PediatrBloodCancer2010;55:1160–1166 Effect of Adapted Physical Activity Sessions in the Hospital on Health-Related Quality of Life for Children With Cancer: A Cross-Over Randomized Trial Elodie Speyer, MSc, PhD student, 1 Aline Herbinet, PhD, 1,2 Anne Vuillemin, PhD, 1, * Serge Brianc ¸on, MD, 1 and Pascal Chastagner, MD, PhD 3 Background. To assess the efficacy of adapted physical activity (APA) on health-related quality of life (HRQoL) of hospitalized chil- dren and adolescents with cancer between 9 and 18 years of age. Procedure. A two-sequence, four-period cross-over study, Activit´ es PhysiquesenOncologieP´ ediatrique (APOP), compared hospital stay with APA sessions versus hospital stay without APA sessions on children’s HRQoL. Children and parents completed the child and parent forms, respectively, of a HRQoL questionnaire, the Child Health Questionnaire, on the last day of hospitalization. We used mixed linear regression to determine the effect of treatment, of treat- ment order and whether response to previous treatment influenced HRQoL. Results. Thirtychildrenwereincluded(meanage13.6 ± 2.9 years; 18 males). Cross-over analysis revealed no effect of period or interaction between APA and period. HRQoL was higher when children practiced than did not practice APA during their hospital- ization, as reported by both children and parents, for the dimensions physical functioning (P < 0.0001), role/social-physical (P = 0.001), self-esteem(P < 0.0001),andmentalhealth(P < 0.0001).Inaddition, APA had a significant effect on the behavior dimension (P = 0.01), as reportedbychildren,andonthebodilypaindimension(P = 0.0004), as reported by parents. The highest significant difference in scores between with and without APA was observed for the self-esteem dimension (P < 0.0001) for both children and parents. Conclusion. APA during hospitalization for children with cancer was associated withbetterHRQoLformostoftheHRQoLpsychologicalandphysical dimensions. Whether this effect is specific for children with can- cer should be explored. Pediatr Blood Cancer. 2010;55:1160–1166. © 2010 Wiley-Liss, Inc. Key words: adapted physical activity; cross-over design; health-related quality of life; hospital; pediatric hematology/oncology INTRODUCTION In France, cancer is the first cause of mortality due to disease in young people. Cancer develops in 1 in 500 children before the age of 15 years and 1 in 1,100 adolescents between 15 and 19 years old [1–3]. Cancer treatment usually requires repeated and/or prolonged hospitalization. Several qualitative studies identified dif- ferent hospitalization-related stressors such as invasive procedures, fear of death, unfamiliar environment, or lack of activities [4–6]. Moreover, cancer treatment often involves painful procedures; chil- dren undergoing cancer treatment have been reported to have more acute physical problems (such as weight change, eating problems, and hair loss) [7,8], psychological distress (such as pain, lack of self- esteem, tiredness, sadness, and depression) [9], and complications and/or modifications of health-related quality of life (HRQoL) in the short-term than do children who have completed treatment [10– 12]. In addition, children with chronic diseases have a significantly lower HRQoL than do healthy children [13]. Practising physical activity is known to decrease depressive pat- terns and anxiety [14–16] and increase self-esteem [17] among children and adolescents in both general and patient populations. As well, exercise during cancer treatment has been found associated with improvement of some physiological, physical, and psycho- logical outcomes in children [18–22]. However, few studies have explored the effects of physical exercise on children undergoing treatment for cancer [19–22]. Some specialists consider that phys- ical activity is inadvisable for children with cancer (especially children with bone metastases, insufficient platelet count or other serious deficiencies). Nevertheless, White et al. [23] recommended that children with cancer practice physical activity during treatment, assuming an adaptation of the dose, frequency, intensity, and type of activity according to the phase of treatment. Despite the numerous benefits of physical activity, children undergoing treatment were found to have a physical activity level markedly reduced in both amount and intensity as compared with those of a control group [24]. Thus, children receiving treatment for cancer should increase their physical activity. One solution could be to propose some indi- vidual and/or group physical activity adapted to children with cancer during their hospitalization course. Bjork et al. [25] found that children need physical activity during their hospitalization. Besides, children with cancer are interested in play and activity during their hospital stay [25,26]. Although many hospital departments integrate activities into the daily routine, most of the activities are sedentary. For example, educators pro- pose manual activities, volunteers bring games and books and play with children, clowns and/or musicians visit, or volunteers accom- pany children to activities inside the hospital. Consequently, some physical activity would supplement the range of activities already proposed in pediatric hospital departments. The introduction of physical activity could allow children undergoing treatment to have a different view of themselves because they would be physically active, even though they are hospitalized. 1 Nancy-Universit´ e, Universit´ e Paul Verlaine Metz, Universit´ e Paris Descartes, EA 4360 Apemac, Nancy, France; 2 Association pour la Pro- motion du Sport chez l’Enfant Malade, APSEM, Nancy, France; 3 CHU Nancy, Service d’h´ emato-oncologie p´ ediatrique, Nancy, France Grant sponsors: Association pour la Promotion du Sport chez l’Enfant Malade (APSEM); Ligue Franc ¸aise contre le cancer; F´ ed´ eration Hospitali` ere Franc ¸aise. Conflict of interest: Nothing to declare. *Correspondence to: Anne Vuillemin, Ecole de Sant´ e Publique, Fac- ult´ e de m´ edecine, 9 Avenue de la Forˆ et de Haye, BP 184, F-54505 Vandoeuvre-l` es-Nancy Cedex, France. E-mail: anne.vuillemin@staps.uhp-nancy.fr Received 4 January 2010; Accepted 18 May 2010 ©2010Wiley-Liss,Inc. DOI10.1002/pbc.22698 Publishedonline29July2010 inWileyOnlineLibrary (wileyonlinelibrary.com).