Physical Activity and Quality of Life of Healthy Children and Patients with Hematological Cancers
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Group
2.2. Research Methods
2.3. Ethics
2.4. Statistical Analysis
3. Results
3.1. Physical Activity Level
3.2. Quality of Life
4. Discussion
5. Limitations
6. Future Research Directions
7. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Diller, L.; Chow, E.J.; Gurney, J.G.; Hudson, M.M.; Kadin-Lottick, N.S.; Kawashima, T.J.; Leisenring, W.M.; Meacham, L.R.; Mertens, A.C.; Mulrooney, D.A.; et al. Chronic Disease in the Childhood Cancer Survivor Study Cohort: A. Review of Published Findings. J. Clin. Oncol. 2009, 27, 2339–2355. [Google Scholar] [CrossRef]
- Reinfjell, T.; Lofstad, G.E.; Veenstra, M.; Vikan, A.; Diseth, T.H. Healthrelated quality of life and intellectual functioning in children in remission from acute lymphoblastic leukaemia. Acta Paediatr. 2007, 96, 1280–1285. [Google Scholar] [CrossRef]
- Rodriguez-Galindo, C.; Friedrich, P.; Morrissey, L.; Frazier, L. Global challenges in pediatric oncology. Curr. Opin. Pediatr. 2013, 1, 3–15. [Google Scholar] [CrossRef]
- Bansal, M.; Sharma, K.K.; Vatsa, M.; Bakhshi, S. Comparison of healthrelated quality of life of children during maintenance therapy with acute lymphoblastic leukemia versus siblings and healthy children in India. Leuk. Lymphoma 2013, 54, 1036–1041. [Google Scholar] [CrossRef]
- Tan, S.Y.; Poh, B.K.; Chong, H.X.; Ismail, M.N.; Rahman, J.; Zarina, A.L.; Juraida, A.R.; Tahir, A.; Ruzita, A.T.; Roslee, R.; et al. Physical activity of pediatric patients with acute leukemia undergoing induction or consolidation chemotherapy. Leuk. Res. 2013, 37, 14–20. [Google Scholar] [CrossRef]
- Green, J.L.; Knight, S.J.; Mccarthy, M.; De Luca, C.R. Motor functioning during and following treatment with chemotherapy for pediatric acute lymphoblastic leukemia. Pediatr. Blood Cancer 2013, 60, 1261–1266. [Google Scholar] [CrossRef]
- Sharkey, A.M.; Carey, A.B.; Heise, C.T.; Barber, G. Cardiac rehabilitation after cancer therapy in children and young adults. Am. J. Cardiol. 1993, 71, 1488–1490. [Google Scholar] [CrossRef]
- te Winkel, M.L.; Pieters, R.; Hop, W.C.; Roos, J.C.; Bökkerink, J.P.; Leeuw, J.A.; Bruin, M.C.; Kollen, W.J.; Veerman, A.J.; de Groot-Kruseman, H.A.; et al. Bone mineral density at diagnosis determines fracture rate in children with acute lymphoblastic leukemia treated according to the DCOG-ALL9 protocol. Bone 2014, 59, 223–228. [Google Scholar] [CrossRef]
- Ness, K.K.; Mertens, A.C.; Hudson, M.M.; Wall, M.M.; Leisenring, W.M.; Oeffinger, K.C.; Sklar, C.A.; Robison, L.L.; Gurney, J.G. Limitations on physical performance and daily activities among long-term survivors of childhood cancer. Ann. Intern. Med. 2005, 143, 639–647. [Google Scholar] [CrossRef]
- Gilliam, M.B.; Madan-Swain, A.; Whelan, K.; Tucker, D.C.; Demark-Wahnefried, W.; Schwebel, D.C. Cognitive Influences as Mediators of Family and Peer Support for Pediatric Cancer Survivors’ Physical Activity. Psychooncology 2013, 22, 1361–1368. [Google Scholar] [CrossRef]
- Abrams, A.N.; Hazen, E.P.; Penson, R.T. Psychosocial issues in adolescents with cancer. Cancer Treat. Rev. 2007, 33, 622–630. [Google Scholar] [CrossRef]
