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Long-term physical impairments are frequent consequences of multimodal therapy for malignant pediatric sarcomas. Surgical interventions like endoprosthetic support or amputations limit participation in many popular sportive activities. Demanding sports like alpine skiing are automatically avoided. Due to the potentials of skiing as an individually adaptable sport, preexisting family-oriented skiing camps for survivors of pediatric cancer since 1994 were expanded to children with sarcomas even with accompanying physical impairments or reduced movement patterns. This work summarizes the individual solutions for 31 participants with soft-tissue sarcomas and bone tumors (age 14 ± 6.5 years, 48% male, various surgical techniques) to detect underlying challenges, benefits and limits of skiing and to improve the decision making process with regard to the optimal skiing technique. All children and adolescents learned skiing in accordance to their individual abilities and limitations. Skiing techniques varied from conventional upright skiing, to one-leg skiing or sit ski. Four case examples are presented in detail. Findings suggest that skiing after pediatric sarcoma is feasible. The wide range of possible adaptions and skiing techniques obviate exclusion of handicapped children in skiing holidays or school ski trips. Interdisciplinary collaborations, professional support and specific equipment and methodology are the key points of successful concepts.

Die weitreichenden Potenziale individualisierter Bewegungsforderung fur krebskranke Kinder und Jugendliche sollten uber den gesamten Zeitraum der Akuttherapie, in der Nachsorge und bei der Ruckkehr in den Alltag genutzt und als Bestandteil der Normalitat aufrechterhalten und gefordert werden. Dieser Artikel stellt beispielhaft fur den Standort Munster Ergebnisse und Erfahrungen aus den letzten 5 Jahren sporttherapeutischer und sportpadagogischer Bewegungsforderung im kinderonkologischen Setting dar und liefert konkrete Zahlen uber die Bewegungsumfange, die erreichten Patienten sowie die Moglichkeiten und Grenzen eines derartigen Angebots.

BACKGROUND Reduced motor performance can negatively affect physical activity and social partake after childhood cancer. Especially in bone tumor patients, who are at risk of physical limitations due to surgical interventions, motor performance has not yet been sufficiently investigated. Therefore, this study aimed at assessing motor performance in pediatric bone tumor patients. PROCEDURE Motor performance was measured within 2 years posttreatment using the MOON (test for MOtor performance in pediatric ONcology) test. This instrument enables quantitative data collection even in physically impaired patients for comparison with age-matched and sex-matched reference values. RESULTS Twenty-one patients (13 male) ages 15.2±2.1 years (median: 15 y, 10 to 19 y) and 9.4±7.4 months posttreatment (median: 6 mo, 2 to 24 mo) were tested. Motor performance was slightly reduced in muscular endurance of the legs; significantly reduced in speed, flexibility, eye-hand coordination, and muscular explosive strength (P

Wahrend einer Krebserkrankung sind die betroffenen Kinder und Jugendlichen fur lange Zeit korperlich inaktiv. Im Sinne einer fruhzeitigen Bewegungsforderung wird schon wahrend der Akuttherapie ein individualisiertes, angepasstes Sportprogramm empfohlen. Die Inhalte orientieren sich dabei an der jeweiligen Sportanamnese, den personlichen Zielen, der aktuellen medizinischen Situation und den altersspezifischen Schulsportinhalten. Die Akzeptanz durch die Patienten ist hoch, doch die haufig auftretenden korperlichen Beschwerden betonen die Notwendigkeit einer breiten Spannweite von Trainingsmethoden, die auch mit schlechtem Allgemeinzustand ein Minimalprogramm erlauben. Zukunftige Bemuhungen sollten sich auf den bundesweiten Ausbau der Versorgungsangebote konzentrieren, um jedem erkrankten Kind eine kindgerechte Bewegungsforderung zu ermoglichen.

OBJECTIVE: Existing research recognizes low levels of physical activity in pediatric patients with cancer, but much uncertainty exists about their capability to self-reflect physical activity levels. The objective of this study was to compare results of subjective self-reports and objective accelerometers regarding levels of daily walking as well as moderate-to-vigorous physical activities. METHODS: Results of the objective assessment tool StepWatchTM Activity Monitor and self-reporting with a standardized questionnaire were compared in 28 children and adolescents during cancer treatment. RESULTS: The patients were 13.8±2.8 years of age and 3.4±2.0 months after cancer diagnosis. The Bland-Altman plots indicated a fairly symmetrical under- and over-estimation for daily minutes of walking with the limits of agreement ranging from -100.8 to 87.3 min (d = -6.7 min). Mean difference for moderate-to-vigorous physical activity was almost zero but limits of agreement are ranging from -126.8 to 126.9 min. The comparison for the days with at least 60 min of moderate-to-vigorous physical activity showed a marked difference with 3.0±2.6 self-reported days versus only 0.1±0.4 measured days. CONCLUSIONS: These findings suggest that physical activity in pediatric cancer patients should preferably be assessed with objective methods. Greater efforts are needed to implement supervised exercise interventions during treatment incorporating methods to improve self-reflection of physical activity.

