL Screen. Secondary outcomes were PA levels using accelerometer and motor performance as measured by MOON-test (motor performance in pediatric oncology-test). Results: In both groups, ADL accomplishment had significantly increased (p < 0.05). However, no significant between-group differences for ASK outcome were noted. Motor performance was reduced in all motor abilities. Conclusions: Both exercise interventions were effective to maintain ADLs and motor performance during intensive treatment. In comparison, regular strength exercise interventions in the course of therapy tended to be more beneficial with regards to muscular explosive and endurance strength.

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OBJECTIVE: Cancer diagnosis, treatment side effects and physical inactivity can lead to reduced muscle strength. Patients undergoing acute treatment experience many burdens that can restrict their mobility and autonomy, leading to limited independence and loss of resources to cope with everyday tasks. In this work, we analyse the status quo and potential influencing factors for the accomplishment of activities of daily living (ADLs) shortly after cancer diagnosis. METHODS: We recruited participants ages 4-18 years diagnosed with acute leukaemia or non-Hodgkin lymphoma. For the baseline analysis, we assessed (1) physical function limitations using the Activities Scale for Kids©, (2) exercise-related ADLs simulated with the Functional ADL Screen, (3) motor performance using the Motor Performance in Paediatric Oncology test and (4) physical activity (PA) level measured using an accelerometer. RESULTS: We conducted the baseline assessment 19.2 ± 12.6 days post-diagnosis in 41 patients. All participants reported functional limitations in ADLs and PA. Motor performance was reduced for all abilities. Cumulative steroid dose was negatively correlated with hand grip strength (r = -0.50, p = 0.009). CONCLUSION: Shortly after diagnosis of paediatric cancer, patients experience various physical impairments that can be counteracted with regular, instructed exercise interventions.

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Background: Cardiovascular diseases in childhood cancer survivors are known late sequelae following treatment. Arterial stiffness, pulse wave velocity (PWV) and central systolic blood pressure (cSBP) are potential predictors to assess the status of cardiovascular health. Frequent inpatient stays and reduced physical activity (PA) during treatment can lead to noticeable impairments regarding motor skills and physical performance. The present study examined parameters of cardiovascular health, motor performance and the status of integration into sports structures shortly after cessation of treatment. Methods: A cross-sectional, monocentric study was conducted from April to June 2019. Participants (6-18 yrs, mixed cancer entities) during maintenance therapy and follow-up care were recruited. Peripheral and central systolic/diastolic blood pressure (pSBP, pDBP, cSBP) and PWV were assessed using the Mobil-O-Graph®. The MOON test (MOtor performance in pediatric ONcology) was used to scale motor performance. PA levels and status of integration into sports structures were assessed with a questionnaire referring to the KiGGS study. All measured data were compared to published reference values. Results: Forty participants (11.3 ± 3.8 years, 50% female) were recruited 1.6 ± 1.8 years post-treatment. PSBP (z-score: 0.87 ± 0.67, p = 0.003), pDBP (0.83 ± 1.94, p = 0.033) and cSBP (≥8 years: 0.60 ± 1.29, p = 0.011) were significantly increased compared to reference values. PWV was also elevated, but not significantly. Motor performance was reduced in almost all motor abilities. Thirty-six percent of the examined group did not participate in physical education at school to the full extent. Only 17% reported 1 hour of daily moderate-to-vigorous PA as recommended for children and adolescents by the World Health Organization. Half of the participants were active sports club members before treatment, but one third did not resume their former membership. Conclusion: Increased cardiovascular parameters and impaired motor performance shortly after cessation of treatment, physical inactivity, and low rates of integration into regular sports programs highlight the support needed. Young cancer patients should receive early support in coping with physical limitations preferably soon after diagnosis. Motor deficits could be reduced by applying targeted interventions. Furthermore, a regular sports therapy program during in- and outpatient care could increase engagement in PA to possibly counteract risk factors and improve cardiovascular health.

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Biodegradable polylactide implants allow secure fixation of osteochondral fractures with minimal adverse effects. The goal of this prospective, randomized animal study was to show whether osteoconductive effects can be achieved through the development of poly-L/DL(70/30)lactide composite implants with 10% beta-tricalcium phosphate, and whether degradation can be positively influenced and adverse effects minimized using such implants. An additional goal was to clarify which radiological procedure is most suitable to observe the course of follow-up. Thirtysix medial femoral condyle osteotomies of sheep were fixed with either 3 poly-L/DL-lactide pins or 3 composite pins, and the pin canal widths were measured with conventional radiographs, with CT, MRI, and histologically after 3, 18, and 36 months. All fractures healed completely without displacement or clinically relevant complications. The pin canals dilated secondary to pin degradation at the 12th month, and then decreased in size later. At 36 months, the pins had microscopically disappeared, and the canals were filled with bone or scar tissue. There were no statistically significant differences between the pin-types. Poly-L/DL-lactide pins and composite C-pins are suitable for secure fixation of small osteochondral fractures. Osteoconductive effects of biocompatibility or osseous integration relating to composite development were not evident. Conventional radiography and computer tomography were suitable techniques for observation of pin canals. Due to frequently observed artifact, MRI was not suitable to observe the course of the implants.

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OBJECTIVE: Handbiking and wheelchair racing have gained increased popularity in Germany. This is important because of the inability of wheelchair-dependent people to maintain cardiovascular health and fitness through daily activities. The purpose of this study was to evaluate the energy expenditure (EE; kcal/h) of wheelchair-dependent individuals. METHODS: Ten wheelchair racers (WR) and 17 handbikers (HB) completed a basal metabolism evaluation, an incremental exercise test until exhaustion and an endurance test. Oxygen uptake and carbon dioxide production ([V(. -)]O(2), [V(. -)]CO(2); ml/min), arterialized capillary blood lactate concentration (LA; mmol/l) and heart rate (HR; bpm) were recorded during each test. EE was calculated by indirect calorimetry. RESULTS: In the endurance test [V(. -)]O(2), [V(. -)]CO(2), LA, HR and EE at an intensity corresponding to 2 mmol/l lactate were: HB: 1332+/-368 ml/min, 1178+/-303 ml/min, 2.23+/-0.85 mmol/l, 116.8+/-19.1 bpm, 389.6+/-105.4 kcal/h; WR:1175+/-285 ml/min, 1145+/-258 ml/min, 2.65+/-0.36 mmol/l, 142.5+/-28.0 bpm, 341.7+/-84.0 kcal/h. At an intensity corresponding to 4 mmol/l lactate the values were: HB: 1792+/-408 ml/min, 1666+/-326 ml/min, 4.27+/-1.40 mmol/l 146.1+/-22.8 bpm, 530.1+/- 115.4 kcal/h; WR: 1505+/-210 ml/min, 1427+/-188 ml/min, 3.31+/-1.0 mmol/l, 165.3+/-22.7 bpm, 445.5+/-70.8 kcal/h. CONCLUSION: The results show that EE of HB and WR is high enough to maintain fitness and probably to help to prevent cardiovascular diseases even at a moderate intensity.

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