Device-measured Physical Activity And Cardiovascular Disease Risk In Adolescent Childhood Cancer Survivors

Abstract

Childhood cancer survivors (CCS) are at increased risk of developing cardiovascular diseases (CVD) due to aggressive cancer treatment. The relationship between physical activity (PA) and CVD risk in CCS has not been thoroughly investigated. PURPOSE: To compare CVD risk in adolescent CCS with an international age- and sex-stratified reference; and examine the association between device-measured PA and CVD risk in adolescent CCS. METHODS: The Physical Activity in Childhood Cancer Survivors (PACCS) Study is a cross-sectional, multicentre study. Data were gathered in Norway and Switzerland on PA and CVD risk factors (VO2-peak in ml/kg/min, body mass index (BMI), systolic blood pressure (SBP, mm/Hg), total-cholesterol/HDL-cholesterol (Total/HDL) from CCS aged 9-18 yrs. Values of CVD risk factors were transformed into external z scores, and an individual CVD risk score was calculated as: (ZVO2-peak + ZBMI + ZSBP + ZTotal/HDL) / 4. CVD risk factors and the CVD risk score were compared with Welch’s t-test. Multivariable mixed models were used to analyse the association between PA and CVD risk. RESULTS: We included 157 CCS aged on average 13.4 yrs at inclusion and 8.2 yrs from diagnosis. Male CCS had lower VO2-peak compared to references (45.0 ± 10.7 vs. 49.4 ± 1.1 ml/kg/min, p < 0.001), as well as a borderline higher CVD risk score (0.16 ± 0.72 vs. 0.0 ± 1.0, p = 0.053). In contrast, female CCS’ CVD risk was comparable to references. Ten minutes increase in low-intensity PA (LPA), moderate-intensity PA (MPA), and vigorous-intensity PA (VPA) were associated with higher VO2-peak ((βLPA = 0.5, 95% CI: 0.2, 0.8; βMPA = 1.2, 95% CI: 0.6, 1.7; and βVPA = 5.0, 95% CI: 2.2, 7.9) and a lower CVD risk score (βLPA = -0.0, 95% CI: -0.1, -0.0; βMPA = -0.1, 95% CI: -0.1, -0.0; and βVPA = -0.4, 95% CI: -0.6, -0.2). Ten minutes increase of MPA was also associated with lower SBP (β = -0.9, 95% CI: -1.5, -0.2), and VPA with lower Total/HDL (β = -0.3, 95% CI: -0.6, -0.1). A 100 count per minute increase in total PA was associated with higher VO2-peak (β = 1.3 (95% CI: 0.5, 2.0), lower SBP (β = -0.9, 95% CI: -1.7, -0.1), lower Total/HDL (β = -0.1, 95% CI: -0.2, -0.0), and a lower CVD risk score (β = -0.1, 95% CI: -0.2, -0.0). CONCLUSIONS: Increased PA in adolescent CCS is associated with lower CVD risk score. Supported by the Norwegian Research Council and the Norwegian Cancer Association