THE CURRENT EVIDENCE ON THE EFFECTS OF PHYSICAL ACTIVITY AND EXERCISE THERAPY ON PEDIATRIC BRAIN TUMOR SURVIVORS: A SYSTEMATIC REVIEW

M. Khaleqi-Sohi¹, G. Sadria², K. Khademi-Kalantari², M. Ghalibafian³

¹MAHAK Pediatric Cancer Treatment and Research Center (MPCTRC), Physiotherapy Department, Tehran, Iran, ²School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Physiotherapy, Tehran, Iran, ³MAHAK Pediatric Cancer Treatment and Research Center (MPCTRC), Radiation Oncology, Tehran, Iran

Background: Pediatric brain tumors are commonly established with late effects such as poor gross motor ability, cerebellar motor dysfunction and cognitive deficits that can significantly affect the children's physical and mental ability as well as their quality of life. Evidence suggests that survivors are less able to participate in physical activity, maintain school work, become involved in conversation with peers and family members. The range of impairments following treatment for childhood brain tumor is varied. Cognitive impairments are the most common. Cognitive deficits are reported due to changes in IQ score, attention, working memory and executive function. Deficits in cognitive and learning processes can lead to a series of educational and social problems in children. Hence it is of great significance to rehabilitate survivors to promote their cognitive skills.

Purpose: The aim of the present systematic review is to investigate the effects of exercise therapy on the complications as well as late effects arising from the nature of tumor and its different treatments in survivors from pediatric brain tumors.

Methods: Six databases, of Embase, Med line, Cochrane Central Database, PubMed, CINAHL and Elsevier from the year of 2000 were searched for the studies focusing on the effects of exercise therapy in pediatric brain tumor following different treatment procedures. After applying the inclusion and exclusion criteria, nine out of 224 articles were included for the present systematic review. The articles were rated based on Physiotherapy Evidence Database (PEDro) scales for methodological assessment.

Results: The study revealed that that the children who survived from brain tumors commonly suffer from damage to hippocampus, cortex and the white matter. The literature also indicated that improvements in motor proficiency and physical fitness after exercise therapy were consistent with such MRI results as increase in the right somatosensory cortical thickness, increased FA in corpus callosum, in the right corticospinal pathway as well as in cingulum.

Conclusions: Motor control and sensorimotor control improvement as a result of a course of exercise therapy in patients suffering from brain tumor seem to occur because of the white matter increase in pre-post central gyri, left temporal pole, left superior temporal gyrus, left Para hippocampal gyrus. With increase in the right somatosensory cortical thickness and neuronal connection enhancement, physical exercises would help the formation of normal sensorimotor experiences, justifying children's better performance in cognitive tests and eventually promoting the quality of life.

Implications: One of the hazards of receiving chemo- and radiation therapy is the damage to hippocampus and brain structures including cortex and the white matter in the individuals who survived from brain tumors during childhood. In addition to the role of the hippocampus in cognition and mental ability, motor skills and physical fitness also seem to play a part in the cognitive processes. Processes such as cognition develop when sufficient growth of motor and perceptual systems as well as connections between them happen. So, children suffering from sensory-motor deficits experience a series of social and educational difficulties.

Funding acknowledgements: The authors thank Dr. Ghalibafian and Dr. Kalantari for providing valuable knowledge and expertise.

Keywords:
Neuro-Oncology, Brain Tumor, Cancer Survivors
Pediatric
Physical Activity, Exercise Therapy

Topics:
Oncology, HIV & palliative care
Paediatrics
Mental health

Did this work require ethics approval? No

Reason: It is a systematic review so ethics approval was not required.