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Check-up, check in: Travis Davis completes a physical assessment with Physical Therapist Lindsey Christoffersen.

Exercise Your Options

A fun fitness study helps children increase activity after leukemia treatment.

By Elizabeth Jane Walker; Photos by Peter Barta

Every evening, parents and kids across the nation sprawl across couches, staring at TVs or other electronic devices. But in the Davis household, 12-year-old Travis is likely joining his dad in a regimen of stretches, crunches and planks. It’s one way the seventh-grader can earn activity points in an exercise study for survivors of acute lymphoblastic leukemia (ALL).

Travis is enrolled in a clinical trial headed by Kiri Ness, PhD, of St. Jude Children’s Research Hospital. The study aims to enroll 384 children and teens in more than 60 sites around the world. Ness and her colleagues are exploring whether a reward-based, interactive website can improve the fitness, quality of life and school attendance of ALL survivors between the ages of 8 and 15.

“During therapy, patients often experience cancer-related fatigue,” says Ness, a faculty member in St. Jude Epidemiology and Cancer Control. “Patients are out of commission for a while during chemotherapy, and once they become sedentary it’s more difficult to regain their strength and energy.

“We’re hoping the kids who participate in this program will become more physically active. That would have positive implications for their long-term health.”

“We’re hoping the kids who participate in this program will become more physically active. That would have positive implications for their long-term health.”

Kiri Ness, PhD


The risks of inactivity

Ness recently joined forces with St. Jude oncologist Hiroto Inaba, MD, PhD; Emily Browne, DNP, RN, Transition Program director, and other colleagues on a separate study that measured the body mass of children with ALL. The team found that most children put on weight during treatment, and the weight gain often continued afterward.

“Today, we have excellent survival rates for ALL, but we need to be careful about adverse effects — both short- and long-term,” Inaba says. “The percentage of overweight and obese patients in our study increased from approximately 25 percent at diagnosis to 50 percent during the off-therapy period. At the same time, their height growth is affected, especially in patients who are 10 years or older at diagnosis and in those with other risk factors. We’re taking steps to develop supportive-care efforts for these children.”

By intervening early, researchers hope to help young ALL survivors maintain a healthy weight — while establishing good habits that will last a lifetime.

Jasmine Hewlett with Travis Davis

Sneaking in exercise

“This study provides a nice way to insert physical activity into the lives of children today, who are attached to the internet,” says Jasmine Hewlett of St. Jude Epidemiology and Cancer Control.

Hop, skip and jump

Each child in the two-year clinical trial wears a physical activity monitor that resembles a wristwatch. The child regularly uploads data from that device into an interactive website.

Participants randomly assigned to the study’s control group receive educational instruction and limited website access. They can view their progress and earn rewards based on points they accrue through physical activity.

The second group gets full access to the website, where they view the progress of their peers, interact with them and earn rewards.

“We want to know whether social interaction and competition increase their physical activity,” explains study coordinator Sarah Terrell. “Does it take peer pressure as well as rewards to motivate these kids to become more active?”

Children in the study receive periodic blood tests, body measurements and fitness evaluations. They also report on their general health, school attendance and quality of life.

Participants can earn points for any type of physical activity, whether it’s walking the dog, stretching before bedtime or helping their parents prepare meals.

“As part of our education component, we also instruct the patients on modifications they may need to make in order to be active,” explains Jennifer Fournier, who handles the study’s collaborating sites.

Inherent rewards

Travis has been excited to set new goals and earn movement points.

“He knew he needed to be active to build the strength and endurance he’d lost during treatment,” his mom says. “This study has given him the opportunity to see how much he’s moving, and it has motivated him to get up and do more.”

Recently, Travis set his sights on learning to play the guitar and speak French. But he also has a third aspiration: He wants to play baseball, a sport he enjoyed before his illness. Through the St. Jude clinical trial, Travis has already rounded third base — having built energy, strength and resilience.

He anticipates that soon he’ll be sliding into home plate.

From Promise, Autumn 2018

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