Exercise intervention for children with acute leukemia: a best evidence summary.

BACKGROUND

Acute leukemia (AL) is the most common malignancy in childhood. Despite significant improvements in survival rates, long-term high-intensity chemotherapy often leads to severe physical dysfunction and cancer-related fatigue (CRF) in pediatric patients. Although exercise intervention is a significant non-pharmacological physical therapy for improving patient prognosis, clinical practice still lacks unified, evidence-based standardized guidance.

OBJECTIVE

To systematically retrieve, evaluate, and synthesize evidence regarding exercise interventions for children with AL, providing a decision-making reference for multidisciplinary clinical teams to develop standardized and individualized exercise rehabilitation programs.

METHODS

Guided by the Joanna Briggs Institute (JBI) evidence-based practice framework, a comprehensive search was conducted in domestic and international databases, including UpToDate, BMJ Best Practice, JBI, PubMed, Cochrane Library, CNKI, and Wanfang, to identify clinical decision supports, guidelines, expert consensuses, systematic reviews, and meta-analyses related to exercise interventions for pediatric AL. The search period spanned from database inception to January 2026. Methodological quality appraisal and data extraction were performed independently by two researchers.

RESULTS

Eighteen publications were included, consisting of 2 clinical practice guidelines and 16 systematic reviews. Seventeen items of best evidence were extracted, covering eight dimensions: intervention principles, safety, exercise modalities, intensity, frequency and timing, stage-specific strategies, intervention settings, and outcome improvement.

CONCLUSION

Children with acute leukemia should engage in long-term, individualized, multimodal exercise interventions under professional supervision. Healthcare professionals should dynamically adjust exercise protocols based on the specific treatment phase. While ensuring safety, incorporating game-based formats can enhance patient adherence, thereby effectively improving bone mineral density, cardiorespiratory endurance, and quality of life.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/view/CRD420261341113/1/0, PROSPERO CRD420261341113.