title: 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.
abstract: BACKGROUND
  Reduced bone mineral density (BMD), altered body composition, impaired motor performance and passive ankle dorsiflexion are side effects of acute lymphoblastic leukemia (ALL) treatment. We performed a randomized study investigating whether an exercise program could prevent these side effects.
  
  
  METHODS
  At diagnosis we randomized 51 ALL patients (median age: 5.4 years) into a group receiving a 2-year exercise program or a control group receiving standard care. BMD of total body (BMD(TB)), lumbar spine (BMD(LS)) and body composition were measured using dual energy X-ray absorptiometry, motor performance with Bayley Scales of Infant Development or Movement-ABC, and passive ankle dorsiflexion with a goniometer. The investigator was blinded to the randomization.
  
  
  RESULTS
  Body fat increased equally during treatment in both groups. One year after cessation of therapy more rapid decline of excessive body fat was observed in the intervention group than in the controls (P = 0.01). Lean body mass, BMD(TB) and BMD(LS) of both groups decreased equally during treatment and increased equally thereafter. Both groups showed a similar decrease in passive ankle dorsiflexion and motor performance during treatment. Adherence to the intervention program varied considerably. Adherence to intervention: 11% of children exercised daily, 37% > once a week, 16% once weekly, 36% < once a week.
  
  
  CONCLUSIONS
  The exercise program was not more beneficial than standard care in preventing reduction in BMD, motor performance and passive ankle dorsiflexion than standard care, most likely due to unsatisfactory compliance. Increased BMI and body fat in the intervention group normalized faster after cessation of chemotherapy.
authors.affiliation: Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. j.hartman@erasmusmc.nl
authors.forename: A
authors.initials: A
authors.lastname: Hartman
authors.forename: M L
authors.initials: ML
authors.lastname: te Winkel
authors.forename: R D
authors.initials: RD
authors.lastname: van Beek
authors.forename: S M P F
authors.initials: SM
authors.lastname: de Muinck Keizer-Schrama
authors.forename: H C G
authors.initials: HC
authors.lastname: Kemper
authors.forename: W C J
authors.initials: WC
authors.lastname: Hop
authors.forename: M M
authors.initials: MM
authors.lastname: van den Heuvel-Eibrink
authors.forename: R
authors.initials: R
authors.lastname: Pieters
mesh_terms: D000293:Adolescent; D000842:Ankle / Q000503:physiopathology; D000886:Anthropometry; D001823:Body Composition; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009048:Motor Skills / Q000145:classification; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D016059:Range of Motion, Articular