Fitness, body composition and vascular health in adolescent and young adult survivors of paediatric brain cancer and cranial radiotherapy

Treya M. Long; Shoshana R. Rath; Tessa D. Maroni; Karen E. Wallman; Helen C. Atkinson; Nicholas G. Gottardo; Catherine H. Cole; Catherine S. Choong; Louise H. Naylor

doi:10.1515/ijamh-2017-0082

Artikel

Fitness, body composition and vascular health in adolescent and young adult survivors of paediatric brain cancer and cranial radiotherapy

Treya M. Long , Shoshana R. Rath , Tessa D. Maroni , Karen E. Wallman , Helen C. Atkinson , Nicholas G. Gottardo , Catherine H. Cole , Catherine S. Choong und Louise H. Naylor

Veröffentlicht/Copyright: 20. September 2017

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Aus der Zeitschrift International Journal of Adolescent Medicine and Health Band 31 Heft 5

Abstract

Background

Survivors of paediatric brain cancer and/or cranial radiotherapy (CRT) are at an increased risk of developing serious comorbidities. Established risk factors for chronic disease include central obesity, endothelial abnormalities and diminished fitness.

Objectives

Here we characterised anthropometry, body composition, bone mineral density (BMD), heart rate (HR), blood pressure (BP), endothelial function, muscular strength and endurance and aerobic fitness in adolescent and young adult (AYA) survivors.

Methods

Twenty survivors (10 male, 10 female; 20 ± 2 years) were compared with 19 matched controls. Muscular strength was assessed using three repetition maximum tests, while muscular endurance was determined as number of repetitions performed per minute. Peak oxygen uptake (VO₂ peak) was assessed on a treadmill using a modified chronotropic protocol. Anthropometric measurements, HR and BP were taken using standard clinical protocols, while body composition and BMD were determined using dual X-ray absorptiometry (DXA). Endothelial function was measured using the flow mediated dilation technique.

Results

Survivors demonstrated deficits in muscular strength (latissimus dorsi pull-down, p = 0.020; bicep curl, p = 0.009), muscular endurance (squats, p = 0.012; sit-ups, p = 0.030; push-ups, p = 0.013), minute ventilation at peak exericse (p = 0.002) and VO_2peak (L/min, p = 0.002; mL/kg/min, p = 0.008; mL/kg LBM/min, p = 0.010). Additionally, survivors had greater waist-to-hip ratios (p = 0.032), resting HR (p = 0.048) and higher percentage of total body (p = 0.017), central (p = 0.009) and peripheral (p = 0.032) fat. Lean body mass (p = 0.004) and BMD (p = 0.005) were lower in the survivor group.

Conclusion

AYA survivors of paediatric brain cancer and/or CRT exhibit altered body composition, increased resting HR and reduced BMD, muscular strength, muscular endurance and cardiorespiratory fitness compared to controls.

Keywords: brain cancer; long-term survival; radiation therapy

Acknowledgement

This work was supported by the Telethon New Children’s Hospital Research Fund (CSC), Princess Margaret Hospital Foundation (SRR), The Perron Family Foundation who supports the Chair of Paediatric Haematology/Oncology (CHC) and the REDiMED Honours Scholarship (TML). We acknowledge the assistance of Miss Kerrie Graham for help with recruitment of study participants and Dr. Mandy Taylor for details regarding radiotherapy treatments of the cancer survivors.

Appendix

Table 5:

Comparison data for cancer survivors who received surgery and/or chemotherapy and cancer survivors who received radiotherapy only.

	Surgery and/or chemotherapy (n = 7)		Radiotherapy (n = 13)
	Mean	SD	Mean	SD	p-Value
Heart rate and blood pressure
Systolic blood pressure, mm Hg	121	9	116	20	0.571
Diastolic blood pressure, mm Hg	69	6	69	13	0.911
Mean arterial pressure, mm Hg	89	5	87	17	0.836
Heart rate, bpm	76	10	75	16	0.905
Endothelial function
Baseline diameter, cm	0.34	0.07	0.31	0.07	0.461
Peak diameter, cm	0.37	0.06	0.34	0.07	0.402
Delta diameter, cm	0.03	0.01	0.06	0.09	0.576
Delta percent, %	10.19	4.69	9.78	3.08	0.836
Time to peak, s	50.41	39.59	54.16	20.93	0.799
Anthropometry
Height, cm	168.51	18.17	161.77	9.12	0.278
Body mass, kg	66.96	18.87	66.33	24.99	0.955
Body mass index, kg/m²	23.1	3.5	25.2	8.3	0.542
Waist circumference, cm	75.6	10.0	81.6	17.6	0.421
Hip circumference, cm	95.0	8.6	96.5	21.4	0.863
Waist:hip ratio	0.79	0.07	0.85	0.07	0.133
Body composition
Total fat mass, kg	20.91	8.06	25.08	15.68	0.521
Central fat mass, kg	12.02	5.10	15.37	10.98	0.459
Peripheral fat mass, kg	14.24	5.45	15.81	8.90	0.677
Total percent fat, %	33.56	10.13	37.43	9.78	0.415
Central percent fat, %	35.02	10.37	38.83	9.62	0.422
Peripheral percent fat, %	36.95	11.44	40.24	10.36	0.522
Total lean body mass, kg	42.96	15.54	37.57	9.30	0.341
Bone mineral density
Total bone mineral density, g/cm	1.14	0.09	1.13	0.12	0.875
Muscular strength, kg
Lateral pull downs	49	18	38	15	0.184
Bicep curl	8	3	7	4	0.805
Muscular endurance (60 s)
Squats	34	12	30	17	0.612
Sit-ups	25	7	28	10	0.500
Push-ups	26	11	23	12	0.628
Graded exercise test
Rating perceived exertion	17	1	16	3	0.345
Maximal heart rate, bpm	190	3	178	15	0.023^a
Minute ventilation, L/min	80.63	39.55	58.41	17.75	0.200
Respiratory exchange ratio	1.01	0.06	1.08	0.35	0.634
V˙O2peak, L/min	2.96	1.51	2.06	0.56	0.209
V˙O2peak, mL/kg/min	43.99	13.66	31.40	11.75	0.064
V˙O2peak, mL/kg LBM/min	65.68	11.29	52.92	12.28	0.053

LBM, lean body mass.
^aDenotes statistical significance (p ≤ 0.05).

