Exercise Training in Childhood Cancer

Cancer-related fatigue measured by the Pediatric Quality of Life Inventory (PedsQL) 3.0 Multidimensional Fatigue Scale. The PedsQL Multidimensional Fatigue Scale is composed of 18 items comprising three dimensions. Scores are transformed on a scale from 0 to 100. Higher scores indicate lower fatigue.

Health-Related Quality of Life measured by the Measurement Model for the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales questionnaire.

On the PedsQL Generic Core Scales, for ease of interpretability, items are reversed scored and linearly transformed to a 0-100 scale, so that higher scores indicate better HRQOL (Health-Related Quality of Life).

Health-Related Quality of Life measured by the Measurement Model for the Pediatric Quality of Life Inventory (PedsQL) 3.0 Cancer Module questionnaire.

Scores are transformed to a 0 to 100 scale. Higher scores indicate lower problems.

WHO (Five) Well-Being Index (1998 version) is used to measure Mental Health.The WHO-5 consists of five statements, which respondents rate according to the scale below:

All of the time = 5 Most of the time = 4 More than half of the time = 3 Less than half of the time = 2 Some of the time = 1 At no time = 0. The total raw score, ranging from 0 to 25, is multiplied by 4 to give the final score, with 0 representing the worst imaginable well-being and 100 representing the best imaginable well-being.

Warwick-Edinburgh Mental Well-being Scale (WEMWBS) is used to measure Mental Health. WEMWBS is a 14 item scale of mental well-being covering subjective well-being and psychological functioning, in which all items are worded positively and address aspects of positive mental health. The total score of the 14-item scale WEMWBS is obtained by summing the score for each of the 14 items. The scoring range for each item is from 1 - 5 and the total score is from 14-70.

Stress reactivity measured by the Mainz Resilience Score for childhood cancer (MRScc). The MRScc consists of 4 dimensions on mental health problems and 6 dimensions on stressor exposure. For both categories mental health problems and stressor exposure 4 - 400 points can be achieved. To calculate the resilience score, the category mental health problems is divided by the category stressor exposure. A score >0 means low resilience, a score < 0 means high resilience.

Resilience will be evaluated using the Brief Resilience Scale (BRS). BRS is a 6 item scale, the items are rated from 1 to 5. A total score is calculated by determining the sum of the individual items which result in a total score ranging from 6 to 30. A higher score means a higher resilience.

Resilience will be evaluated using the Child & Youth Resilience Measure-Revised (CYRM-R).

The items within the measures can be directly summed to gain a total score of an individual's resilience. For the unmodified 5-point measure (with responses going from 1-5), the minimum score is 17 and the maximum score is 85. For the overall measure and subscales, higher scores indicate characteristics associated with resilience.

General self-efficacy will be evaluated using the General self-efficacy scale (GSE). The total score is calculated by finding the sum of the 10 items. For the GSE, the total score ranges between 10 and 40, with a higher score indicating more self-efficacy.

Physical self-efficacy will be evaluated using the Physical exercise self-efficacy scale (PESE). The total score is calculated by finding the sum of the 10 items. For the GSE, the total score ranges between 5 and 20, with a higher score indicating more self-efficacy.

Physical activity level will be evaluated using the Modifed Recent Physical Activity Questionnaire (mRPAQ).

The duration of listed physical activities were reported (recall time: over the past 7 days). Descriptive Statistics will be performed.

Physical activity level will be evaluated using Modified Youth Physical Activity Questionnaire (mYPAQ).

The duration of listed physical activities were reported (recall time: over the past 7 days). Descriptive Statistics will be performed.

Physical activity level will be evaluated using Modified Children's Physical Activity Questionnaire (mCPAQ).

The duration of listed physical activities were reported (recall time: over the past 7 days). Descriptive Statistics will be performed.

In a semi-structured interview on physical activity, qualitative data will be collected regarding activity behaviour, motivating factors and barriers to physical activity.

Measured via Six Minute Walk Test (6MWT). Functional capacity is evalauted by the walked distance.

Measured via assisted 6-minute cycling test (A6MCT). Endurance performance is evaluated by the cumulative revolutions after 6 minutes.

Endurance performance will be evaluated by the adapted Yo-Yo-Test.

Muscle impairment will be evaluated by near infrared spectroscopy (NIRS).

Cardiopulmonary Exercise Testing (CPET) will be performed during an endurance test to exhaustion to determine the peak oxygen uptake (VO2peak).

measured via the quick motor function test

measured via the sit and reach test

a goniometer is used to measure the angles during foot, knee and hip flexion

Functional strength will be evaluated using the sit to stand test.

