Sport Therapy

In the early years of life and during adolescence, physical activity is crucial for good development of motor skills. It is even more so for those children and young people who are forced to undergo anti-cancer therapies and therefore undergo long periods of hospitalization (often bedridden) and prolonged periods of physical inactivity.

The research project “Sport Therapy” was born with the aim of demonstrating that, through targeted physical activity administered by the sports physician in collaboration with the pediatrician hematologist, it is possible to facilitate the full recovery of these patients, avoiding the high risk of chronic diseases related to a sedentary lifestyle and allowing them to better reintegrate, once healed, in their community of origin (school, sport and social relations).

The research project “Sport Therapy” was born within the Maria Letizia Verga Center at the Pediatric Clinic of the University of Milan Bicocca, at the San Gerardo Hospital in Monza. Every year, around 80 children and adolescents with leukemia, lymphoma or blood disorders leading to bone marrow transplantation are treated here.

The Sport Therapy research project is 3 years old. This report tells the story and future prospects of this initiative which was conceived and developed thanks to the foresight and support of pediatricians and people who for years have been dedicated to raising funds for the activities of the Maria Letizia Verga Center.

STATE OF THE ART

Today, thanks to the progress made in the early diagnosis and treatment of cancer, there are more than 300 thousand young patients in Europe who have been cured of pediatric cancer, and by 2020 there will be almost half a million. For these children and young people, having the opportunity to perform targeted physical activity during treatment plays a key role in preventing diseases due to physical inactivity, which are one of the worst and most widespread consequences for healed patients.

Children and adolescents suffering from cancer of the blood, because of the therapies to which they are subjected, suffer a progressive reduction in respiratory and cardiac capacity, as well as muscle strength. Targeted physical exercise is a possible therapeutic approach to solving their significant problems of reduced ability to perform exercise. It is possible to administer this type of therapy thanks to the synergy created by the collaboration between pediatricians, hematologists, and sports physicians.

The purpose of this study is to assess the impact of a precision training program on the efficiency of the systems necessary for the transport and utilization of  oxygen (O2)  in girls and boys who are undergoing treatment for hematological diseases. The experiment has a multidisciplinary approach that involves prior recommendation of the potential patient by the blood-oncologist pediatrician to the sports doctor. A sports medical check-up and an evaluation of the degree of aerobic power, strength, stability and flexibility are carried out with the sports doctor and exercise physiologists. Sustainable and individualized training is then prescribed for highly vulnerable patients and patients with fewer functional deficits. The purpose of this precision training is to maintain or improve the efficiency of the respiratory, cardiovascular and musculoskeletal systems. If there are joint hindrances and structural deficiencies that cannot be modified with training, an osteopath takes over to administer manual treatment prescribed by the sports doctor.

Pediatricians, sports physicians, exercise physiologists and osteopaths are in constant consultation and develop precision training schemes to assist in the clinical progress of the individual athlete/patient. Psychologists and dieticians also participate in the evaluation of the individual’s response to the exercise regime necessary to carry out the training program.  By the end of the period after taking over, the tolerance level of the individual athlete/patient to exercise is re-evaluated. The collected data is then analyzed and used for scientific purposes to validate the impact of the treatment.

GENESIS OF THE PROJECT

2009 pilot project, In collaboration with the Pediatric Clinic of the San Gerardo Hospital and the Human Physiology Unit of the University of Milan Bicocca, on non-invasive evaluation of exercise tolerance in children at the end of treatment for lymphoblastic acute leukemia

2015 meeting with the medical researchers of the Pediatric Clinic and those of the Human Physiology Unit to prepare the Sport Therapy research protocol, dedicated to the use of precision exercise in children with malignant hemopathy. The head, Prof. Biondi invited Tommaso Moriggi (thesis in motor sciences), and bone marrow transplant survivor a when 3-year-old c / o the Pediatric Clinic San Gerardo of Monza, to join the Sport Therapy team

July 2016 beginning of cost planning (equipment and materials) by the Maria Letizia Verga Committee. Preparation of the research protocol to be submitted to the ethics committee of the University of Milan Bicocca.

4 April 2017 inauguration of the Sport Therapy gym at the Maria Letizia Verga Center

7 April 2017 approval of the research protocol “Individualized training in children with leukemia, during therapy. SPORT THERAPY “. Beginning  of patient recruitment and activation of quarterly precision training rounds.

September 2017 Maria Letizia Verga Committee takes charge of staff costs

June 2018 approved amendment by the ethical committee of the University of Milan Bicocca regarding the temporal extension of the project and the inclusion of all patients treated at  the cCentre. New title: “Individualized training in patients of developmental age with malignant hemopathy during therapy and / or while undergoing bone marrow transplantation. SPORT THERAPY Project

September 2019 inauguration of the garden outdoor gym for Sport Therapy

April 2021  expected conclusion date of the current research protocol

WHY IS THE RESEARCH IMPORTANT

For at least three reasons:

  1. the results of the “Sport Therapy” research project will launch precision training as one of the therapeutic weapons available to combat the consequences of hematological diseases in childhood;
  2. by increasing the physical capacity of children and adolescents with malignant hemopathies during the phases of cancer treatment, we will reduce the heavy legacy left by treatment, thus bridging the gap regarding their disadvantage towards healthy peers and ensuring their full reintegration into their communities (school, sport, social relations);
  3. a standardization of the methodology for using precision exercise in hospitalized children and adolescents will facilitate the monitoring of the progress of these type of interventions at the international level and the data from the “Sport Therapy” project will allow governments and concerned bodies not to further postpone the establishment of strategies necessary to improve the health and welfare of people cured of cancer diseases.

INNOVATIVE ASPECTS OF RESEARCH

At the end of the research project “Sport Therapy”:

  • new strategies will be available to combat cardiopulmonary and skeletal muscle damage resulting from anticancer therapies;
  • it will be definitively demonstrated how, from the very beginning of the disease, physical exercise can be a therapeutic option and not just a decorative element in the critical process of caring for children and adolescents suffering from oncological blood diseases, from the beginning of the disease;
  • the possibility of introducing new technical figures in the hospital context will be clear. Sports medicine physician and exercise physiologists will be part of the multidisciplinary team that connects the hospital environment to the territory;
  • the future perspective, once the experimentation has been completed and the effectiveness of the precision training intervention on the psycho-physical health of children and adolescents suffering from cancer has been demonstrated, will be to make “Sport Therapy” a permanent care service during the treatment of patients of developing age.