{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T21:05:07Z","timestamp":1793048707023,"version":"4.5.0"},"reference-count":52,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CA21765 (C Roberts,PI)"],"award-info":[{"award-number":["CA21765 (C Roberts,PI)"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01 CA129384 (CL Cox,PI)"],"award-info":[{"award-number":["R01 CA129384 (CL Cox,PI)"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The early effects of childhood acute lymphoblastic leukemia (ALL) include decreased physical function, bone mineral density (BMD\/g\/cm<jats:sup>2<\/jats:sup>), and health\u2010related quality of life (HRQL). We assessed the capacity of a physical therapy and motivation\u2010based intervention, beginning after diagnosis and continuing through the end of treatment, to positively modify these factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>A 2.5\u2010year randomized controlled trial of 73 patients aged 4\u201318.99\u00a0years within 10\u00a0days of ALL diagnosis assessed BMD at baseline (T<jats:sup>0<\/jats:sup>) and end of therapy (T<jats:sup>3<\/jats:sup>), strength, range of motion, endurance, motor skills, and HRQL at baseline (T<jats:sup>0<\/jats:sup>), 8 (T<jats:sup>1<\/jats:sup>), 15 (T<jats:sup>2<\/jats:sup>), and 135 (T<jats:sup>3<\/jats:sup>) weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no significant changes between groups (intervention, n\u00a0=\u00a033; usual care, n\u00a0=\u00a040) in BMD (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.059) at T<jats:sup>3<\/jats:sup> or physical function and HRQL at T<jats:sup>0<\/jats:sup>\u2013T<jats:sup>3<\/jats:sup>. While BMD declined in both the intervention (T<jats:sup>0<\/jats:sup>\u00a0=\u00a0\u22120.21, T<jats:sup>3<\/jats:sup>\u00a0=\u00a0\u22120.55) and usual care (T<jats:sup>0<\/jats:sup>\u00a0=\u00a0\u22120.62, T<jats:sup>3<\/jats:sup>\u00a0=\u00a0\u22120.78) groups, rates of decline did not differ between groups (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.56). Univariate analysis (n\u00a0=\u00a073) showed associations of higher T<jats:sup>3<\/jats:sup> bone density with body mass index T<jats:sup>1<\/jats:sup> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.01), T<jats:sup>2<\/jats:sup> (<jats:italic>P<\/jats:italic>\u00a0=\u00a0&lt;0.0001), T<jats:sup>3<\/jats:sup> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.01), T<jats:sup>3<\/jats:sup> ankle flexibility\/strength (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.001), and T<jats:sup>2<\/jats:sup> parent (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.02)\/T<jats:sup>0<\/jats:sup> child (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.03) perceptions of less bodily pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The intervention delivered during treatment was not successful in modifying BMD, physical function, or HRQL. Physical activity, at the level and intensity required to modify these factors, may not be feasible during early treatment owing to the child's responses to the disease and treatment. Future studies will consider intervention implementation during late maintenance therapy, extending into survivorship.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.26929","type":"journal-article","created":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T15:16:42Z","timestamp":1514560602000},"source":"Crossref","is-referenced-by-count":65,"title":["Modifying bone mineral density, physical function, and quality of life in children with acute lymphoblastic leukemia"],"prefix":"10.1002","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0625-328X","authenticated-orcid":false,"given":"Cheryl L.","family":"Cox","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital  Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics The University of Texas Health Science Center at Houston  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue C.","family":"Kaste","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital  Memphis Tennessee"},{"name":"Department of Radiology The University of Tennessee Health Science Center  Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumar","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital  Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Barnes","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital  Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul C.","family":"Nathan","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children University of Toronto  Toronto Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Wells","sequence":"additional","affiliation":[{"name":"Division of Pediatrics\u2010Unit 87 MD Anderson Cancer Center  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten K.","family":"Ness","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital  Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,12,29]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"25","volume-title":"American Cancer Society: Cancer Facts and Figures 2014","author":"American Cancer 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