1. The impact of physical activity level on nutritional treatment among Danish
children with cancer
Study and validation of methods for estimating PAL (Physical Activity Level)
Bachelor abstract
This assignment examines the physical activity level of ill children during hospitalization and home stay,
to obtain knowledge about potential differences. The study, which is carried out at Pediatric Oncology
Department, Rigshospitalet, includes 20 cancer affected children and their parents, and is the first of its
kind in Denmark.
The assignment outlines the methods for estimating physical activity level (PAL) for which the clinical
nutritionists at Pediatric Nutrition Unit currently are using. At this point, PAL is estimated with a great
uncertainty due to lack of knowledge about ill children’s level of physical activity. Since, that the course
of treatment extends over a period of approximately 3 years, the children are at risk of being both under-
and malnourished due to the side effects of treatment.
In this context, it is investigated to what extend the children’s parents can provide a valid estimate of
their child’s physical activity level, and hereby contribute to the dietician’s estimation of PAL in order to
ensure that the child is sufficiently nourished. The levels of the children’s physical activity is registered
via accelerometers attached to their right wrist and right hip, while the parents via an activity log, are
asked to perform a continuous subjective evaluation of their child’s physical activity level.
Five different hypotheses are tested using objective and subjective measurement methods, to answer the
following research questions:
In what way does cancer affected children’s physical activity levels differentiate during
hospitalization and home stay, and to what extend should the clinical dietician account for potential
differences when nutrition plans are made?
In what way do the objective and subjective methods for estimating physical activity levels correlate,
and in what way can the parents provide a valid estimate of the child’s physical activity level?
Newer literature with evidence strength A and B is used to illustrate to what extend physical activity
exerts any positive effects on acute and late complications associated with treatment of childhood cancer.
Results from this study are also included to determine the physical activity level of cancer affected
children, and evaluation of their parent’s assessment.
We found that:
There is increasing scientific evidence of physical activity having beneficial physical, psychological
and social effects for children with cancer.
Cancer affected children have significantly higher levels of physical activity when at home compared
to when in hospital.
Cancer affected children have significantly higher PAL values when at home compared to when in
hospital.
There is significantly difference between total energy expenditure (TEE), which is highest when the
children are at home. Therefore, the clinical dietician should differentiate nutrition plans for whether the
child is at home or in hospital
Statistical significant data suggests that the parents can provide a valid estimation of the level of
physical activity of their child during both hospitalization and home stay. In the light of this, parents
should, to a further extend, be used as a resource in clarifying their children’s PAL values, due to
ensuring sufficient nutrition.
Cancer affected children should generally receive at least a score of 1,3 PAL when hospitalized and
1,4 PAL when at home