An excess of physical activity (PA) was associated with worse treatment symptoms and impaired cognitive development among pediatric patients with acute lymphocytic leukemia (ALL), according to study results published in Cancer Nursing

Children who receive leukemia treatment often experience a symptom cluster consisting of fatigue, sleep disturbance, pain, nausea, and depression, and often have decreased level of PA during the first year of treatment. The impact of exercise, or the lack thereof, on long term symptom management and cognitive outcomes in this patient population requires further study. 

For this study, researchers utilized the longitudinal parallel-process model to evaluate the outcomes of 327 children undergoing treatment for ALL. Symptoms, physical activity, and cognitive function were assessed at 4 different periods: at the start of postinduction therapy, 4 and 8 months post induction therapy, and during the first cycle of maintenance/continuation therapy. 

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Results showed that children who had higher PA levels at postinduction had reductions in their symptom clusters throughout the first year of therapy. When physical activity increased over the other periods, however, symptom severity also increased. 

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Cognitive function was also significantly associated with symptom severity. Analyses revealed that severe symptom clusters at postinduction therapy was associated with worse cognitive function at postinduction, and if symptoms worsened over time, cognitive function also declined. 

Physical activity is important for childhood development, but may negatively affect outcomes during cancer therapy. The authors concluded that “future research needs to focus on how PA impacts symptoms and how clinicians can decrease symptom distress and advance cognitive health for children with leukemia.”


Hooke MC, Rodgers C, Taylor O, et al. Physical activity, the childhood cancer symptom cluster—leukemia, and cognitive function: a longitudinal mediation analysis[published online August 17, 2018]. Cancer Nurs. doi: 10.1097/NCC.0000000000000634