Background Due to growing evidence about the value of exercise in pediatric cancer patients, the purpose of this study was to determine factors that influence participation in physical activities and exercise in children and adolescents during treatment. Procedure This cross-sectional qualitative study included 40 pediatric cancer patients during intensive treatment. Patients were recruited at the Department for Pediatric Hematology and Oncology, University Hospital of Muenster where a supervised exercise program has been implemented for hospital stays. The qualitative approach included semi-structured guideline interviews, transcription and coding based on grounded theory. Four major topics were discussed in the interviews: (1) values and beliefs, (2) barriers to exercise, (3) motivations to exercise, and (4) encouragement from parents and physicians. Results Patients reported mainly positive attitudes toward physical activities during treatment and the local exercise program was desired and valued as essential for engaging in exercise during in-patient stays. Identified barriers included physical, psychological, and organizational aspects. Motivational aspects were based on improvements in physical fitness and mental well-being. Parents' behavior related to physical activities of their children differed between being supportive, inhibiting, and inert. Few patients received information about exercise during treatment by their physicians. Conclusions Interventions that aim at maintaining physical activities during treatment and eliminating exercise barriers are required due to the patients' positive attitudes and multiple motivations toward exercise. These interventions need to be supervised and should include health-counseling programs for patients, parents, and physicians to underline the importance of physical activities in childhood cancer patients. Pediatr Blood Cancer 2014;61:1632–1637. © 2014 Wiley Periodicals, Inc.

Resumption of physical activity and reintegration into social surroundings after treatment for pediatric cancer is of high importance to recover from the burden of disease and treatment and to positively influence long-term health outcomes. Eighty-three children who had completed intensive treatment for pediatric cancer were surveyed regarding their participation in physical education at school (PES). The results show a concerning low rate of participation, particularly in children treated for pediatric bone tumors, and associated barriers. Reported reasons for quitting PES seem to be conquerable by individual and entity-related support to enable participation according to the children's desire.

Background. Physical activities are important for the development of children and increasing evidence suggests beneficial effects of physical activity promotion during cancer treatment as well. The present study aimed at evaluating the current need of exercise interventionsinpediatriccancerpatientsundergoingacutetreatment and identifying risk factors for inactivity. Procedure. Data about selfreported physical activity before and during treatment was collected in a cross-sectional design with the physical activity questionnaire from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) in a modified cancer specific version. Results. One hundred thirty pediatric cancer patients with various entities were questioned 3.0 � 1.6 months since diagnosis. Patients’ activity levels before diagnosis mainly matched reference values for healthy children in Germany. Reductions during treatment affected all dimensions of daily physical activities and minutes of exercise per week decreased significantly (P

Pediatric cancer patients suffer from various negative consequences due to the disease, the medical therapy and the inactivity during the intensive treatment. Only few studies have systematically identified the adverse effects of cancer on motor performance in childhood. To determine the motor performance of pediatric cancer patients, a motor performance test was developed which is applicable for this specific patient group. Eight test items with reference values for healthy children were merged to the MOON-test (test for motor performance in the oncology). MOON was tested for feasibility and acceptance in 33 patients aged 4–18 years. Feasibility was confirmed for children with different types of cancer (hematological malignancies and solid tumors) and with amputation, endoprosthesis, during aplasia as well as reduced general condition. Furthermore the patients showed a broad acceptance. Based on the study findings, the use of MOON-test as a standardized motor performance diagnostic tool in clinical routine of oncological acute clinics as well as rehabilitation clinics can be recommended.·

Resumption of physical activity and reintegration into social surroundings after treatment for pediatric cancer is of high importance to recover from the burden of disease and treatment and to positively influence long-term health outcomes. Eighty-three children who had completed intensive treatment for pediatric cancer were surveyed regarding their participation in physical education at school (PES). The results show a concerning low rate of participation, particularly in children treated for pediatric bone tumors, and associated barriers. Reported reasons for quitting PES seem to be conquerable by individual and entity-related support to enable participation according to the children's desire.

Reduced motor performance may particularly limit reintegration into normal life after cessation of treatment in pediatric cancer patients. This study aimed at analyzing motor performance at the end of the acute treatment phase and reveals potential risk factors for motor deficits. A childhood cancer population with different tumor entities was assessed with the MOON test, which allows for comparison with age- and gender-matched reference values of healthy children, at the end of the acute treatment phase. Forty-seven patients were tested at 7.0 ± 2.6 months after diagnosis. Significant reductions of motor performance affected muscular explosive strength (P

Physical activities are important for the development of children and increasing evidence suggests beneficial effects of physical activity promotion during cancer treatment as well. The present study aimed at evaluating the current need of exercise interventions in pediatric cancer patients undergoing acute treatment and identifying risk factors for inactivity.Data about self-reported physical activity before and during treatment was collected in a cross-sectional design with the physical activity questionnaire from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) in a modified cancer specific version.One hundred thirty pediatric cancer patients with various entities were questioned 3.0 ± 1.6 months since diagnosis. Patients' activity levels before diagnosis mainly matched reference values for healthy children in Germany. Reductions during treatment affected all dimensions of daily physical activities and minutes of exercise per week decreased significantly (P0.001). Largest reductions of physical activities during treatment were identified for bone tumor patients and in-patient stays.Due to the well known importance of physical activity during childhood and the identified risk of inactivity during cancer treatment, supervised exercise interventions should be implemented into acute treatment phase to enhance activity levels and ensure a continuously support by qualified exercise professionals.

In analytical chemical experiments as well as animal experiments the quality of two charges of krill meal produced in the scope of test hauls was tested in comparison to fish meal. The krill meal samples tested in our experiments with their minimal values per kg dry matter of approximately 640 g crude protein 48 g lysine and 20 g methionine + cystine are by all means comparable to fish meal of medium or good quality. The digestibility of the two krill meal samples was good. Krill meal of this quality can replace the fish meal quota in broiler feed. Analogously to fish meal, the quota of krill meal should not exceed 70 to 80 g per kg feed, on the one hand for reasons of nutrient economy and on the other hand in order to avoid a negative influence on the taste of the broiler meat. In addition to that, reference is made to storage problems of krill meal and mixed feeding containing krill meal and to the necessity of clarifying toxicologic problems.