SURfit - A Physical Activity Intervention for Childhood Cancer Survivors (SURfit)

Effects of a 1-year Partially Supervised Exercise Program in Childhood Cancer Survivors - a Randomized Controlled Trial

Exercise can play a major role to mitigate or even prevent late effects in cancer survivors, such as cardiovascular disease, obesity, osteoporosis, fatigue, depression, reduced quality of life, mental health and physical performance.

The objective of this study is to assess the effect of an exercise program of 1 year on cardiovascular health, obesity and diabetes, osteoporosis, physical fitness, mental health and quality of life in childhood cancer survivors. The investigators will recruit childhood cancer survivors aged 16 years and above from three Swiss paediatric oncology clinics and randomize them into an intervention and a control group. The intervention group will be asked to increase physical activity for 1 year by at least 2.5 hours of intense physical activity weekly. Regular feedback will be given via a step counter, an online activity diary, and by the centre staff. The control group participants will keep their activity level constant. All participants will be seen after 3, 6 and 12 months to assess health and quality of life parameters over one year. After 1 year, the control group is offered to receive the same intervention to profit as well from an active lifestyle.

If the program shows to be effective, a complete package will become available to interested centres treating paediatric cancer patients in Switzerland to promote exercise in all survivors. The program will allow clinicians without previous experience in exercise counselling to improve the care of their patients.

Study Overview

• Status: Completed
• Conditions: Late-effects of Childhood Cancer
• Intervention / Treatment: Behavioral: partially supervised exercise intervention

• Study Type: Interventional
• Enrollment (Actual): 151
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Basel, Switzerland, 4056
    • University Children's Hospital Basel (UKBB)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Registered in the Swiss Childhood Cancer Registry.
• Age at cancer diagnosis <16 years.
• Diagnosed with a cancer classifiable within the International Classification of Childhood Cancer (ICCC-3) or diagnosed with a Langerhans Cell Histiocytosis.
• Diagnosed and/or treated at the University Children's Hospital Basel, Cantonal Hospital of Aarau and/or Cantonal Hospital of Lucerne.
• Survived ≥5 years since primary cancer diagnosis or any subsequent cancer event (relapse or further cancer diagnoses)
• Age at the time of the study ≥16 years
• Informed Consent as documented by signature

Exclusion Criteria:

