Customized Exercise Programming – Pediatrics

pediatric cancer cancer exercise training institute

Judy received a referral for a 14 year-old child with a stage II Medulloblastoma (Brain Cancer). She’s been a Cancer Exercise Specialist for five years, but has not had any experience working with childhood cancer. She asked if she could hire me to help her with custom exercise programming and teach her how to put together Emily’s exercise program. She completed her initial assessment and health history and shared the following information with me:

  • Emily is 14 years old and a healthy active child prior to her cancer diagnosis
  • Emily is 5’3″ and 100 lbs. She has 25% bodyfat.
  • She had been running track, doing gymnastics, and swimming prior to her cancer diagnosis. 
  • She was diagnosed with brain cancer in February 2019
  • She underwent radiation (external beam and brachytherapy) in March, prior to her craniotomy to remove the tumor
  • She completed chemotherapy in May 2019
  • She is struggling with fatigue and difficulty concentrating and learning
  • Her BP is 110/60 and her RHR is 65.

Judy conducted a basic postural assessment. Emily has good posture for a growing adolescent, but “carries herself’ in a way that shows her insecurity and lack of self-confidence. Her hair is starting to grow back in, but she refers to herself as “ugly.”

Since the craniotomy, Emily has had peripheral neuropathy in both feet and has a very difficult time with balance and coordination. Her doctors are also concerned that Emily may have delayed growth and development from the treatment. Emily is seeing a psychologist to help her with depression. She is very weak and gets tired after about five minutes of activity. Emily is also working with a registered dietician to help her safely lose body fat and get all of the nutrients that she needs. Although she only had her menstrual period for a year, she has not had it since her treatment began. Doctors are concerned about the effects of treatment on her reproductive cycle.

I started by compiling my own notes and breaking everything down for Judy one step at a time.

  1. Because she underwent chemotherapy she is still struggling with fatigue (compounded by the radiation) and will need to start with shorter sessions. She will begin with 20-30 min. 3-4 times per week at a very low intensity. The long-term side-effects of chemotherapy include damage to the heart and lungs, diabetes, and osteoporosis, therefore, the exercise program must include both cardio and strength training to minimize or prevent those particular co-morbidities.
  2. Because she has peripheral neuropathy in both feet, Emily must avoid all high-impact activities. She needs to work on balance, but must do so in a way that is safe and effective. Because her psyche is so fragile, Judy must boost Emily’s self-confidence through activities that she can be successful at. Positive reinforcement will be a critical component of each session.
  3. Because of her poor self-esteem and the way she carries herself, Emily has a degree of upper-crossed syndrome. She needs to stretch both her pecs and lats while strengthening the scapular stabilizers. She should avoid pushing exercises like push-ups and chest press and focus on shoulder retraction/depression, rowing, and maybe reverse flys.  
  4. Judy is going to include brain-training exercises – math, direction, and memory, to help her with her cognitive skills. She also recommends a Lumosity account and practice drills daily to her parents.
  5. Judy suggests that Emily discuss assisting her gymnastics or track coach and helping out with the team in various ways, until she is able to actively participate on her own. This will help her to still feel as if she is part of the team and create a sense of belonging for Emily. Because her immune system is still weak, Judy explains that Emily should avoid public swimming areas for the time being.
 
Once I wrapped my head around the 10 aforementioned notes, I was able to come up with the following workout routine for Tom to facilitate with John for his initial 6-8 weeks.
 
DAILY 
Lumosity exercises that will help with cognitive function and memory. Judy creates a plan for her family to work with her on exercises that involved directional changes (up, down, forward, back, left, right), and speed changes for 10-minutes per day. 
 
Balance training – starting very basic. Emily will hold on to counter top (stable) and try to lift one foot off of the floor slightly. The goal will be to keep hips level, engage abdominal muscles, and BREATHE while holding for up to 5-10 seconds (if pain free). She should increase the time with each session providing that there is no pain. She can also lessen her grip on countertop as she feels more stable. Judy will look for any noticeable muscle imbalances and compensations and make sure to correct them.
 
2 x PER WEEK
Stretch pecs and lats. This can be done more often if desired and tolerated. Start with corner stretch for chest and progress to door stretch. Hold for 20-30 sec. To stretch lats, perform a modified childs’ pose while sitting in a chair and letting arms stretch forward onto a table. 
 
Perform several repetitions of scapular stabilization exercises.
 
2 x PER WEEK
Her parents purchased an Upper Body Ergometer so that Emily can work on her cardio without worrying about balance and neuropathy. She will start with five minute sessions and increase frequency, intensity, and duration as tolerated.
 
Squats are critical for activities of daily living. Working with Emily on form is important to her quality of life. This will be based on pain level in her feet on training days.  She will start with body weight and do as many repetitions as she can with good form and, in the absence of pain. 
 
While adding strength-training to her routine is definitely in her future, the goal for this initial period is to boost her self-confidence and endurance while preventing injury or further setback. Judy is going to include some basic yoga moves as well as core exercises on the foam roller and balance ball.
 
 
Judy will re-assess Emily in 8 weeks and either continue with this routine, or progress to longer duration of cardio, more repetitions, and the addition of strength training exercises.
If you are in need of assistance with a special-needs or physically-challenged client, you can get Andrea Leonard’s help in with custom exercise programming.
 

According to the American Cancer Society, the overall estimate of 1,735,350 cases for 2018 equals more than 4,700 new cancer diagnoses each day. The lifetime probability of being diagnosed with cancer is 39.7% for men and 37.6% for women, which is a little more than 1 in 3. Cancer affects us all at one point or another.

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