In children and adolescents undergoing cancer treatment, exercise can be performed safely during and after therapy when appropriately supervised and individualized; further, appropriately prescribed exercise should be included as part of supportive cancer care, according to a new American College of Sports Medicine (ACSM) Expert Consensus Statement published by Fridh et al in the journal Medicine & Science in Sports & Exercise.
The statement provides the first evidence-based exercise recommendations specifically developed for children and adolescents with cancer. The international panel of experts screened more than 12,000 studies and synthesized findings from randomized controlled trials to establish practical exercise guidance for pediatric oncology care.
“Exercise should no longer be viewed as optional in pediatric oncology care,” said corresponding author Alejandro Lucia, MD, PhD, of Universidad Europea de Madrid. “This consensus statement shows that, when properly prescribed, exercise is safe and can improve physical function and strength in children and adolescents with cancer.”
Cancer remains one of the leading causes of death among children and adolescents worldwide, with more than 380,000 young people diagnosed each year. While survival rates now exceed 80% in many high-income countries, treatment often leaves patients with significant short- and long-term physical challenges, including declines in muscle strength, physical function, and cardiorespiratory fitness.
Key Findings
The expert panel found:
- Exercise can be performed safely during and after cancer treatment when appropriately supervised and individualized.
- Moderate-quality evidence shows that combined aerobic and resistance exercise improves muscle strength and physical function—two outcomes that directly affect a child’s ability to move, play, and participate in daily activities and recover from treatment.
- Moderate-quality evidence shows that aerobic exercise improves cardiorespiratory fitness after treatment, particularly among survivors of acute lymphoblastic leukemia.
- Children and adolescents with cancer should be encouraged to avoid prolonged inactivity and bed rest whenever medically feasible.
- Significant research gaps remain for outcomes such as cardiac health, bone health, immune function, fatigue, sleep, and cognitive function, underscoring the need for well-designed multicenter trials.
Practical Guidance for Clinicians
The statement offers FITT-based (Frequency, Intensity, Time and Type) recommendations to help clinicians and exercise professionals implement exercise programs in real-world pediatric oncology settings.
For improving muscle strength and physical function, the authors recommend supervised concurrent aerobic and resistance training two to three times per week for at least 8 weeks, with sessions lasting approximately 30 to 45 minutes. Recommended activities include running, cycling, ball games, and age-appropriate strength exercises targeting major muscle groups.
The guidance also includes safety considerations, contraindications, and recommendations for adapting exercise to individual medical conditions and treatment status.
A Shift in Pediatric Cancer Care
The authors emphasized that exercise should be viewed as a supportive therapy throughout the cancer journey, not simply as a lifestyle recommendation after treatment ends.
“Children with cancer face significant physical challenges during and after treatment, but the evidence now shows that movement matters,” said Dr. Lucia. “Exercise can help preserve and restore physical function during some of the most difficult periods of a young person’s life.”
Because pediatric cancer differs substantially from adult cancers in diagnosis, treatment, and recovery, the authors noted that dedicated pediatric exercise guidance has been urgently needed. This consensus statement represents an important step toward integrating exercise into routine pediatric oncology care worldwide.
DISCLOSURE: For full disclosures of the study authors, visit journals.lww.com/acsm-msse.