• Participation in another clinical trial <4 weeks prior to baseline assessment (eventually later re-enrolment)
• Contradiction to one of the inclusion criteria mentioned above
• Inability to exercise
• Exercise potentially harmful
• Women who are pregnant or breast feeding
• Women who intend to become pregnant during the course of the study
• Instable clinical condition (eventually later re-enrolment)
• Under treatment for relapse or further cancer diagnoses
• Cardiac arrhythmias under exercise (during baseline assessment or by history)
• Diagnosis of diabetes <3 months ago (eventually re-enrolment after 3 months if diabetes is under good control)
• Detection of a clinical condition that needs immediate treatment during baseline assessments (eventually re-enrolment after 3 months if in stable clinical condition)
• Planned relevant surgeries for the next 12 months
• Major musculoskeletal injuries, fractures <2 months ago (eventually later re-enrolment)
• Recent change in medication that interfere with the parameters of the CVD risk score (primary outcome) <1 month ago (eventually later re-enrolment)
• >4 hours of reported vigorous activities per week
• Inability to follow the procedures and understand the intervention and assessments of the study e.g. due to cognitive impairment, language problems, psychological disorders etc.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Group; Partially supervised exercise intervention: Survivors in the intervention group will be asked to add at least 2.5 hours of intense physical activities per week. These should include at least 30 min of strength building exercises and 2 hours of aerobic exercises per week. Exercise bouts lasting 20 min or longer will be counted with respect to total weekly training time.	Behavioral: partially supervised exercise intervention; Other Names: physical activity intervention
No Intervention: Control Group; The control group will keep their physical activity level constant over the 1 year of the study. Thereafter, they will have the opportunity to receive the same intervention than the intervention group had received (off-trial) to benefit in the same way from an active lifestyle.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Composite cardiovascular risk score [z-score]	summarized mean z-score of waist circumference, blood pressure, HOMA-IR, inverted high density lipoprotein cholesterol, triglycerides and cardiorespiratory fitness	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Waist circumference [cm]		3, 6, and 12 months
Systolic and diastolic blood pressure [mmHg]		3, 6, and 12 months
Homeostasis Model Assessment Insulin Resistance (HOMA-IR)	calculated from insulin and glucose	6 and 12 months
HbA1C [mmol/mol]		6 and 12 months
Insulin resistance from response to oral glucose tolerance test (oGTT)	Assessment of fasting glucose [mmol/l] and insulin [mIU/l] and glucose 2 hours after drinking of a glucose solution	12 months
Inverted high-density lipoprotein cholesterol (HDL) [mmol/l]		6 and 12 months
Low-density lipoprotein cholesterol (LDL) [mmol/l]		6 and 12 months
Total cholesterol [mmol/l]		6 and 12 months
Triglycerides [mmol/l]		6 and 12 months
Body Mass Index (BMI) [z-score]	Calculated from height and weight	3, 6, and 12 months
Absolute [kg] and relative [%] body fat mass	Assessed with two methods: skinfold measurement (3, 6, and 12 months) and dual x-ray absorptiometry (DXA, 12 months only).	3, 6, and 12 months
Areal bone mineral density [g/cm2 and z-scores]	Bone mineral density for total body, lumbar spine, and femoral neck assessed with dual x-ray absorptiometry (DXA)	12 months
Bone mineral content [g/cm and z-scores]	Bone mineral content for total body, lumbar spine, and femoral neck assessed with dual x-ray absorptiometry (DXA)	12 months
Total cross sectional bone area [mm2 and z-scores]	Cross sectional area of the distal and proximal sites of radius and tibia assessed with peripheral quantitative computer tomography (pQCT)	12 months
Cortical cross sectional bone area [mm2 and z-scores]	Cross sectional area of the proximal site of radius and tibia assessed with peripheral quantitative computer tomography (pQCT)	12 months
Total and trabecular bone mineral density [g/cm3 and z-scores]	Bone mineral density of the distal site of radius and tibia assessed with peripheral quantitative computer tomography (pQCT)	12 months
Cortical bone mineral density [g/cm3 and z-scores]	Bone mineral density of the proximal site of radius and tibia assessed with peripheral quantitative computer tomography (pQCT)	12 months
Muscle cross-sectional area [cm2 and z-scores]	Muscle cross-sectional area of the proximal site of radius and tibia assessed with peripheral quantitative computer tomography (pQCT)	12 months
Peak oxygen uptake (VO2max) [ml/(kg*min) and % predicted]	Assessed with maximal spiroergometry test	6 and 12 months
Peak performance [watt/kg and % predicted]	Assessed with maximal spiroergometry test	6 and 12 months
Heart rate recovery [delta beats/min]	Assessed at the end of the maximal spiroergometry test: delta beats/min between peak heart rate and heart rate 1 minute post exercise.	6 and 12 months
Hand grip strength in the left and right hand [kg]	Assessed with a hydrolic hand grip dynamometer.	6 and 12 months
Leg strength and endurance [repetitions/min]	Assessed with the 1 minute sit-to-stand test	6 and 12 months
Total physical activity [counts/min]	Assessed by accelerometer	6 and 12 months
Moderate to vigorous physical activities [minutes/day]	Assessed by accelerometer	6 and 12 months
High impact activities with ground forces >3.9 G [n/day]	Assessed by accelerometer	6 and 12 month
Sedentary behaviour [minutes/day]	Assessed by accelerometer	6 and 12 months
Number of steps per day [steps/day]	Assessed by accelerometer	6 and 12 months
Health related quality of life [T-score with mean=50, standard deviation=10 and range=0-100]	Health related quality of life assessed by the self-reported questionnaire short form 36 (SF-36).	6 and 12 months
Psychological distress [T-score with mean=50, standard deviation=10 and range=0-100]	Psychological distress assessed by the self-reported questionnaire Brief Symptom Inventory (BSI).	6 and 12 months
Fatigue on a visual analogue scale (VAS) [mm]		3, 6 and 12 months
Fatigue	Fatigue assessed with the self-reported questionnaire Checklist of Individual Strength (CIS).	3, 6 and 12 months
Number of adverse events and serious adverse events [n]	Number of participants with adverse events and exercise related complications categorized into seriousness of the event (adverse event [AE] or severe adverse event [SAE]).	3, 6 and 12 months
Proportion of aimed physical activity reached [%]	Only intervention participants: compliance with intervention	12 months
Number of weeks where physical activity aim was reached [n/year]	Only intervention participants: compliance with intervention	12 months
Number of missing days in the online diary [n/year]	Only intervention participants: compliance with intervention	12 months

