Active video games to promote physical activity in children with cancer: a randomized clinical trial with follow-up

BMC Pediatrics

Sanna Salanterä¹  Tero Vahlberg⁴  Johan Lilius⁵  Anna Axelin³  Olli J Heinonen²  Mikko Arola⁶  Päivi M Lähteenmäki⁷  Liisa Järvelä⁷  Lotta Kauhanen³ 

[1] Hospital District of Southwest Finland, Kiinamyllynkatu 4-8, 20520 Turku, Finland;Paavo Nurmi Centre, Sports & Exercise Medicine Unit & Department of Health and Physical Activity, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland;Department of Nursing Science, University of Turku, Lemminkäisenkatu 1, FI-20014 Turku, Finland;Department of Biostatistics, University of Turku, Lemminkäisenkatu 1, FI-20014 Turku, Finland;Department of Information Technologies, Åbo Akademi University, Joukahaisenkatu 3-5A, 20520 Turku, Finland;Department of Pediatrics, Tampere University Hospital, PL 2000 Tampere, Finland;Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland

关键词: Active video games;    Rehabilitation;    Fatigue;    Motor performance;    Sedentary behavior;    Physical activity;    Cancer;    Pediatrics;   

Others  :  1138920
DOI  :  10.1186/1471-2431-14-94

 received in 2013-09-11, accepted in 2014-03-21,  发布年份 2014

【 摘 要 】

Background

Low levels of physical activity, musculoskeletal morbidity and weight gain are commonly reported problems in children with cancer. Intensive medical treatment and a decline in physical activity may also result in reduced motor performance. Therefore, simple and inexpensive ways to promote physical activity and exercise are becoming an increasingly important part of children’s cancer treatment.

Methods

The aim of this study is to evaluate the effect of active video games in promotion of physical activity in children with cancer. The research is conducted as a parallel randomized clinical trial with follow-up. Patients between 3 and 16 years old, diagnosed with cancer and treated with vincristine in two specialized medical centers are asked to participate. Based on statistical estimates, the target enrollment is 40 patients. The intervention includes playing elective active video games and, in addition, education and consultations for the family. The control group will receive a general recommendation for physical activity for 30 minutes per day. The main outcomes are the amount of physical activity and sedentary behavior. Other outcomes include motor performance, fatigue and metabolic risk factors. The outcomes are examined with questionnaires, diaries, physical examinations and blood tests at baseline and at 2, 6, 12 and 30 months after the baseline. Additionally, the children’s perceptions of the most enjoyable activation methods are explored through an interview at 2 months.

Discussion

This trial will help to answer the question of whether playing active video games is beneficial for children with cancer. It will also provide further reasoning for physical activity promotion and training of motor skills during treatment.

Trial registration

ClinicalTrials.gov identifier: NCT01748058 (October 15, 2012).