- Yeh, C.H.; Man-Wai, J.P.; Lin, U.S.; Chiang, Y.C. A pilot study to examine the feasibility and effects of a home-based aerobic program on reducing fatigue in children with acute lymphoblastic leukemia. Cancer Nurs. 2011, 34, 3–12. [Google Scholar] [CrossRef]
- San Juan, A.; Chamorro-Viña, C.; Moral, S.; Fernández del Valle, M.; Madero, L.; Ramírez, M.; Pérez, M.; Lucia, A. Benefits of Intrahospital Exercise Training after Pediatric Bone Marrow Transplantation. Int. J. Sports Med. 2008, 29, 439–446. [Google Scholar] [CrossRef]
- San Juan, A.; Fleck, S.; Chamorro-Viña, C.; Maté-Muñoz, J.; Moral, S.; Pérez, M.; Cardona, C.; Del Valle, M.; Hernández, M.; Ramírez, M.; et al. Effects of an intrahospital exercise program intervention for children with leukemia. Med. Sci. Sports Exerc. 2007, 39, 13–21. [Google Scholar] [CrossRef]
- Daniel, C.L.; Emmons, K.M.; Fasciano, K.; Nevidjon, B.; Fuemmeler, B.F.; Demark-Wahnefried, W. Needs and Lifestyle Challenges of Adolescents and Young Adults with Cancer: Summary of an Institute of Medicine and Livestrong Foundation Workshop. Clin. J. Oncol. Nurs. 2015, 19, 675–681. [Google Scholar] [CrossRef]
- Chamorro-Viña, C.; Ruiz, J.; Santana-Sosa, E.; González Vicent, M.; Madero, L.; Pérez, M.; Fleck, S.; Pérez, A.; Ramírez, M.; Lucía, A. Exercise during Hematopoietic Stem Cell Transplant Hospitalization in Children. Med. Sci. Sports Exerc. 2010, 42, 1045–1053. [Google Scholar] [CrossRef] [Green Version]
- Li, W.; Lopez, V.; Joyce Chung, O.K.; Ho, K.Y.; Chiu, S.Y. The impact of cancer on the physical, psychological and social well-being of childhood cancer survivors. Eur. J. Oncol. Nurs. 2013, 17, 214–219. [Google Scholar] [CrossRef]
- Schmitz, K.H.; Courneya, K.S.; Matthews, C.; Demark-Wahnefried, W.; Galvão, D.A.; Pinto, B.M.; Irwin, M.L.; Wolin, K.Y.; Segal, R.J.; Lucia, A.; et al. American College of Sports Medicine. American college of sports medicine roundtable on exercise guidelines for cancer survivors. Med. Sci. Sports Exerc. 2010, 42, 1409–1426. [Google Scholar] [CrossRef]
- Anzar, S.; Webster, A.L.; San Juan, A.F.; Camorro-Vina, C.; Mate-Munoz, J.L.; Moral, S.; Perez, M.; Garcia-Castro, J.; Ramirez, M.; Madero, L.; et al. Physical activity during treatment in children with leukemia: A pilot study. Appl. Physiol. Nutr. Metab. 2006, 31, 407–413. [Google Scholar] [CrossRef]
- Kelly, A.K. Physical activity prescription for childhood cancer survivors. Curr. Sports Med. Rep. 2011, 10, 352–359. [Google Scholar] [CrossRef]
- Braam, K.I.; van der Torre, P.; Takken, T.; Veening, M.A.; van Dulmen-den Broeder, E.; Kaspers, G.J. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst. Rev. 2013, 4. [Google Scholar] [CrossRef]
- Janssen, I.; Leblanc, A.G. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int. J. Behav. Nutr. Phys. Act. 2010, 7. [Google Scholar] [CrossRef]
- Doyle, C.; Kushi, L.H.; Byers, T.; Courneya, K.S.; Demark-Wahnefried, W.; Grant, B.; Mc Tiernan, A.; Rock, C.L.; Thompson, C.; Gansler, T.; et al. Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society. Nutrition and physical activity during and after cancer treatment: An American Cancer Society guide for informed choices. CA Cancer J. Clin. 2006, 56, 323–353. [Google Scholar] [CrossRef]
