24 October 2019

Low levels of cardiovascular fitness in survivors of childhood acute lymphoblastic leukaemia (ALL) are associated with increased neurocognitive problems, according to a study published earlier this week.

A team led by Drs Kirsten Ness and Nicholas Phillips, from St Jude Children’s Research Hospital in Memphis, Tennessee, USA, found that even small increases in physical activity could be beneficial for cognitive function.

Survivors of childhood ALL are at increased risk of experiencing neurocognitive deficits and reduced exercise capacity because of their disease and its treatment. The researchers wanted to understand if there was a link between the neurocognitive effects and cardiovascular fitness.

In their study, the team examined exercise and neuropsychological test results and questionnaire answers from 341 adult survivors of childhood ALL from the St. Jude Lifetime cohort, and 288 healthy controls. The researchers measured how much physical activity survivors could tolerate and how that related to their ability to think, learn, memorise, read, and do maths.

Writing online in the journal Cancer, they found that, compared with the healthy control cohort, ALL survivors had worse cardiovascular fitness and poorer performance on neuropsychological tests, including those related to attention, memory, and academic skills.

After adjusting for age, sex, radiation and chemotherapy treatments, smoking status, and physical activity, the researchers found that increases in exercise capacity were associated with better performance on various neuropsychological tests among former ALL patients.

They add their findings suggest that children with cancer who need potentially neurotoxic anticancer treatments might benefit from increasing their exercise.

Lead author of the study Dr Nicholas Phillips said: “Our research suggests that a minor improvement in exercise tolerance, such as going from sitting on the couch and watching TV to walking around the block for 30 minutes a day, can have a significant impact on survivors’ intellectual health.

 “We know that memory and thinking skills decline as we age. Any improvement in exercise tolerance, even in adulthood, may have an impact on a survivor’s ability to think, learn, and memorise.”

The researchers say that a randomised clinical trial would be needed to see if interventions that improve exercise capacity could be effective.


Phillips, N.S., Howell, C.R., Lanctot, J.Q., Partin, R.E., Pui, C.-H., Hudson, M.M., Robison, L.L., Krull, K.R., Ness, K.K. (2019) “Physical fitness and neurocognitve outcomes in adult survivors of childhood acute lymphoblastic leukemia: A report from the St. Jude Lifetime Cohort”, Cancer, doi: 10.1002/cncr.32510


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