【 授权许可】

   
2014 Kauhanen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA: SEER Cancer Statistics Review, 1975–2010. Bethesda, MD: National Cancer Institute; 2012. [http://seer.cancer.gov/csr/1975_2010/ webcite]
• [2]Love E, Schneiderman JE, Stephens D, Lee S, Barron M, Tsangaris E, Urbach S, Staneland P, Greenberg M, Nathan PC: A cross-sectional study of overweight in pediatric survivors of acute lymphoblastic leukemia (ALL). Pediatr Blood Cancer 2011, 57(7):1204-1209.
• [3]Reilly JJ, Ventham JC, Newell J, Aitchison T, Wallace WH, Gibson BE: Risk factors for excess weight gain in children treated for acute lymphoblastic leukaemia. Int J Obes Relat Metab Disord 2000, 24(11):1537-1541.
• [4]Baillargeon J, Langevin AM, Lewis M, Grady JJ, Thomas PJ, Mullins J, Estrada J, Pitney A, Sacks N, Pollock BH: Therapy-related changes in body size in Hispanic children with acute lymphoblastic leukemia. Cancer 2005, 103(8):1725-1729.
• [5]Nathan PC, Jovcevska V, Ness KK, Mammone D’Agostino N, Staneland P, Urbach SL, Barron M, Barrera M, Greenberg ML: The prevalence of overweight and obesity in pediatric survivors of cancer. J Pediatr 2006, 149(4):518-525.
• [6]Baillargeon J, Langevin AM, Lewis M, Estrada J, Grady JJ, Mullins J, Pitney A, Pollock BH: Demographic correlates of body size changes in children undergoing treatment for acute lymphoblastic leukemia. Pediatr Blood Cancer 2007, 49(6):793-796.
• [7]Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, Friedman DL, Marina N, Hobbie W, Kadan-Lottick NS, Schwartz CL, Leisenring W, Robison LL, Childhood Cancer Survivor Study: Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 2006, 355(15):1572-1582.
• [8]Van der Sluis IM, van den Heuvel-Eibrink MM: Osteoporosis in children with cancer. Pediatr Blood Cancer 2008, 50(2 Suppl):474-478. discussion 486
• [9]Kaste SC, Jones-Wallace D, Rose SR, Boyett JM, Lustig RH, Rivera GK, Pui CH, Hudson MM: Bone mineral decrements in survivors of childhood acute lymphoblastic leukemia: frequency of occurrence and risk factors for their development. Leukemia 2001, 15(5):728-734.
• [10]Järvelä LS, Niinikoski H, Lähteenmäki PM, Heinonen OJ, Kapanen J, Arola M, Kemppainen J: Physical activity and fitness in adolescent and young adult long-term survivors of childhood acute lymphoblastic leukaemia. J Cancer Surviv 2010, 4(4):339-345.
• [11]Jarfelt M, Fors H, Lannering B, Bjarnason R: Bone mineral density and bone turnover in young adult survivors of childhood acute lymphoblastic leukemia. Eur J Endocrinol 2006, 154(2):303-309.
• [12]Gocha Marchese V, Chiarello LA, Lange BJ: Strength and functional mobility in children with acute lymphoblastic leukemia. Med Pediatr Oncol 2003, 40(4):230-232.
• [13]Hartman A, van den Bos C, Stijnen T, Pieters R: Decrease in peripheral muscle strength and ankle dorsiflexion as long-term side effects of treatment for childhood cancer. Pediatr Blood Cancer 2008, 50(4):833-837.
• [14]Windebank AJ, Grisold W: Chemotherapy-induced neuropathy. J Peripher Nerv Syst 2008, 13(1):27-46.
• [15]Ramchandren S, Leonard M, Mody RJ, Donohue JE, Moyer J, Hutchinson R, Gurney JG: Peripheral neuropathy in survivors of childhood acute lymphoblastic leukemia. J Peripher Nerv Syst 2009, 14(3):184-189.
• [16]Lehtinen SS, Huuskonen UE, Harila-Saari AH, Tolonen U, Vainionpaa LK, Lanning BM: Motor nervous system impairment persists in long-term survivors of childhood acute lymphoblastic leukemia. Cancer 2002, 94(9):2466-2473.
• [17]Ness KK, Baker KS, Dengel DR, Youngren N, Sibley S, Mertens AC: Body composition, muscle strength deficits and mobility limitations in adult survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2007, 49(7):975-981.
• [18]Gallahue DL, Ozmun JC, Goodway JD: Understanding Motor Development: Infants, Children, Adolescents, Adults. New York: McGraw-Hill; 2012.
• [19]Winter C, Müller C, Hoffmann C, Boos J, Rosenbaum D: Physical activity and childhood cancer. Pediatr Blood Cancer 2010, 54(4):501-510.
• [20]Van Brussel M, Takken T, Lucia A, van der Net J, Helders PJ: Is physical fitness decreased in survivors of childhood leukemia? A systematic review. Leukemia 2005, 19(1):13-17.
• [21]Aznar S, Webster AL, San Juan AF, Chamorro-Viña C, Maté-Muñoz JL, Moral S, Pérez M, García-Castro J, Ramírez M, Madero L, Lucia A: Physical activity during treatment in children with leukemia: a pilot study. Appl Physiol Nutr Metab 2006, 31(4):407-413.