- Poitras, V.J.; Gray, C.E.; Borghese, M.M.; Carson, V.; Chaput, J.P.; Janssen, I.; Katzmarzyk, P.T.; Pate, R.R.; Connor-Gorber, S.; Kho, M.E.; et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl. Physiol. Nutr. Metab. 2016, 41, 197–239. [Google Scholar] [CrossRef]
- Tremblay, M.S.; Colley, R.C.; Saunders, T.J.; Healy, G.N.; Owen, N. Physiological and health implications of a sedentary lifestyle. Appl. Physiol. Nutr. Metab. 2010, 35, 725–740. [Google Scholar] [CrossRef]
- Carson, V.; Ridgers, N.D.; Howard, B.J.; Winkler, E.A.; Healy, G.N.; Owen, N.; Dunstan, D.W.; Salmon, J. Light-intensity physical activity and cardiometabolic biomarkers in US adolescents. PLoS ONE 2013, 8, e71417. [Google Scholar] [CrossRef]
- Gocha-Marchese, V.; Chiarello, L.A.; Lange, B.J. Strength and functional mobility in children with acute lymphoblastic leukemia. Med. Pediatr. Oncol. 2003, 40, 230–232. [Google Scholar] [CrossRef]
- Belgaumi, A.F.; Al-Bakrah, M.; Al-Mahr, M.; Al-Jefri, A.; Al-Musa, A.R.; Saleh, M.; Salim, M.F.; Osman, M.; Osman, L.; El-Solh, H. Dexamethasone-associated toxicity during induction chemotherapy for childhood acute lymphoblastic leukemia is augmented by concurrent use of daunomycin. Cancer 2003, 97, 2898–2903. [Google Scholar] [CrossRef]
- Lucia, A.; Ramírez, M.; San Juan, A.F.; Fleck, S.J.; García-Castro, J.; Madero, L. Intrahospital supervised exercise training: A complementary tool in the therapeutic armamentarium against childhood leukemia. Leukemia 2005, 19, 1334–1337. [Google Scholar] [CrossRef]
- Götte, M.; Kesting, S.; Winter, C.; Rosenbaum, D.; Boos, J. Comparison of self-reported physical activity in children and adolescents before and during cancer treatment. Pediatr. Blood Cancer 2014, 61, 1023–1028. [Google Scholar] [CrossRef]
- Bhat, S.R.; Goodwin, T.L.; Burwinkle, T.M.; Lansdale, M.F.; Dahl, G.V.; Huhn, S.L.; Gibbs, I.C.; Donaldson, S.S.; Rosenblum, R.K.; Varni, J.W.; et al. Profile of Daily Life in Children with Brain Tumors: An Assessment of Health-Related Quality of Life. J. Clin. Oncol. 2005, 23, 5493–5500. [Google Scholar] [CrossRef]
- Davies, B.; Whitsett, S.F.; Bruce, A.; McCarthy, P. A Typology of Fatigue in Children with Cancer. J. Pediatr. Oncol. Nurs. 2002, 19, 12–21. [Google Scholar] [CrossRef]
- Speyer, E.; Herbinet, A.; Vuillemin, A.; Briancon, S.; Chastagner, P. Effect of adapted physical activity sessions in the hospital on health-related quality of life for children with cancer: a cross-over randomized trial. Pediatric Blood Cancer 2010, 55, 1160–1166. [Google Scholar] [CrossRef]
- Moody, K.; Meyer, M.; Mancuso, C.A.; Charlson, M.; Robbins, L. Exploring concerns of children with cancer. Support Care Cancer 2006, 14, 960–966. [Google Scholar] [CrossRef]
- Kourti, M.; Tragiannidis, A.; Makedou, A.; Papageorgiou, T.; Rousso, I.; Athanassiadou, F. Metabolic syndrome in children and adolescents with acute lymphoblastic leukemia after the completion of chemotherapy. J. Pediatric Hematol. Oncol. 2005, 27, 499–501. [Google Scholar] [CrossRef]
