ONCOFIT is a randomized clinical trial with a two-arm parallel design aimed at determining the influence of a multidisciplinary Prehabilitation and Postoperative Program (PPP) on post-surgery complications in patients undergoing resection of colon cancer. This intervention will include supervised physical exercise, dietary behavior change, and psychological support comparing its influence to the standard care. Primary and secondary endpoints will be assessed at baseline, at preoperative conditions, at the end of the PPP intervention (after 12 weeks) and 1-year post-surgery, and will include: post-surgery complications (primary endpoint); prolonged hospital length of stay; readmissions and emergency department call within 1-year after surgery; functional capacity; patient reported outcome measures targeted; anthropometry and body composition; clinical/tumor parameters; physical activity levels and sedentariness; dietary habits; other unhealthy habits; sleep quality; and fecal microbiota diversity and composition. Considering the feasibility of the present intervention in a real-life scenario, ONCOFIT will contribute to the standardization of a cost-effective strategy for preventing and improving health-related consequences in patients undergoing resection of colon cancer with an important clinical and economic impact, not only in the scientific community, but also in clinical practice.

BACKGROUND: Although surgery is commonly regarded as the primary curative treatment for colorectal cancer, it could potentially be associated with postoperative morbidity and mortality. OBJECTIVE: To determine the pooled effect of exercise and multidisciplinary prehabilitation interventions on postoperative hospital length of stay and functional capacity in patients undergoing resection of colorectal cancer. DATA SOURCES: A systematic search was conducted in MEDLINE (via PubMed) and Web of Science databases from inception to November 2022. STUDY SELECTION: The original systematic search retrieved 2005 studies. After the removal of duplicates and screening by title and abstract, 77 eligible full-text documents were evaluated for final inclusion in the meta-analysis. A total of 12 randomized controlled trials, 5 nonrandomized controlled trials, and 3 uncontrolled before-and-after studies were selected. MAIN OUTCOME MEASURES: Postoperative hospital length of stay (in days) and functional capacity (assessed with the peak of oxygen consumption [VO₂ peak] and 6-minute walking test) were the outcome measures. RESULTS: The meta-analysis was conducted on 20 studies (3805 participants). Randomized controlled trials and nonrandomized controlled trials showed significant reductions in postoperative hospital length of stay (d = –0.10, nearly 2 days) and significant incremental improvements in VO₂ peak (d = 0.27) and 6-minute walking test (d = 0.31). Regarding the before-and-after studies, the pooled effect of multidisciplinary prehabilitation interventions was positively significant for VO₂ peak (d = 0.29) and 6-minute walking test (d = 0.29). There was no risk of publication bias (Egger test: p > 0.05), with a score of 0.71 (0–1) on average. LIMITATIONS: There was a high between-studies heterogeneity, and several outcomes did not have the required number of studies for a desirable statistical power. CONCLUSIONS: These findings suggest that multidisciplinary prehabilitation interventions might be effective at decreasing postoperative hospital length of stay (nearly 2 days) and improving functional capacity. REGISTRATION: PROSPERO registration number CRD42022373982.

Background: Sarcopenia and low areal bone mineral density (aBMD) are prevalent musculoskeletal complications after paediatric cancer treatment. However, their relationship has not been examined in young paediatric cancers survivors. This study aimed to evaluate aBMD differences according to sarcopenia status and the risk of low aBMD Z‐score in young paediatric cancer survivors with sarcopenia confirmed/probable.Methods: This cross‐sectional study included 116 paediatric cancer survivors (12.1 ± 3.3 years old; 42.2% female). Handgrip strength was used to assessed muscle strength. Dual‐energy X‐ray absorptiometry estimated aBMD (g/cm²) and appendicular lean mass index (ALMI, kg/m²). ‘No sarcopenia’ was defined when muscle strength was >decile 2. ‘Sarcopenia probable’ was defined when muscle strength was ≤ decile 2 and ALMI Z‐score was > −1.5 standard deviation (SD). ‘Sarcopenia confirmed’ was defined when muscle strength was ≤ decile 2 and ALMI Z‐score ≤ −1.5 SD. Analysis of covariance and logistic regression, adjusted for time from treatment completion, radiotherapy exposure, calcium intake, and physical activity, was used to evaluate aBMD and estimate the odds ratios (ORs) of low aBMD (aBMD Z‐score < −1.0).Results: Survivors with sarcopenia confirmed had significantly lower aBMD than those without sarcopenia at total body (−1.2 [95% CI: −1.5 to −0.8] vs. 0.2 [−0.2 to 0.6], P < 0.001), lumbar spine (−0.7 [−1.1 to −0.3] vs. 0.4 [0.0 to 0.8], P < 0.001), total hip (−0.5 [−0.9 to −0.2] vs. 0.4 [0.1 to 0.8], P < 0.001), and femoral neck (−1.0 [−1.4 to −0.6] vs. 0.1 [−0.3 to 0.4], P = 0.001). Compared with survivors with sarcopenia probable, survivors with sarcopenia confirmed had significantly lower aBMD Z‐score at total body (−1.2 [−1.5 to −0.8] vs. −0.2 [−0.7 to 0.4], P = 0.009), total hip (−0.5 [−0.9 to −0.2] vs. 0.5 [−0.1 to 1.0], P = 0.010), and femoral neck (−1.0 [−1.4 to −0.6] vs. 0.1 [−0.5 to 0.7], P = 0.014). Survivors with sarcopenia confirmed were at higher risk of low aBMD Z‐score at the total body (OR: 6.91, 95% CI: 2.31–24.15), total hip (OR: 2.98, 1.02–9.54), and femoral neck (OR: 4.72, 1.72–14.19), than those without sarcopenia. Survivors with sarcopenia probable were at higher risk of low aBMD Z‐score at the total body (OR: 4.13, 1.04–17.60) than those without sarcopenia.Conclusions: Young paediatric cancer survivors with sarcopenia present higher risk of low aBMD. Resistance training‐based interventions designed to mitigate osteosarcopenia in this population should be implemented at early stages.

