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The diagnosis of cancer as well as accompanying acute and late effects of treatment are influencing physical activity behavior of patients with childhood cancer and survivors. Research has shown that a pediatric cancer diagnosis is associated with impairments of physical performance, and function, as well as reduced physical, and psychosocial, health conditions. From an ethical perspective, lack of knowledge of health care providers, lack of physical activity promotion, and environmental, and structural barriers to physical activity restrict children’s right to move and actively engage in physical activities. Network ActiveOncoKids is a German-wide initiative with the main goal of enabling children, adolescents, and young adults with exercise opportunities during and after cancer treatment. Since the network’s foundation in 2012, Network ActiveOncoKids focuses on: (1) physical activity support for patients and families, (2) policy change to establish structures and guidelines, and (3) generating evidence through scientific projects. The purpose of this paper is to present an overview of Network ActiveOncoKids structure, aims, and projects. This topical review will highlight the network’s structural development, research work, and implementation progress of exercise programs for patients with pediatric cancer and survivors, link international collaborations, and discuss future directions.

Regular physical activity is an important requirement for the development and the general health in childhood and adolescence. However, patients during and after treatment for childhood cancer show high levels of physical inactivity, and only a marginal extent of physical activity. In addition to the negative side effects of treatment, this lack of physical activity and exertion has further negative implications for their health, such as decrease in physical performance and health related quality of life. In order to reduce these negative effects and provide access to regular physical activity for children and adolescents with cancer, childhood cancer patients should participate in targeted physical exercise therapy sessions at the treating hospital. Physical activity promotion for children and adolescents with cancer is an effective measure to enhance or preserve functional mobility, physical performance and health related quality of life. Both the behavioral level (person) and the setting (environment) should be taken into account for a sustainable implementation of physical activity promotion in the treatment of childhood cancer. The Leipzig Movement Concept promotes physical activity both during and after treatment for childhood cancer. On the basis of the modular concept, factors influencing physical activity in childhood cancer, alongside requirements for the successful and long-term implementation of physical activity programs and clinical exercise therapy are described. Furthermore financing options, based on Book V § 43 of the German Social Welfare Code, are presented.Regelmäßige körperliche Aktivität ist eine wichtige Voraussetzung für die Gesundheit und die Entwicklung von Kindern und Jugendlichen. Insbesondere während aber auch nach einer Krebserkrankung sind Kinder und Jugendliche jedoch in sehr geringem Umfang körperlich aktiv und weisen eine stark ausgeprägte körperliche Inaktivität auf. Diese chronische körperlich-motorische Unterforderung hat, zusätzlich zu den Nebenwirkungen der Behandlung, weitere negative Folgen für die Gesundheit, wie z. B. starke Einbußen der körperlichen Leistungsfähigkeit und der Lebensqualität. Um diese Folgen zu verringern, kann den PatientInnen im Rahmen von gezielten sporttherapeutischen Bewegungsangeboten Zugang zu regelmäßiger körperlicher Aktivität ermöglicht werden. Bewegungsförderung für Kinder und Jugendliche mit Krebserkrankungen stellt eine supportive Maßnahme zur Verbesserung und Erhaltung der funktionalen Mobilität, der körperlichen Leistungsfähigkeit und der gesundheitsbezogenen Lebensqualität dar. Für eine nachhaltige Bewegungsförderung müssen sowohl die Verhaltensebene (Person) als auch die Verhältnisebene (Lebenswelt) berücksichtigt werden. Anhand des Leipziger Bewegungskonzepts werden Einflussebenen auf die körperliche Aktivität von Kindern und Jugendlichen mit Krebserkrankungen erläutert sowie inhaltliche, systemische und strukturelle Voraussetzungen für die Implementierung einer behandlungsbegleitenden Bewegungsförderung in der Pädiatrischen Onkologie beschrieben. Zusätzlich werden Finanzierungsmöglichkeiten, basierend auf dem SGB V §43, aufgezeigt.

Cancer- and treatment-related side effects in patients with childhood cancer may cause limitations in motor performance affecting activities of daily living (ADLs). Data focusing on long-term effects are available, but little is known with regard to the short-term perspective. Therefore, the purpose of this study was to assess muscle strength performance and quality of life (QoL) in children and adolescents with cancer at the beginning of primary treatment. Forty children and adolescents aged 5-18 years (mean: 11.39 ± 4.08 years) with different types of childhood cancer were enrolled. On average 36 ± 20.5 days after diagnosis, strength performance in 7 muscle groups was assessed by handheld dynamometry. KINDL questionnaires were completed to evaluate QoL (children's self-report and parents' report). All parameters were compared with age- and gender-matched reference values. Patients with childhood cancer showed significantly lower strength values in all muscle groups (P.01) compared with age- and gender-matched controls. Most affected were the lower extremities, with a -57.1% ± 10.4%, median: -59.2%, minimum: -75.4%, maximum: -41.4% percentage deviation in knee flexion from healthy peers. Children themselves and parents assessed total QoL significantly below age- and gender-matched reference values (P.01). Correlation between elbow flexion and self-reported QoL was detected. Broader correlations were found for the parents' report. Muscle weakness and decreased QoL in children and adolescents seem to persist already at the beginning of anticancer treatment. This underlines the need of counteracting measures, such as exercise intervention programs, starting as early as possible during the treatment process. Efforts on this topic are currently being carried out by our group.

This review aims to summarize the evidence for impairments of muscle strength and balance during and after treatment for childhood cancer. Thirty-two articles, identified in scientific databases by means of a structured search for investigations of muscle strength and balance in pediatric cancer patients and survivors, are evaluated. A summary of results is given with respect to matching reporting items to provide a qualitative analysis of the evidence. The majority of the studies reached a level 3 rating according to Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 levels of evidence. Muscle strength and balance seem to be impaired in varying degrees depending on the diagnosis, treatment received, and time elapsed between treatment and evaluation. Drawing specific conclusions from the identified studies is difficult because of heterogeneous study samples and methods of research. Individual targeted exercise therapy programs during treatment and follow-up of childhood cancer could help to prevent and further diminish impairments of muscle strength and balance function among childhood cancer patients and survivors.