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Objective: To assess the feasibility of a supervised, controlled and personalised physical exercise programme and its potential efficacy in improving functional capacity and quality of life in children and adolescents with cancer.
Design: Hybrid quasi-experimental pilot trial, clinical and phase I implementation.
Methods: The learning collaborative approach based on the Institute for Healthcare Improvement Breakthrough Series Collaborative Model will be followed through quarterly Plan-Do-Study-Act (P-D-S-A) cycles. Participants: For feasibility, at least, 45 patients will be included in 3 successive PDSA cycles of at least 15 patients each, aged 4-18 years diagnosed with any type of cancer. Variables: clinical and socio-demographic, body composition, physical condition and mobility, quality of life, physical activity and implementation. Intervention: Everyone will receive a physical exercise intervention combining strength and aerobic capacity work. Initially it will be carried out in the hospital setting, and later in streaming supervised by a professional. The intervention will be modelled through a formative evaluation process with the collaboration of all the agents involved, experimenting in each cycle with an increasingly adapted version of the exercise programme.
Statistical analysis: Recruitment rates will be calculated, characteristics associated with project participation and adherence to the exercise programme will be identified. Outcome variables will be compared before and after the intervention, identifying those with the greatest validity, reliability and sensitivity to change, which will then be used in phase II and III trials.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Physical exercise program | Other | At least two sessions a week for a 6-month supervised and individualized physical exercise program that will have two phases: one that will be carried out in person in the hospital environment taking advantage of medical visits, and a second phase that will allow the patient to carry out the exercise sessions from home with live virtual supervision. | ||
| Type of the physical exercise program | Other | Two types of intervention are proposed depending on the age of the patients: Exercise intervention for adolescents (12 to 18 years): training will be based on strength training (2 - 3 sets of 8 - 12 repetitions) with elastic bands, weights, weights, medicine balls or body weight and aerobic work on a stationary bike, treadmill or other aerobic exercises. Sessions will last about 30-60 minutes (depending on the patient's situation). Exercise intervention for children (4 to 11 years old): The aim will be to work on basic motor skills through play, thus trying to avoid the delay in motor development, and to indirectly work on their physical condition to better cope with the effects of the treatments. Music, games that require movement and materials such as balls, hoops, etc., will be used to motivate the child to move while enjoying themselves. This will be done in sessions of 20 - 40 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Quarterly recruitment rates assessed by comparing those who participate with those who do not. | To assess the feasibility of the exercise programme, quarterly recruitment rates will be calculated over the recruitment and follow-up period, and socio-demographic and morbidity variables associated with study participation will be identified, comparing those who participate with those who do not, using logistic regression analysis. | 2 years |
| Adherence rates assessed by the proportion of sessions completed and adherence to the prescribed exercise protocol | Participants' adherence to the programme will be described in terms of the proportion of sessions completed and compliance with the exercise protocol prescribed for each patient, and variables associated with compliance will be identified. | 2 years |
| Body composition assessed by the Body Mass Index | Body Mass Index (BMI): Diagnoses and classifies obesity. weight and height will be combined to report BMI in kg/m^2). Measured at baseline, and 3 months. | 2 years |
| Muscle mass | Muscle mass will be measured in kgs by a bioimpedance scale. Measured at baseline, and 3 months. | 3 months |
| Bone mineral density | Bone mineral density will be in g/cm2 measured by a bioimpedance scale. Measured at baseline, and 3 months. | 3 months |
| Physical condition assessed by the 6 min walking test and manual grip test with a dynamometer | The 6 minutes walking Test applies to assess functional capacity, as well as a predictor of morbidity and mortality in people with different pathologies. Most of the daily activities that the patients with these pathologies are performed at submaximal exercise intensity, similar to this test is performed. It would be measured at 0 and 3 months. |
| Measure | Description | Time Frame |
|---|---|---|
| Security assessment | To assess the safety of this new exercise programme by describing the occurrence of injuries, incidence of complications. | 2 years |
| Costs associated estimation | Estimate the costs associated with the implementation of the programme. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Nere Mendizabal | Contact | +34946006637 | nere.mendizabalgallastegui@osakidetza.eus |
| Name | Affiliation | Role |
|---|---|---|
| Marta Menchaca Torio | Basque Health Service | Principal Investigator |
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| ID | Term |
|---|---|
| D009043 | Motor Activity |
| D009369 | Neoplasms |
| ID | Term |
|---|---|
| D001519 | Behavior |
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| 3 months |
| Muscular strength assessed by manual grip test with a dynamometer | The manual grip test with a dynamometer applies to assess muscular strength. Most of the daily activities that the patients with these pathologies are performed at submaximal exercise intensity, similar to this test is performed. It would be measured at 0 and 3 months. | 3 months |
| General Quality of life assessed by the PedsQL 4.0 questionnaire | The PedsQL Measurement Model is a modular approach to measuring health-related quality of life (HRQOL) in healthy children and adolescents and those with acute and chronic health conditions. The PedsQL Measurement Model integrates seamlessly both generic core scales and disease-specific modules into one measurement system. The questionnaire is self-reported for children over 8 years old and self-reported by parents for children under 8 years old. This questionnaire has been validated in the Spanish population. It would be measured at 0 and 3 months. | 3 months |
| Specific Quality of life assessed by the PedsQL cancer questionnaire | The Pediatric Quality of Life Inventory (PedsQL) Cancer Module is a standard tool designed to assess the HRQOL among pediatric oncology patients. Consists of an instruction section and 27 items, contained in 8 dimensions. This questionnaire has been validated in the Spanish population. It would be measured at 0 and 3 months. | 3 months |
| Fatigue assessed by the PedsQL Multidimensional Fatigue Scale Acute Version (PedsQL-MFS) | The PedsQL™ Multidimensional Fatigue Scale was designed as a generic symptom-specific instrument to measure fatigue in patients with acute and chronic health conditions as well as healthy school and community populations. The appropriate questionnaire will be used depending on the age of the patients (Toddlers (2-4 years of age), Young Child (5-7 years of age), Child (8-12 years of age), Adolescent (13-18 years of age)). This questionnaire has been validated in the Spanish population. It would be measured at 0 and 3 months. | 3 months |
| Physical activity level assessed by accelerometers | Objectively registered with Actigraph wGT3X-BT accelerometer. Measured at 0 and 3 months | 3 months |
| 3 years |
| Implementation barriers and facilitators | Describe the most important difficulties encountered in its implementation, identify barriers and facilitating factors for its implementation and realisation with minimum quality criteria, using the Consolidated Framework for Implementation Research (CFIR) as a theoretical framework for implementation. | 2 years |