Table 6:

Comparison data for cancer survivors with and without hormone deficiency.

	GHD and TSH deficiency (n = 8)		Normal GH and TSH (n = 12)			FSH deficiency (n = 7)		Normal FSH (n = 13)
	Mean	SD	Mean	SD	p-Value	Mean	SD	Mean	SD	p-Value
Heart rate and blood pressure
Systolic blood pressure, mm Hg	112	15	121	18	0.247	119	24	116	14	0.784
Diastolic blood pressure, mm Hg	66	6	71	13	0.283	71	15	68	9	0.534
Mean arterial pressure, mm Hg	84	10	90	16	0.329	89	18	87	11	0.760
Heart rate, bpm	73	6	77	18	0.550	83	18	71	9	0.063
Endothelial function
Baseline diameter, cm	0.28	0.07	0.34	0.06	0.060	0.29	0.06	0.33	0.07	0.229
Peak diameter, cm	0.30	0.07	0.37	0.06	0.053	0.31	0.07	0.36	0.07	0.235
Delta diameter, cm	0.07	0.11	0.03	0.01	0.267	0.08	0.12	0.03	0.01	0.182
Delta percent, %	11.77	3.53	9.36	3.91	0.213	11.93	1.89	9.49	4.41	0.222
Time to peak, s	50.03	14.80	55.66	32.43	0.657	55.21	27.09	51.85	25.86	0.795
Anthropometry
Height, cm	155.53	12.21	169.87	10.24	0.011^a	159.49	9.09	166.63	14.31	0.250
Body mass, kg	55.08	20.67	74.20	21.08	0.061	67.87	33.59	65.84	15.40	0.854
Body mass index, kg/m²	22.19	5.73	25.99	7.53	0.242	26.03	11.16	23.63	3.53	0.478
Waist circumference, cm	73.57	13.80	82.78	15.49	0.212	82.50	25.70	77.95	8.01	0.559
Hip circumference, cm	85.86	10.35	101.88	18.34	0.050^a	96.75	28.99	95.62	10.28	0.900
Waist: hip ratio	0.85	0.08	0.81	0.07	0.272	0.85	0.09	0.82	0.06	0.354
Body composition
Total fat mass, kg	19.91	10.19	26.09	15.10	0.326	26.67	20.23	21.98	8.48	0.470
Central fat mass, kg	11.60	7.14	15.93	10.48	0.323	16.54	14.29	12.93	5.55	0.424
Peripheral fat mass, kg	12.96	5.63	16.79	8.77	0.290	16.65	11.40	14.51	5.30	0.569
Total percent fat, %	36.78	7.61	35.61	11.36	0.440	37.56	10.34	35.28	9.85	0.633
Central percent fat, %	37.63	9.03	37.41	10.66	0.953	38.31	11.46	37.06	9.25	0.793
Peripheral percent fat, %	40.29	7.21	38.30	12.58	0.099	41.10	9.90	38.01	11.15	0.547
Total lean body mass, kg	32.39	11.01	44.16	10.02	0.023^a	37.48	12.22	40.2	11.84	0.594
Bone mineral density
Total bone mineral density, g/cm	1.08	0.10	1.16	0.11	0.261	1.14	0.11	1.13	0.11	0.871
Muscular strength, kg
Lateral pull downs	36	17	46	16	0.220	37	15	44	17	0.371
Bicep curl	7	2	8	3	0.215	7	2	8	3	0.444
Muscular endurance (60 s)
Squats	27	13	35	16	0.255	30	11	33	17	0.696
Sit-ups	24	5	29	11	0.294	24	5	28	11	0.402
Push-ups	20	10	28	11	0.146	22	9	26	12	0.547
Graded exercise test
Rating perceived exertion	17	3	17	3	0.791	16	3	17	2	0.606
Maximal heart rate, bpm	179	13	185	14	0.362	182	10	182	15	0.959
Minute ventilation, L·min⁻¹	53.37	14.46	76.21	33.40	0.089	62.65	7.78	68.89	36.31	0.663
Respiratory exchange ratio	0.99	0.12	1.10	0.35	0.406	1.18	0.43	0.98	0.09	0.120
V˙O2peak, L/min	1.75	0.41	2.82	1.15	0.033^a	1.99	0.33	2.60	1.26	0.272
V˙O2peak, mL/kg/mim	30.79	5.44	39.38	16.49	0.207	29.10	7.17	39.52	15.00	0.133
V˙O2peak, mL/kg LBM/min	53.40	9.13	60.24	15.22	0.307	51.16	8.25	60.84	14.40	0.154

FSH, follicle stimulating hormone; GH, growth hormone; GHD, Growth hormone deficiency; LBM, Lean body mass; TSH, thyroid stimulating hormone.
^aDenotes statistical significance (p ≤ 0.05).

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Received: 2017-05-09

Accepted: 2017-07-19

Published Online: 2017-09-20

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brain cancer; long-term survival; radiation therapy