Arm strength will be evaluated using 5 repetition maximum for biceps curls.

Upper body strength will be evaluated using medicine ball shot test.

Knee flexor strength will be evaluated using a handheld dynamometer.

Leg extension strength will be evaluated using 5 repetition maximum for leg extension test measured via leg extension machine.

Functional mobility will be evaluated using the timed up and down stairs test (TUDS).

Static balance will be determined with the static stand test.

Body composition is measured via plicometry of the triceps.

A multifrequency (5, 50, 100 kHz) bioelectrical impedance analysis is performed using a phase-sensitive impedance analyser (BIAcorpus RX4004M). For this purpose, a sinusoidal alternating current with a constant intensity is applied to the patient's wrists and ankles. The phase angle (PA, ° degree) is measured by the impedance analyser as the phase shift between current and voltage. The phase angle provides conclusions about nutritional status and body composition.

In the dual energy X-ray absorptiometry (DEXA) total muscle mass and total fat mass is determined.

Usage frequency derived from dates within an exercise diary is recorded during the entire time the AR (augmented reality) app is used.

Exploration of app usability via user experience, incl. functions/features, technical bugs. For this purpose, qualitative data will be collected in a semi-structured interview.

The pixformance station is a digital training tool. Pixformance usability should be explored through user experience, incl. functions/features, and technical bugs. For this purpose, qualitative data will be collected in a semi-structured interview.

Socioeconomic status will be assessed in order to perform a confounder analysis for the main outcome cancer-related fatigue.

The calculation of the socioeconomic status index is based on the dimensions "levels of education", "occupational status" and "income". Scores for each dimension ranged from 1 to a maximum of 7. Since the 3 subscales are included in the calculation with the same weight, the socioeconomic status index can assume values between 3.0 and 21.0. Higher scores mean higher socioeconomic status.

The purpose of the biomarker analysis is to describe peripheral circulating immune cell profiles and DNA methylation status at baseline (T-1) (i.e. before chemo- and/or radiotherapy), and pre- (T0) and post-exercise intervention (T1) (both during chemo- and/or radiotherapy) solely in adolescent and young adult patients suffering from a solid tumour excluding cancers of the immune system e.g. leukemia and lymphoma.

The purpose of the biomarker analysis is to describe peripheral circulating immune cell profiles and DNA methylation status at baseline (T-1) (i.e. before chemo- and/or radiotherapy), and pre- (T0) and post-exercise intervention (T1) (both during chemo- and/or radiotherapy) solely in adolescent and young adult patients suffering from a solid tumour excluding cancers of the immune system e.g. leukemia and lymphoma.

The purpose of the biomarker analysis is to describe peripheral circulating immune cell profiles and DNA methylation status at baseline (T-1) (i.e. before chemo- and/or radiotherapy), and pre- (T0) and post-exercise intervention (T1) (both during chemo- and/or radiotherapy) solely in adolescent and young adult patients suffering from a solid tumour excluding cancers of the immune system e.g. leukemia and lymphoma.

The purpose of the biomarker analysis is to describe peripheral circulating immune cell profiles and DNA methylation status at baseline (T-1) (i.e. before chemo- and/or radiotherapy), and pre- (T0) and post-exercise intervention (T1) (both during chemo- and/or radiotherapy) solely in adolescent and young adult patients suffering from a solid tumour excluding cancers of the immune system e.g. leukemia and lymphoma.

The purpose of the biomarker analysis is to describe peripheral circulating immune cell profiles and DNA methylation status at baseline (T-1) (i.e. before chemo- and/or radiotherapy), and pre- (T0) and post-exercise intervention (T1) (both during chemo- and/or radiotherapy) solely in adolescent and young adult patients suffering from a solid tumour excluding cancers of the immune system e.g. leukemia and lymphoma.

The purpose of the biomarker analysis is to describe peripheral circulating immune cell profiles and DNA methylation status at baseline (T-1) (i.e. before chemo- and/or radiotherapy), and pre- (T0) and post-exercise intervention (T1) (both during chemo- and/or radiotherapy) solely in adolescent and young adult patients suffering from a solid tumour excluding cancers of the immune system e.g. leukemia and lymphoma.

The purpose of the biomarker analysis is to describe peripheral circulating immune cell profiles and DNA methylation status at baseline (T-1) (i.e. before chemo- and/or radiotherapy), and pre- (T0) and post-exercise intervention (T1) (both during chemo- and/or radiotherapy) solely in adolescent and young adult patients suffering from a solid tumour excluding cancers of the immune system e.g. leukemia and lymphoma.