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Int J Cancer. 2020 Mar 13. doi: 10.1002/ijc.32963. [Epub ahead of print]

High impact physical activity and bone health of lower extremities in childhood cancer survivors: A cross-sectional study of SURfit.

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Department of Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Department of Pediatric Hematology and Oncology, University Children's Hospital Basel (UKBB) and the University of Basel, Basel, Switzerland.
Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Preventive Cardiology and Sports Medicine, University Clinic of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland.
Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland.
Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.


Childhood cancer survivors (CCS) are at risk of reduced bone health and premature osteoporosis. As physical activity with high impact loading (IL-PA) is known to promote bone health, we compared bone densitometry and microstructure between groups of CCS who performed different amounts of physical activities in their daily life. We used baseline data of a single-center PA trial including 161 CCS from the Swiss Childhood Cancer Registry, aged <16 at diagnosis, ≥16 at study and ≥5 years since diagnosis. Lower body bone health was assessed with peripheral quantitative computed tomography (pQCT) and dual-energy X-ray absorptiometry (DXA). Daily IL-PA (duration in activities >2 g acceleration and numbers of vertical impacts/hr >2 g) was captured using hip-worn accelerometers (1-3 weeks). For both IL-PA approaches, we formed low, middle and high activity groups based on tertiles. Bone health of the high and middle active groups was compared to the low active group. 63% of CCS had indication of at least one bone mineral density z-score ≤ -1 measured by pQCT or DXA. The high IL-PA group performing 2.8 min/day or 19.1 impact peaks/hr > 2 g (median) showed about 3-13% better microstructural and densitometric bone health as compared to the low IL-PA group with 0.38 min/day or 0.85 peaks/hr > 2 g. Just a few minutes and repetitions of high IL-PA as easily modifiable lifestyle factor may be sufficient to improve bone health in adult CCS. Future longitudinal research is needed to better understand pattern and dosage of minimal impact loading needed to strengthen bone in growing and adult CCS.


DXA; accelerometry; bone; bone health; bone mineral density; childhood cancer survivors; densitometry; high impact load; pQCT; physical activity


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