- Oeffinger, K.C.; Mertens, A.C.; Sklar, C.A.; Yasui, Y.; Fears, T.; Stovall, M.; Vik, T.A.; Inskip, P.D.; Robison, L.L. Obesity in adult survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study. J. Clin. Oncol. 2003, 21, 1359–1365. [Google Scholar] [CrossRef]
- Davies, J.H.; Evans, B.A.; Jenney, M.E.; Gregory, J.W. Skeletal morbidity in childhood acute lymphoblastic leukaemia. Clin. Endocrinol. (Oxf.) 2005, 63, 1–9. [Google Scholar] [CrossRef]
- Mertens, A.C.; Yasui, Y.; Neglia, J.P.; Potter, J.D.; Nesbit, M.E.; Ruccione, K.; Smithson, W.A.; Robison, L.L. Late mortality experience in five-year survivors of childhood and adolescent cancer: The Childhood Cancer Survivor Study. J. Clin. Oncol. 2001, 19, 3163–3172. [Google Scholar] [CrossRef]
- Morales, J.S.; Valenzuela, P.L.; Rincón-Castanedo, C.; Takken, T.; Fiuza-Luces, C.; Santos-Lozano, A.; Lucia, A. Exercise training in childhood cancer: A systematic review and meta-analysis of randomized controlled trials. Cancer Treat Rev. 2018, 70, 154–167. [Google Scholar] [CrossRef]
Parameter | Group I Children Undergoing Treatment | Group II Children after Treatment | Group III Healthy Children |
---|---|---|---|
Age [years] | 13 ± 1.5 | 13 ± 1.9 | 13 ± 0.47 |
Weight [kg] | 47 ± 13 | 51 ± 11 | 50 ± 10 |
Height [cm] | 156 ± 13 | 159 ± 12 | 163 ± 8.7 |
Group I | Group II | Group III |
---|---|---|
Inclusion Criteria | ||
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Exclusion Criteria | ||
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Question/Variable | Answer | Group I | Group II | Group III |
---|---|---|---|---|
The number of days per week in which the child performed the physical activity of at least 60 min (MVPA)—HBSC 1 | 0 days | 100.00 | 17.9 | - |
1 day | - | 10.7 | - | |
2 days | - | 25.0 | - | |
3 days | - | 21.4 | 20.0 | |
4 days | - | - | 40.0 | |
5 days | - | - | 20.0 | |
6 days | - | 7.1 | 6.7 | |
7 days | - | 17.9 | 13.3 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** <0.0001 |
Frequency of undertaking vigorous physical activity—HBSC 2 | daily | - | 14.3 | 16.7 |
4–6 times/week | - | 7.1 | 36.7 | |
2–3 times/week | - | 28.6 | 33.3 | |
once a week | - | 17.9 | 10.0 | |
once a month | - | 10.7 | - | |
< once a week | 23.3 | 7.1 | 3.3 | |
never | 76.7 | 14.3 | - | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.026 |
The number of hours per week devoted to vigorous physical activity—HBSC 3 | none | 80.0 | 14.3 | - |
about 30 min | 20.0 | 21.3 | - | |
about 1 h | - | 17.9 | - | |
about 2 h | - | 17.9 | 10.0 | |
about 3 h | - | 10.7 | 23.3 | |
about 4 h | - | 3.6 | 36.7 | |
about 5 h | - | 3.6 | 16.7 | |
about 6 h | - | - | 3.3 | |
about 7 h or more | - | 10.7 | 10.0 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.0003 |
Question/Variable | Answer | Group I | Group II | Group III |
---|---|---|---|---|
The number of hours in front of a TV screen per week—HBSC 4.1 | none | - | 17.9 | 16.7 |
about 30 min/day | - | 14.3 | 6.7 | |
about 1 h/day | 13.3 | - | 16.7 | |
about 2 h/day | 40.0 | 25.0 | 36.5 | |
about 3 h/day | 33.4 | 21.4 | - | |
about 4 h/day | 13.3 | 10.7 | 6.7 | |
about 5 h/day | - | 7.1 | 6.7 | |
about 6 h/day | - | - | 6.7 | |
