Skip to content

Paeds Cancer – Improvement in Cardio-pulmonary fitness

Evidence Summary
There is some evidence that cardiopulmonary fitness (heart and lung capacity to exercise) can be lower for young people affected by cancer both during illness and in the long term (1,2)

Being active can help heart and lung fitness before, during and after treatment, with most of the evidence being for endurance activity (such as running, ball sports and cycling) but some also in strength-based activity such as yoga.
Ask your healthcare teams about the right level of activity that is safe for you.

Being active from the ward and also at home with friends and family is helpful. Benefits are seen at the time of treatment and up to one year, but also in smaller studies in the longer-term (3-22)

Effects of treatment can have an impact on heart health (27) Exercise can help reduce this risk increasing.
Exercise medicine advice can help progress physical activity training to return to sport

Quality of Evidence
Low – Moderate
Strength of Recommendation
Whilst fitness and ability fully to participate will be impacted during illness and treatment, children and young adults should be supported to maintain physical activity in order to support heart and lung health in childhood and reduce long term cardiac risks (26, 27)


  1. Järvelä LS, Niinikoski H, Lähteenmäki PM, Heinonen OJ, Kapanen J, Arola M, et al. Physical activity and fitness in adolescent and young adult long-term survivors of childhood acute lymphoblastic leukaemia. J Cancer Surviv. 2010;4(4):339-45.
  2. Antwi GO, Jayawardene W, Lohrmann DK, Mueller EL. Physical activity and fitness among pediatric cancer survivors: a meta-analysis of observational studies. Support Care Cancer. 2019:1-12.
  3. Moyer-Mileur LJ, Ransdell L, Bruggers CS. Fitness of children with standard-risk acute lymphoblastic leukemia during maintenance therapy: response to a home-based exercise and nutrition program. J Pediatr Hematol Oncol. 2009;31(4):259-66.
  4. Senn-Malashonak A, Wallek S, Schmidt K, Rosenhagen A, Vogt L, Bader P, et al. Psychophysical effects of an exercise therapy during pediatric stem cell transplantation: a randomized controlled trial. Bone Marrow Transplant. 2019:1.
  5. Tanir MK, Kuguoglu S. Impact of exercise on lower activity levels in children with acute lymphoblastic leukemia: a randomized controlled trial from Turkey. Rehabil Nurs. 2013;38(1):48-59.
  6. Galvão DA, Newton RU. Review of exercise intervention studies in cancer patients. J Clin Oncol. 2005;23(4):899-909.
  7. Mizrahi D, Wakefield CE, Fardell JE, Quinn VF, Lim Q, Clifford BK, et al. Distance-delivered physical activity interventions for childhood cancer survivors: A systematic review and meta-analysis. Crit Rev Oncol Hematol. 2017;118:27-41.
  8. Morales JS, Valenzuela PL, Rincon-Castanedo C, Takken T, Fiuza-Luces C, Santos-Lozano A, et al. Exercise training in childhood cancer: A systematic review and meta-analysis of randomized controlled trials. Cancer Treat Rev. 2018;70:154-67.
  9. Müller C, Krauth KA, Gerß J, Rosenbaum D. Physical activity and health-related quality of life in pediatric cancer patients following a 4-week inpatient rehabilitation program. Support Care Cancer. 2016;24(9):3793-802.
  10. Munsie C, Ebert J, Joske D, Ackland T. The Benefit of Physical Activity in Adolescent and Young Adult Cancer Patients During and After Treatment: A Systematic Review. J Adolesc Young Adult Oncol. 2019.
  11. Piscione P, Bouffet E, Timmons B, Courneya K, Tetzlaff D, Schneiderman J, et al. Exercise training improves physical function and fitness in long-term paediatric brain tumour survivors treated with cranial irradiation. Eur J Cancer. 2017;80:63-72.
  12. Rustler V, Hagerty M, Daeggelmann J, Marjerrison S, Bloch W, Baumann FT. Exercise interventions for patients with pediatric cancer during inpatient acute care: A systematic review of literature. Pediatr Blood Cancer. 2017;64(11):e26567.
  13. West SL, Gassas A, Schechter T, Egeler RM, Nathan PC, Wells GD. Exercise intolerance and the impact of physical activity in children treated with hematopoietic stem cell transplantation. Pediatr Exerc Sci. 2014;26(3):358-64.
  14. Wolin KY, Ruiz JR, Tuchman H, Lucia A. Exercise in adult and pediatric hematological cancer survivors: an intervention review. Leukemia. 2010;24(6):1113.
  15. Wurz A, Chamorro‐Vina C, Guilcher GM, Schulte F, Culos‐Reed SN. The feasibility and benefits of a 12‐week yoga intervention for pediatric cancer out‐patients. Pediatr Blood Cancer. 2014;61(10):1828-34.
  16. Järvelä LS, Kemppainen J, Niinikoski H, Hannukainen JC, Lähteenmäki PM, Kapanen J, et al. Effects of a home‐based exercise program on metabolic risk factors and fitness in long‐term survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2012;59(1):155-60.
  17. Järvelä LS, Niinikoski H, Heinonen OJ, Lähteenmäki PM, Arola M, Kemppainen J. Endothelial function in long‐term survivors of childhood acute lymphoblastic leukemia: Effects of a home‐based exercise program. Pediatr Blood Cancer. 2013;60(9):1546-51.
  18. Järvelä LS, Saraste M, Niinikoski H, Hannukainen JC, Heinonen OJ, Lähteenmäki PM, et al. Home‐Based Exercise Training Improves Left Ventricle Diastolic Function in Survivors of Childhood ALL: A Tissue Doppler and Velocity Vector Imaging Study. Pediatr Blood Cancer. 2016;63(9):1629-35.
  19. Braam KI, van der Torre P, Takken T, Veening MA, van Dulmen‐den Broeder E, Kaspers GJ. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev. 2016(3).
  20. Braam KI, van Dijk-Lokkart EM, Kaspers GJ, Takken T, Huisman J, Bierings MB, et al. Cardiorespiratory fitness and physical activity in children with cancer. Support Care Cancer. 2016;24(5):2259-68.
  21. Baumann FT, Bloch W, Beulertz J. Clinical exercise interventions in pediatric oncology: a systematic review. Pediatr Res. 2013;74(4):366.
  22. Berkman AM, Lakoski SG. A Review of cardiorespiratory fitness in adolescent and young adult survivors of childhood cancer: factors that affect its decline and opportunities for intervention. Journal of adolescent and young adult oncology. 2016;5(1):8-15.
  23. Aznar S, Webster AL, San Juan AF, Chamorro-Vina C, Mate-Munoz JL, Moral S, et al. Physical activity during treatment in children with leukemia: a pilot study. Applied physiology, nutrition, and metabolism. 2006;31(4):407-13.
  24. Bogg TFT, Broderick C, Shaw P, Cohn R, Naumann FL. Feasibility of an inpatient exercise intervention for children undergoing hematopoietic stem cell transplant. Pediatr Transplant. 2015;19(8):925-31.
  25. Bourdon A, Grandy SA, Keats MR. Aerobic exercise and cardiopulmonary fitness in childhood cancer survivors treated with a cardiotoxic agent: a meta-analysis. Support Care Cancer. 2018;26(7):2113-23.
  26. Jones LW, Liu Q, Armstrong GT, Ness KK, Yasui Y, Devine K, et al. Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study. J Clin Oncol. 2014;32(32):3643.
  27. Scott JMS, Nilsen TS, Gupta D, Jones L. Exercise therapy and cardiovascular toxicity in Cancer, Circulation. 2018; 137:1176–1191