• [22]Winter C, Müller C, Brandes M, Brinkmann A, Hoffmann C, Hardes J, Gosheger G, Boos J, Rosenbaum D: Level of activity in children undergoing cancer treatment. Pediatr Blood Cancer 2009, 53(3):438-443.
• [23]Fuemmeler BF, Pendzich MK, Clark K, Lovelady C, Rosoff P, Blatt J, Demark-Wahnefried W: Diet, physical activity, and body composition changes during the first year of treatment for childhood acute leukemia and lymphoma. J Pediatr Hematol Oncol 2013, 35(6):437-443.
• [24]White J, Flohr JA, Winter SS, Vener J, Feinauer LR, Ransdell LB: Potential benefits of physical activity for children with acute lymphoblastic leukaemia. Pediatr Rehabil 2005, 8(1):53-58.
• [25]Hartman A, te Winkel ML, van Beek RD, de Muinck Keizer-Schrama SM, Kemper HC, Hop WC, van den Heuvel-Eibrink MM, 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(1):64-71.
• [26]Huang TT, Ness KK: Exercise interventions in children with cancer: a review. Int J Pediatr 2011, 2011:461512.
• [27]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.
• [28]San Juan AF, Wolin K, Lucía A: Physical activity and pediatric cancer survivorship. Recent Results Cancer Res 2011, 186:319-347.
• [29]Nintendo Co., Ltd: Consolidated Sales Transition by Region Nintendo. 2013. [http://www.nintendo.co.jp/ir/library/historical_data/pdf/consolidated_sales_e1212.pdf webcite]
• [30]Primack BA, Carroll MV, McNamara M, Klem ML, King B, Rich M, Chan CW, Nayak S: Role of video games in improving health-related outcomes: a systematic review. Am J Prev Med 2012, 42(6):630-638.
• [31]Biddiss E, Irwin J: Active video games to promote physical activity in children and youth: a systematic review. Arch Pediatr Adolesc Med 2010, 164(7):664-672.
• [32]Barnett A, Cerin E, Baranowski T: Active video games for youth: a systematic review. J Phys Act Health 2011, 8(5):724-737.
• [33]Penko AL, Barkley JE: Motivation and physiologic responses of playing a physically interactive video game relative to a sedentary alternative in children. Ann Behav Med 2010, 39(2):162-169.
• [34]Baranowski T, Abdelsamad D, Baranowski J, O’Connor TM, Thompson D, Barnett A, Cerin E, Chen TA: Impact of an active video game on healthy children’s physical activity. Pediatrics 2012, 129(3):e636-e642.
• [35]Gordon C, Roopchand-Martin S, Gregg A: Potential of the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy in a developing country: a pilot study. Physiotherapy 2012, 98(3):238-242.
• [36]Howcroft J, Klejman S, Fehlings D, Wright V, Zabjek K, Andrysek J, Biddiss E: Active video game play in children with cerebral palsy: potential for physical activity promotion and rehabilitation therapies. Arch Phys Med Rehabil 2012, 93(8):1448-1456.
• [37]Salem Y, Gropack SJ, Coffin D, Godwin EM: Effectiveness of a low-cost virtual reality system for children with developmental delay: a preliminary randomized single-blind controlled trial. Physiotherapy 2012, 98(3):189-195.
• [38]Shih CH, Chen LC, Shih CT: Assisting people with disabilities to actively improve their collaborative physical activities with Nintendo Wii balance boards by controlling environmental stimulation. Res Dev Disabil 2012, 33(1):39-44.
• [39]de Kloet AJ, Berger MA, Verhoeven IM, van Stein CK, Vlieland TP: Gaming supports youth with acquired brain injury? A pilot study. Brain Inj 2012, 26(7–8):1021-1029.
• [40]Andrysek J, Klejman S, Steinnagel B, Torres-Moreno R, Zabjek KF, Salbach NM, Moody K: Preliminary evaluation of a commercially available videogame system as an adjunct therapeutic intervention for improving balance among children and adolescents with lower limb amputations. Arch Phys Med Rehabil 2012, 93(2):358-366.
• [41]Chamorro-Viña C, Guilcher GM, Khan FM, Mazil K, Schulte F, Wurz A, Williamson T, Reimer RA, Culos-Reed SN: EXERCISE in pediatric autologous stem cell transplant patients: a randomized controlled trial protocol. BMC Cancer 2012, 10:12. 401
• [42]Schulz KF, Altman DG, Moher D: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010, 340:c332.
• [43]Henderson SE, Sugden DA, Barnett AL: Movement Assessment Battery for Children. Examiner’s Manual. 2nd edition. London, UK: Harcourt Assessment; 2007.
• [44]Ministry of Justice, Finland: FINLEX ® 9.4.1999/488. Laki Lääketieteellisestä Tutkimuksesta. 9.4.1999/488. Finland: Edita Publishing Oy; 2010. http://www.finlex.fi/fi/laki/ajantasa/1999/19990488 webcite
