A goal-directed therapeutic exercise program in paediatric posterior fossa brain tumour survivors: a case study from the Physical ACTivity in Survivorship (PACTS) randomised controlled trial

Abstract

Aims: Survivors of posterior fossa brain tumours (PFBT) experience a plethora of disease- and treatment-related complications that can persist into adulthood. Therapeutic exercise interventions have been shown to improve quality of survivorship in other paediatric cancer diagnoses. There is also evidence that goal-directed interventions are effective at improving motor activities, function, and self-care in children with other complex health conditions. There is currently no evidence on the efficacy of goal-directed therapeutic exercise in paediatric PFBT survivors. The Physical ACTivity in Survivorship (PACTS) study aims to investigate the effects of a novel, goal-directed therapeutic exercise program on cardiorespiratory fitness and physical activity-related goal attainment in PFBT.

Method: PFBT survivors, aged 5-17 years, who underwent surgery at least 12 months earlier and completed radiation and/or chemotherapy at least six months prior, are being recruited. Participants are randomised into the exercise or usual care group. The exercise group receives weekly individualised, goal-directed exercise therapy delivered face-to-face for 12 weeks, alongside a home-based program (3 sessions/week). Outcomes are assessed at pre-, post-, 6- and 12-months post-intervention. Primary outcomes are cardiorespiratory fitness (Peak VO2) and physical activity-related goal attainment (Canadian Occupational Performance Measure). Secondary outcomes include cardiorespiratory endurance, high-level mobility skills, functional strength, habitual physical activity, gait, balance, quality of life, fatigue, participation, perceived motor competence and body composition.

Results: Thirteen participants have been recruited (target n = 48). This case study demonstrates the application of a goal-directed exercise intervention for an 11-year-old medulloblastoma survivor who experiences ongoing motor and cognitive impairments. Self-selected participant goals included swimming, tennis, and bike riding activities. The exercise program was individualised according to the participant's goals, functional capacity, and presence of side-effects.

Discussion: PACTS is the first study to investigate the efficacy of goal-directed therapeutic exercise in children with PFBT and provide evidence needed to inform clinical practice for PFBT survivors.