about 7 h or more/day | - | 3.6 | 3.3 | |
p | * 0.0101 | ** 0.0101 | *** 0.0102 | **** 0.0652 |
The number of hours spent playing games per week—HBSC 5.1 | none | 33.3 | 32.2 | 33.4 |
about 30 min/day | 10.0 | 10.7 | 3.3 | |
about 1 h/day | 40.0 | 7.1 | 13.3 | |
about 2 h/day | 16.7 | 10.7 | 13.3 | |
about 3 h/day | - | 14.3 | 23.4 | |
about 4 h/day | - | 7.1 | 10.0 | |
about 5 h/day | - | 3.6 | - | |
about 6 h/day | - | 3.6 | - | |
about 7 h or more/day | - | 10.7 | 3.3 | |
p | * 0.0324 | ** 0.0132 | *** 0.0169 | **** 0.6676 |
The number of hours spent in front of a computer screen per week—HBSC 6.1 | none | - | 17.9 | 6.7 |
about 30 min/day | 43.3 | - | 6.7 | |
about 1 h/day | 56.7 | 32.1 | 13.3 | |
about 2 h/day | - | 17.9 | 23.3 | |
about 3 h/day | - | 14.3 | 10.0 | |
about 4 h/day | - | 3.6 | 20.0 | |
about 5 h/day | - | 3.6 | 10.0 | |
about 6 h/day | - | - | 6.7 | |
about 7 h or more/day | - | 10.6 | 3.3 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.1050 |
Question/Variable | Answer | Group I | Group II | Group III |
---|---|---|---|---|
The number of hours in front of a TV screen at the weekend—HBSC 4.2 | none | - | 14.3 | 16.7 |
about 30 min/day | - | 10.7 | 3.3 | |
about 1 h/day | - | 7.1 | 6.7 | |
about 2 h/day | 20.00 | 14.3 | 6.7 | |
about 3 h/day | 50.00 | 17.9 | 33.2 | |
about 4 h/day | 30.00 | 25.0 | 16.7 | |
about 5 h/day | - | 3.6 | 6.7 | |
about 6 h/day | - | - | 3.3 | |
about 7 h or more/day | - | 7.1 | 6.7 | |
p | * 0.0876 | ** n/a | *** n/a | **** n/a |
The number of hours spent playing games at the weekend—HBSC 5.2 | none | 13.3 | 21.5 | 16.7 |
about 30 min/day | 30.0 | 7.1 | 3.3 | |
about 1 h/day | 16.7 | - | 6.7 | |
about 2 h/day | 26.7 | 17.9 | 10.0 | |
about 3 h/day | 13.3 | 7.1 | 20.0 | |
about 4 h/day | - | 14.3 | 10.0 | |
about 5 h/day | - | 10.7 | 10.0 | |
about 6 h/day | - | 7.1 | 10.0 | |
about 7 h or more/day | - | 14.3 | 13.3 | |
p | * 0.0077 | ** 0.0028 | *** 0.0021 | **** 0.7355 |
The number of hours spent in front of a computer screen at the weekend—HBSC 6.2 | none | - | 10.7 | - |
about 30 min/day | - | 7.1 | 3.3 | |
about 1 h/day | 43.3 | 3.6 | 3.3 | |
about 2 h/day | 56.7 | 25.0 | 23.3 | |
about 3 h/day | - | 17.9 | 16.7 | |
about 4 h/day | - | 17.9 | 10.0 | |
about 5 h/day | - | 7.1 | 16.7 | |
about 6 h/day | - | - | 6.7 | |
about 7 h or more/day | - | 10.7 | 20.0 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.4277 |
Question/Variable | Answer | Group I | Group II | Group III |
---|---|---|---|---|
Feeling fit and well—KID 1 | not at all | 40.00 | 3.6 | - |
slightly | 60.00 | 7.1 | 6.7 | |
moderately | - | 53.6 | 10.0 | |
very | - | 14.3 | 53.3 | |
extremely | - | 21.4 | 30.0 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.0022 |
Feeling of strength and energy—KID 2 | never | 23.3 | - | - |
seldom | 76.7 | 14.3 | 6.7 | |
quite often | - | 46.4 | 23.3 | |
very often | - | 14.3 | 26.7 | |
always | - | 25.0 | 43.3 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.1364 |
Feeling of sadness—KID 3 | never | - | 35.7 | 30.0 |
seldom | - | 46.4 | 56.7 | |
quite often | 40.00 | 17.9 | 13.3 | |
very often | 60.00 | - | - | |
always | - | - | - | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.7302 |