• [45]USA Government, Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity (DNPAO): Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity (DNPAO). 2011. [http://www.cdc.gov/physicalactivity/everyone/measuring/index.html webcite]
• [46]Rowlands A, Eston RG: The measurement and interpretation of children’s physical activity. J Sports Sci Med 2007, 6(3):270-276.
• [47]Tryon WW: Actigraphy: The Ambulatory Measurement of Physical Activity. In Behavioral Sport Psychology: Evidence-Based Approaches to Performance Enhancement. Edited by Luiselli JK, Reed DD. Springer New York: Dordrecht Heidelberg London; 2011:25-41. ISBN ISBN 978-1-4614-0070-7
• [48]Raitakari OT, Taimela S, Porkka KV, Leino M, Telama R, Dahl M, Viikari JSA: Patterns of intense physical activity among 15- to 30-year-old Finns. The cardiovascular risk in young Finns study. Scand J Med Sci Sports 1996, 6:36-39.
• [49]Pahkala K, Heinonen OJ, Simell O, Viikari JS, Rönnemaa T, Niinikoski H, Raitakari OT: Association of physical activity with vascular endothelial function and intima-media thickness. Circulation 2011, 124(18):1956-1963.
• [50]Lehtonen-Veromaa M, Möttönen T, Svedström E, Hakola P, Heinonen OJ, Viikari J: Physical activity and bone mineral acquisition in peripubertal girls. Scand J Med Sci Sports 2000, 10:236-243.
• [51]Mansikkaniemi K, Juonala M, Taimela S, Hirvensalo M, Telama R, Huupponen R, Saarikoski L, Hurme M, Mallat Z, Benessiano J, Jula A, Taittonen L, Marniemi J, Kähönen M, Lehtimäki T, Rönnemaa T, Viikari J, Raitakari OT: Cross-sectional associations between physical activity and selected coronary heart disease risk factors in young adults: the cardiovascular risk in young Finns study. Ann Med 2012, 44(7):733-744.
• [52]Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, Kriska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS Jr, Patrick K, Pollock ML, Rippe JM, Sallis J, Wilmore JH: Physical activity and public health. A recommendation from the centers for disease control and prevention and the American college of sports medicine. JAMA 1995, 273(5):402-407.
• [53]Baranowski T, Dworkin RJ, Cieslik CJ, Hooks PC, Clearman RD, Ray L, Dunn JK, Nader PR: Reliability and validity of self-report of aerobic activity: family health project. Res Q Exercise Sport 1984, 55:309-317.
• [54]Henderson S, Sugden D: The Movement Assessment Battery for Children: Manual. London: Psychological Corporation; 1992.
• [55]Croce RV, Horvat M, McCarthy E: Reliability and concurrent validity of the movement assessment battery for children. Percept Mot Skills 2001, 93(1):275-280.
• [56]Hartman A, van den Bos C, Stijnen T, Pieters R: Decrease in motor performance in children with cancer is independent of the cumulative dose of vincristine. Cancer 2006, 106(6):1395-1401.
• [57]Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P: The PedsQL in pediatric cancer: reliability and validity of the pediatric quality of life inventory generic core scales, multidimensional fatigue scale, and cancer module. Cancer 2002, 94(7):2090-2106.
• [58]Tomlinson D, Hinds PS, Ethier MC, Ness KK, Zupanec S, Sung L: Psychometric properties of instruments used to measure fatigue in children and adolescents with cancer: a systematic review. J Pain Symptom Manage 2013, 45(1):83-91.
• [59]Chow EJ, Pihoker C, Friedman DL, Lee SJ, McCune JS, Wharton C, Roth CL, Baker KS: Glucocorticoids and insulin resistance in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2013, 60(4):621-626.
• [60]Steinberger J, Sinaiko AR, Kelly AS, Leisenring WM, Steffen LM, Goodman P, Mulrooney DA, Dietz AC, Moran A, Perkins JL, Baker KS: Cardiovascular risk and insulin resistance in childhood cancer survivors. J Pediatr 2012, 160(3):494-499.
• [61]Schumacher KL, Koresawa S, West C, Dodd M, Paul SM, Tripathy D, Koo P, Miaskowski C: Qualitative research contribution to a randomized clinical trial. Res Nurs Health 2005, 28(3):268-280.
• [62]Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin JA, Doré CJ, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D: SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013, 158(3):200-207.
• [63]Van Brussel M, van der Net J, Hulzebos E, Helders PJ, Takken T: The Utrecht approach to exercise in chronic childhood conditions: the decade in review. Pediatr Phys Ther 2011, 23(1):2-14.