Exercise capacity in long-term survivors of pediatric cancer: An analysis from the cardiac risk factors in childhood cancer survivors study†
Angela M. Miller MSPH
Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
Search for more papers by this authorGabriela Lopez-Mitnik MS
Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
Search for more papers by this authorGabriel Somarriba DPT
Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
Search for more papers by this authorStuart R. Lipsitz DSc
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Search for more papers by this authorAndrea S. Hinkle MD
Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
Search for more papers by this authorLouis S. Constine MD
Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
Search for more papers by this authorSteven E. Lipshultz MD
Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
Search for more papers by this authorCorresponding Author
Tracie L. Miller MD
Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
Division of Pediatric Clinical Research, Department of Pediatrics (D820), University of Miami Miller School of Medicine, Batchelor Children's Research Institute, PO Box 016820, Miami, FL 33101.===Search for more papers by this authorAngela M. Miller MSPH
Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
Search for more papers by this authorGabriela Lopez-Mitnik MS
Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
Search for more papers by this authorGabriel Somarriba DPT
Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
Search for more papers by this authorStuart R. Lipsitz DSc
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Search for more papers by this authorAndrea S. Hinkle MD
Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
Search for more papers by this authorLouis S. Constine MD
Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
Search for more papers by this authorSteven E. Lipshultz MD
Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
Search for more papers by this authorCorresponding Author
Tracie L. Miller MD
Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
Division of Pediatric Clinical Research, Department of Pediatrics (D820), University of Miami Miller School of Medicine, Batchelor Children's Research Institute, PO Box 016820, Miami, FL 33101.===Search for more papers by this authorConflict of interest: Nothing to declare.
Abstract
Background
Childhood cancer survivors may have premature symptomatic cardiovascular and non-cardiovascular diseases that contribute to reduced capacity for physical activity. Studies of exercise capacity and identification of risk factors for reduced capacity in survivors are limited.
Procedure
We assessed maximal myocardial oxygen consumption (
, a measure of exercise capacity) in survivors at least 4 years after cancer diagnosis and sibling controls. We evaluated associations between 
and age, sex, treatments, cardiac structure and function, biomarkers, endocrine function, and physical activity.
Results
Of 72 survivors (mean age, 22 years; range, 8.0–40 years) and 32 siblings (mean age, 20.2 years; range, 8–46 years), about half were male. Mean time since diagnosis was 13.4 years (range, 4.5–31.6 years). In age- and sibling-pair adjusted analyses, 
was lower in survivors than siblings (males, 28.53 vs. 30.90 ml/kg/minute, P = 0.08; females, 19.81 vs. 23.40 ml/kg/minute, P = 0.03). In males, older age (P = 0.01), higher percent body fat (P < 0.001) and high or low left ventricular (LV) mass Z-scores (P = 0.03) predicted lower 
. In females, older age (P < 0.001), methotrexate exposure (P = 0.01), and higher, but normal, LV load-dependent contractility (P = 0.02) predicted lower 
.
Conclusions
Fitness for most survivors and controls was poor and generally lower in survivors, particularly females. Older age, higher body fat, methotrexate exposure, and extremes of LV mass/function were associated with lower 
in survivors. Because physical activity can improve nutritional and cardiac conditions, survivors should be encouraged to exercise regularly with close monitoring. Pediatr Blood Cancer 2013; 60: 663–668. © 2012 Wiley Periodicals, Inc.
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