Physical Activity, the Childhood Cancer Symptom Cluster-Leukemia, and Cognitive Function: A Longitudinal Mediation Analysis.
Mary C Hooke, Cheryl Rodgers, Olga Taylor and 6 others
PMID 30124481WHAT IT FOUND
In children with leukemia, more severe fatigue, pain, nausea, sleep problems and depression were associated with lower parent-reported cognition and greater cognitive decline over the first year.
Physical activity was measured, not assigned, so these links do not prove activity protects thinking.
Key findings
01Higher initial physical activity was associated with a greater decrease in symptom cluster severity over time, but it was not associated with lower symptom severity at the first measurement.
02Children whose physical activity increased over the four measurements had symptom severity that increased over the same period.
03More severe symptom cluster was associated with lower cognition at the first measurement and with greater decline in cognition over time.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational study, so it cannot show that physical activity caused symptom change or that symptoms caused cognitive decline. Physical activity and symptoms were self-report, and cognition was only parent-reported, with no direct cognitive testing. Parents reported for children age 6 years or younger, so young children's own symptom experience was not captured directly. The study followed usual leukemia treatment without measuring pre-diagnosis activity, objective activity, biological markers or genetic factors. The study measured natural variation in activity, not assigned activity, so the surprising activity finding cannot be interpreted as an effect of activity. The sample came from four U.S. centers and included only children fluent in English or Spanish, so it may not apply to all settings or languages. The final model was modified after the initial model did not fit well, so it is not a simple pre-specified test.
Declared interests
The supplied article text does not include a conflict of interest declaration. The supplied journal metadata lists NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that increasing physical activity improves symptoms or protects cognition. This was an observational study with no activity intervention, and the activity findings were mixed: higher starting activity was linked to symptom improvement, but increasing activity was linked to worsening symptoms.