Abstract
Background: Leukemia is the most common cancer in pediatrics, with many late effects such as higher risk of dyslipidemia, insulin resistance, obesity, and metabolic syndrome. The objective of this work was to investigate substrate oxidation during submaximal exercise in survivors of childhood acute leukemia. Methods: A total of 20 leukemia survivors and 20 healthy children were matched by sex, age, and Tanner stage. They all took a submaximal incremental exercise test to determine fat and carbohydrate oxidation rates. Results: Cardiorespiratory fitness was significantly lower in leukemia survivors, with lower relative VO2 peaks (p < 0.001), lower heart rate values (p = 0.02), and lower exercise power (p = 0.012), whereas rest metabolism and body mass index did not differ between the two groups. During exercise, upward of heart rate relative to VO2 peak was significantly higher (p < 0.001) in childhood leukemia survivors. We found lower carbohydrate and fat oxidation rates (p = 0.07) in leukemia survivors compared with healthy children, and also a significantly lower relative maximal fat oxidation rate (p = 0.014). Conclusion: Despite impaired physical fitness and metabolic response to exercise, childhood leukemia survivors remained sensitive to physical activity interventions, and could readily adapt to submaximal exercise intensity.
Highlights
Acute childhood leukemia, lymphoblastic (ALL) and myeloblastic (AML), is the most common cancer in pediatrics, with an overall age-specific incidence of 46.4 per million persons per year [1]
There was no significant difference between our childhood leukemia survivors and healthy children in rest metabolism (1577.9 ± 579.4 vs. 1553.5 ± 517.3 kcal.day−1, p = 0.51, Hedge’s g = −0.04 (−0.66, 0.58)), physical activity level (1883.5 ± 1042.9 vs. 2527.7 ± 1496.2 metabolic equivalent of task (MET)-minutes/week, p = 0.30, Hedge’s g = 0.49 (−0.14, 1.12)), and in body mass index (BMI) for age percentile (50.5 ± 28.9 vs. 42.3 ± 27.3 percentile, p = 0.35, Hedge’s g = −0.29 (−0.91, 0.34))
The present study showed an impairment in physical fitness and in metabolic fitness in leukemia survivors, they remained well adapted to exercise, with no difference in exercise intensities at which maximal fat oxidation (MFO) was achieved
Summary
Lymphoblastic (ALL) and myeloblastic (AML), is the most common cancer in pediatrics, with an overall age-specific incidence of 46.4 per million persons per year [1]. Several articles have been published on late effects of treatment in this population, notably increased endocrine deficiency [6,7], obesity [8], mitochondrial dysfunction [9], pulmonary [10] and neuromuscular [11] toxicity, cardiovascular diseases [12], and metabolic syndrome [13,14]. Methods: A total of 20 leukemia survivors and 20 healthy children were matched by sex, age, and Tanner stage They all took a submaximal incremental exercise test to determine fat and carbohydrate oxidation rates. Conclusion: Despite impaired physical fitness and metabolic response to exercise, childhood leukemia survivors remained sensitive to physical activity interventions, and could readily adapt to submaximal exercise intensity
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