Objective: To examine the associations of self‐perceived and objectively‐measured physical fitness with psychological well‐being and distress indicators in young pediatric cancer survivors.Materials and Methods: A total of 116 participants (12.1 ± 3.3 years, 56.9% boys) from the iBoneFIT project participated in this cross‐sectional study. Objectively‐measured physical fitness (muscular fitness) was obtained by handgrip strength and standing long jump tests for the upper and lower body, respectively. Self‐perceived physical fitness was obtained by the International Fitness Scale (IFIS). Positive and negative affect were assessed by the positive affect schedule for children (PANAS‐C), happiness by Subjective Happiness Scale (SHS), optimism by Life Orientation Test‐Revised (LOT‐R), self‐esteem by the Rosenberg Self‐Esteem Scale (RSE), anxiety by State–Trait Anxiety Inventory for Children (STAIC‐R), and depression by Children Depression Inventory (CDI). Multiple linear regressions adjusted by key covariates were performed to analyze associations.Results: No associations were found between objectively‐measured muscular fitness and any of the psychological well‐being and distress indicators (p > 0.05). Self‐perceived overall fitness and flexibility were positively associated with positive affect (β ≥ 0.258, p < 0.05). Self‐perceived cardiorespiratory fitness, speed/agility, and flexibility were negatively associated with depression (β ≥ −0.222, p < 0.05). Finally, self‐perceived cardiorespiratory fitness was also negatively associated with anxiety and negative affect (β ≥ −0.264, p < 0.05).Conclusions: Perceived physical fitness, but not objectively physical fitness, seems to be inversely related to psychological distress variables and to less extent positively related to psychological well‐being. The findings from this study highlight the importance of promoting self‐perceived fitness in the pediatric oncology population.

Background/Objectives: This study aims to investigate the association of movement behaviors with irisin, sclerostin, and bone turnover markers in young pediatric cancer survivors. Methods: A total of 116 young pediatric cancer survivors (12.1 ± 3.3 years; 42% female) were recruited. Time spent in movement behaviors over at least seven consecutive 24 h periods was measured by accelerometers (wGT3x-BT accelerometer, ActiGraph). Blood samples were collected at rest and serum was analyzed for irisin, sclerostin, cross-linked telopeptide of type I collagen (CTX), procollagen type I amino-terminal propeptide (P1NP), total osteocalcin (OC), alkaline phosphatase (ALP), 25-hydroxyvitamin D, parathyroid hormone (PTH), calcium, phosphorous, and magnesium. Results: Irisin and sclerostin were not significantly correlated with bone turnover markers. Sedentary time was negatively correlated with the P1NP (r = −0.411, p = 0.027) and total OC (r = −0.479, p = 0.015) Z-scores, whereas moderate-to-vigorous physical activity was positively correlated with the P1NP (r = 0.418, p = 0.024) and total OC (r = 0.478, p = 0.016) Z-scores. Moreover, total physical activity was positively correlated with the total OC Z-score (r = 0.448, p = 0.025). Finally, the uncoupling index [CTX/P1NP] was positively correlated with sedentary time (r = 0.424, p = 0.012) and negatively correlated with light physical activity (r = −0.352, 0.041). Conclusions: Reducing sedentary time and increasing physical activity may favor bone formation over resorption in young pediatric cancer survivors.

Due to the lack of available knowledge in the current literature, this systematic review and meta-analysis was aimed to assess the effectiveness of exercise-based lifestyle interventions, including healthy diet and/or psychological well-being on mental, physical and global health-related quality of life (HRQoL) in adults after cancer treatment. MEDLINE (via PubMed) and Web of Science databases were searched for randomised controlled trials (RCTs) published until August 2024 evaluating exercise-based lifestyle interventions, including healthy diet and/or psychological well-being, which assessed mental, physical and global HRQoL. Of 6193 screened studies, 32 RCTs met the criteria. The total sample comprised 5528 participants (3003 intervention and 2525 control). There was a small effect size in a pooled analysis that found exercise-based lifestyle interventions improve mental HRQoL (d 0.11, 95 % CI 0.05 to 0.18). These effects were greater in those studies that combined exercise with psychological well-being (d = 0.19, P = 0.004), and with moderate-to-high intensity aerobic exercise (moderate intensity; d = 0.11, P = 0.02, high intensity; d = 0.16, P = 0.02, aerobic exercise; d = 0.16, P = 0.26). Exercise-based lifestyle interventions do not enhance physical nor global HRQoL, yet those combined with psychological well-being seem to improve mental HRQoL in individuals after cancer treatment. CRD42022369169.