Collaborators and Investigators

• Sponsor: University of Zurich
• Collaborators: University Children's Hospital Basel
• Investigators: Principal Investigator: Nicolas X von der Weid, Prof, MD, University Children's hospital Basel, UKBB

Publications and helpful links

General Publications

• Schindera C, Usemann J, Zuercher SJ, Jung R, Kasteler R, Frauchiger B, Naumann G, Rueegg CS, Latzin P, Kuehni CE, von der Weid NX. Pulmonary Dysfunction after Treatment for Childhood Cancer. Comparing Multiple-Breath Washout with Spirometry. Ann Am Thorac Soc. 2021 Feb;18(2):281-289. doi: 10.1513/AnnalsATS.202003-211OC.
• Rueegg CS, Zurcher SJ, Schindera C, Jung R, Deng WH, Banteli I, Schaeff J, Hebestreit H, von der Weid NX, Kriemler S. Effect of a 1-year physical activity intervention on cardiovascular health in long-term childhood cancer survivors-a randomised controlled trial (SURfit). Br J Cancer. 2023 Oct;129(8):1284-1297. doi: 10.1038/s41416-023-02410-y. Epub 2023 Aug 31.
• Deng WH, Zurcher SJ, Schindera C, Jung R, Hebestreit H, Banteli I, Bologna K, von der Weid NX, Kriemler S, Rueegg CS. Effect of a 1-year physical activity intervention on quality of life, fatigue, and distress in adult childhood cancer survivors-A randomized controlled trial (SURfit). Cancer. 2024 May 15;130(10):1869-1883. doi: 10.1002/cncr.35207. Epub 2024 Feb 5.
• Schindera C, Zurcher SJ, Jung R, Boehringer S, Balder JW, Rueegg CS, Kriemler S, von der Weid NX. Physical fitness and modifiable cardiovascular disease risk factors in survivors of childhood cancer: A report from the SURfit study. Cancer. 2021 May 15;127(10):1690-1698. doi: 10.1002/cncr.33351. Epub 2021 Jan 6.
• Jung R, Zurcher SJ, Schindera C, Braun J, Deng WH, von der Weid NX, Rueegg CS, Kriemler S. Adherence and contamination in a 1-year physical activity program in childhood cancer survivors: A report from the SURfit study. Cancer Med. 2023 Jul;12(13):14731-14741. doi: 10.1002/cam4.6096. Epub 2023 May 18.
• Jung R, Zurcher SJ, Schindera C, Eser P, Meier C, Schai A, Braun J, Deng WH, Hebestreit H, Neuhaus C, Schaeff J, Rueegg CS, von der Weid NX, Kriemler S. Effect of a physical activity intervention on lower body bone health in childhood cancer survivors: A randomized controlled trial (SURfit). Int J Cancer. 2023 Jan 15;152(2):162-171. doi: 10.1002/ijc.34234. Epub 2022 Aug 26.
• Zurcher SJ, Jung R, Monnerat S, Schindera C, Eser P, Meier C, Rueegg CS, von der Weid NX, Kriemler S. High impact physical activity and bone health of lower extremities in childhood cancer survivors: A cross-sectional study of SURfit. Int J Cancer. 2020 Oct 1;147(7):1845-1854. doi: 10.1002/ijc.32963. Epub 2020 Mar 25.
• Rueegg CS, Kriemler S, Zuercher SJ, Schindera C, Renner A, Hebestreit H, Meier C, Eser P, von der Weid NX. A partially supervised physical activity program for adult and adolescent survivors of childhood cancer (SURfit): study design of a randomized controlled trial [NCT02730767]. BMC Cancer. 2017 Dec 5;17(1):822. doi: 10.1186/s12885-017-3801-8.

Helpful Links

• Study Homepage
• Study Facebook Page

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2015
• Primary Completion (Actual): March 1, 2019
• Study Completion (Actual): March 1, 2019

Study Registration Dates

• First Submitted: December 10, 2015
• First Submitted That Met QC Criteria: March 31, 2016
• First Posted (Estimated): April 6, 2016

Study Record Updates

• Last Update Posted (Actual): April 4, 2025
• Last Update Submitted That Met QC Criteria: April 1, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Other Study ID Numbers: SURfit

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO