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Fitness and metabolic response to exercise in young adult survivors of childhood lymphoma

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Abstract

Purpose

Childhood lymphoma survivors (CLSs) are at high risk of reduced daily activity. This work studied metabolic substrate use and cardiorespiratory function in response to exercise in CLSs.

Methods

Twenty CLSs and 20 healthy adult controls matched for sex, age, and BMI took an incremental submaximal exercise test to determine fat/carbohydrate oxidation rates. Resting echocardiography and pulmonary functional tests were performed. Physical activity level, and blood metabolic and hormonal levels were measured.

Results

CLSs reported more physical activity than controls (6317 ± 3815 vs. 4268 ± 4354 MET-minutes/week, p = 0.013), had higher resting heart rate (83 ± 14 vs. 71 ± 13 bpm, p = 0.006), and showed altered global longitudinal strain (− 17.5 ± 2.1 vs. − 19.8 ± 1.6%, p = 0.003). We observed no difference in maximal fat oxidation between the groups, but it was reached at lower relative exercise intensities in CLSs (Fatmax 17.4 ± 6.0 vs. 20.1 ± 4.1 mL/kg, p = 0.021). At V̇O2 peak, CLSs developed lower relative exercise power (3.2 ± 0.9 vs. 4.0 ± 0.7 W/kg, p = 0.012).

Conclusion

CLSs reported higher levels of physical activity but they attained maximal fat oxidation at lower relative oxygen uptake and applied lower relative power at V̇O2 peak. CLSs may thus have lower muscular efficiency, causing greater fatigability in response to exercise, possibly related to chemotherapy exposure during adolescence and childhood. Long-term follow-up is essential and regular physical activity needs to be sustained.

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Data Availability

Data are available on request.

Abbreviations

3MST :

3-Minute step test

BMI:

Body mass index

CHOs:

Carbohydrates

CLSs:

Childhood lymphoma survivors

CRP:

C reactive protein

ES:

Effect size

FEV1 :

Forced expiratory volume in one second

FVC:

Forced vital capacity

GH:

Growth hormone

GLS :

Global longitudinal strain

HOMA-IR:

Homeostasis

HR:

Heart rate

IWST:

Isometric wall squat test

IGF-1:

Insulin-like growth factor

MFO:

Maximal fat oxidation

NT-pro-BNP:

N-terminal section of brain natriuretic peptide precursor

PA:

Physical activity

Q1:

First quartile

Q3:

Third quartile

RER:

Respiratory exchange ratio

RV:

Residual volume

SEV:

Systolic ejection volume

TLC:

Total lung capacity

TLCO:

Lung diffusion capacity for carbon monoxide

V̇CO2 :

Carbon dioxide excretion

V̇O2 :

Dioxygen uptake

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Acknowledgements

This project was conducted as part of a research program by the Health and Exercise Response in Children with Chronic and auto-immUne pathoLogiEs (HERCCULE). The investigators were Alexandre Armand; Corinne Borderon; Aurélie Chausset; Pascale Duché; Stéphane Echaubard; Solenne Fel; Justyna Kanold; Emmanuelle Labraise; Etienne Merlin; Stéphane Nottin; Justine Paysal; Charline Pegon; Bruno Pereira; Ruddy Richard; Emmanuelle Rochette; Nadège Rouel; Oussama Saidi, Catherine Sarret and Daniel Terral.

Funding

This study was supported by a grant from Ligue Contre le Cancer, Comité départemental du Puy-de-Dôme.

Author information

Authors and Affiliations

  1. CHU Clermont-Ferrand, Pédiatrie, 63000, Clermont-Ferrand, France

    Alexandre Armand, Emmanuelle Rochette, Victoria Grèze, Florentina Isfan, Eric Doré, Pauline Girard-Monin, Charline Pegon, Emmanuelle Labraise & Justyna Kanold

  2. Unité CRECHE (INSERM CIC1405), Université Clermont Auvergne, 63000, Clermont-Ferrand, France

    Alexandre Armand, Emmanuelle Rochette, Victoria Grèze, Emmanuelle Labraise & Justyna Kanold

  3. Université de Toulon, Laboratoire IAPS, 83041, Toulon, France

    Emmanuelle Rochette & Pascale Duché

  4. Pôle Santé République, 63000, Clermont-Ferrand, France

    Severine Monzy

  5. CHU Clermont-Ferrand, Plateforme d’Investigation Clinique (INSERM CIC1405), F-63000, Clermont-Ferrand, France

    Christian Dualé

  6. CHU Clermont-Ferrand, Délégation de La Recherche Clinique Et Innovations, 63000, Clermont-Ferrand, France

    Bruno Pereira

Authors
  1. Alexandre Armand
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  2. Emmanuelle Rochette
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Consortia

on behalf of the HERCCULE group

Contributions

Conceptualisation, A.A.; E.R.; P.D.; and J.K.; data curation, A.A; E.R; B.P.; formal analysis, B.P.; funding acquisition, J.K.; investigation, A.A.; E.R.; V.G.; S.M.; C.D.; E.L.; E.D.; F.I.; C.P.; and P.G-M.; methodology, A.A. and E.R.; project administration, A.A. and E.R.; validation, A.A.; E.R.; B.P.; J.K.; and P.D.; writing—original draft, A.A. and E.R.; writing—review and editing, A.A.; E.R.; J.K. and P.D. All the authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Alexandre Armand.

Ethics declarations

Ethics approval

Approval was granted by the Comité de Protection des Personnes Sud-Est V (No. 21.02921.000036 cat 1).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

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Implications/contribution

This work highlights the metabolic dysfunction met in young adult survivors after exposure to long courses of chemotherapy for the treatment of lymphomas during a crucial development period. It underlines the importance of early interventions to develop long-term health-sustaining behaviours.

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Armand, A., Rochette, E., Grèze, V. et al. Fitness and metabolic response to exercise in young adult survivors of childhood lymphoma. Support Care Cancer 31, 358 (2023). https://doi.org/10.1007/s00520-023-07812-5

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