Feeling of loneliness—KID 4 | never | 26.7 | - | 53.4 |
seldom | 50.0 | 50.0 | 40.0 | |
quite often | 23.3 | 39.3 | 3.3 | |
very often | - | 10.7 | - | |
always | - | - | 3.3 | |
p | * <0.0001 | ** 0.0367 | *** 0.0078 | **** <0.0001 |
Question/Variable | Answer | Group I | Group II | Group III |
---|---|---|---|---|
Having enough time for yourself—KID 5 | never | - | - | 3.3 |
seldom | 43.3 | 7.1 | 6.7 | |
quite often | 53.4 | 28.6 | 23.3 | |
very often | 3.3 | 39.3 | 36.7 | |
always | - | 25.0 | 30.0 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.8699 |
Performing the things that you want to do—KID 6 | never | 3.3 | 3.6 | 3.3 |
seldom | 30.0 | 7.1 | 3.3 | |
quite often | 63.4 | 17.9 | 26.7 | |
very often | 3.3 | 50.0 | 40.0 | |
always | - | 21.4 | 26.7 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.8446 |
Question/Variable | Answer | Group I | Group II | Group III |
---|---|---|---|---|
Being treated fairly by parents/Good relations with parents—KID 7 | never | - | - | - |
seldom | - | - | - | |
quite often | - | 7.1 | 20.00 | |
very often | 10.00 | 42.9 | 13.3 | |
always | 90.00 | 50.00 | 66.7 | |
p | * 0.0008 | ** 0.0008 | *** 0.0032 | **** 0.0302 |
Good relations with peers, fun—KID 8 | never | 40.00 | 3.6 | 6.7 |
seldom | 60.00 | 7.1 | 3.3 | |
quite often | - | 14.3 | 13.3 | |
very often | - | 53.6 | 40.0 | |
always | - | 21.4 | 36.7 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.6618 |
Question/Variable | Answer | Group I | Group II | Group III |
---|---|---|---|---|
Positive feelings related to the school environment—KID 9 | not at all | 26.7 | - | - |
slightly | 63.3 | 3.6 | 3.3 | |
moderately | 10.0 | 42.9 | 30.0 | |
very | - | 39.2 | 40.0 | |
extremely | - | 14.3 | 26.7 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.6284 |
Ability to pay attention—KID 10 | never | 23.3 | 3.6 | - |
seldom | 76.7 | 7.1 | 10.0 | |
quite often | - | 46.5 | 23.4 | |
very often | - | 21.4 | 33.3 | |
always | - | 21.4 | 33.3 | |
p | * <0.0001 | ** <0.0001 | *** <0.0001 | **** 0.2938 |
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Kowaluk, A.; Woźniewski, M.; Malicka, I. Physical Activity and Quality of Life of Healthy Children and Patients with Hematological Cancers. Int. J. Environ. Res. Public Health 2019, 16, 2776. https://doi.org/10.3390/ijerph16152776
Kowaluk A, Woźniewski M, Malicka I. Physical Activity and Quality of Life of Healthy Children and Patients with Hematological Cancers. International Journal of Environmental Research and Public Health. 2019; 16(15):2776. https://doi.org/10.3390/ijerph16152776
Chicago/Turabian StyleKowaluk, Aleksandra, Marek Woźniewski, and Iwona Malicka. 2019. "Physical Activity and Quality of Life of Healthy Children and Patients with Hematological Cancers" International Journal of Environmental Research and Public Health 16, no. 15: 2776. https://doi.org/10.3390/ijerph16152776
APA StyleKowaluk, A., Woźniewski, M., & Malicka, I. (2019). Physical Activity and Quality of Life of Healthy Children and Patients with Hematological Cancers. International Journal of Environmental Research and Public Health, 16(15), 2776. https://doi.org/10.3390/ijerph16152776