Future-oriented exercise support

Titel

• Our exercise support in practice

  Our exercise support in practice

  Stepped-care model

  We work according to a stepped-care model, in which the intensity of exercise support is tailored to individual needs. Each level builds on a solid foundation of information, guidance, and child-friendly exercise facilities.

  Figure 1. Pediatric Psychosocial Preventive Health Model – Kazak A. et al.

  Maximaal Bewegen

  The ‘Maximaal Bewegen’ program is at the core of our exercise support. It helps children and parents stay active, both during hospital admission and at home, through daily, achievable physical activities. These activities match the child’s level and the specific needs of the child and parents.

  We offer exercise sessions at set times, tailored by age group, such as toddler gym and teen sports. We also encourage children to stay active in their rooms, so that movement becomes a natural part of the day.

  Specialized interventions

  For children with specific risks or support needs, such as brain tumors, bone tumors, or loss of strength, balance, and mobility due to treatment, we provide direct pediatric physical therapy care. In addition, several care improvement initiatives are underway, including:

  • ALL gait function study: insight into temporary functional loss and expected recovery

  • Fit-4-Surgery: prehabilitation for children with bone tumors

  • Postoperative exercise recommendations for children with endoprostheses

  • Multidisciplinary fatigue clinic: support for long-term fatigue

  Shared decision-making

  We actively involve children and parents in choices that affect daily functioning. We do this by discussing their personal goals: what they want to achieve and what matters most to them.

  Through research on shared decision-making, we also improve support for choices related to surgery and recovery. In this way, decisions are medically sound and aligned with the wishes and possibilities of both child and parents.

• Research: focused on physical vulnerability and recovery

  Research: focused on physical vulnerability and recovery

  Identifying and understanding physical vulnerability

  We develop methods to better assess children with increased physical vulnerability, such as the Pediatric SARC-F questionnaire. This allows us to identify children who need additional support and to study which factors influence their recovery.

  Monitoring gait function and physical activity

  We study how disease, medication, and surgery affect motor skills and gait function. We focus on:

  • the effects of treatment phases in acute lymphoblastic leukemia (ALL);

  • recovery after brain tumors;

  • changes in muscle function and movement patterns.

  In addition, we conduct studies using wearable technology, such as smartwatches, to monitor physical activity over a longer period and in real time.

  Interventions and prehabilitation

  We develop and test interventions that can be introduced at the right time during the treatment process, such as:

  • prehabilitation before stem cell transplantation (SCT);

  • Fit-4-Surgery for children with bone cancer;

  • home-based exercise programs, in collaboration with colleagues in community care.

• Knowledge sharing and collaboration

  Knowledge sharing and collaboration

  Professionals within and outside the Máxima Center

  At the Máxima Center, we provide education for nurses, physicians, and other healthcare professionals to help integrate exercise support into daily practice.

  Outside the Máxima Center, we share our expertise through guest lectures, workshops, symposia, and online modules. In this way, we strengthen exercise support for children with cancer in the Netherlands and internationally.

  KinderOncoNet

  Through the national network KinderOncoNet, we improve the continuity and quality of exercise support close to home. Healthcare professionals in primary, secondary, and tertiary care can find:

  • reliable and relevant information

  • training on specific diagnoses

  • colleagues with expertise in pediatric oncology

  Education and international collaboration

  We collaborate with Utrecht University of Applied Sciences, the Wilhelmina Children’s Hospital, and international partners. Together, we develop interventions, new treatment strategies, and international guidelines for exercise support.

  Within SIOP’s international Rehabilitation & Physical Medicine working group, we contribute to knowledge exchange, innovation, and international consensus building.