Moving Forward: A Practical Guide to Exercise with Wilms Tumor

Receiving a Wilms tumor diagnosis for a child is an incredibly challenging time for families. Amidst the whirlwind of medical appointments, treatments, and emotional ups and downs, maintaining a sense of normalcy and promoting overall well-being becomes paramount. Exercise, often overlooked in the immediate aftermath of such a diagnosis, plays a crucial role in a child’s physical and mental recovery. This guide cuts through the noise, offering clear, actionable, and practical advice on how to integrate safe and beneficial exercise into the life of a child with Wilms tumor. We’ll focus on the “how-to,” providing concrete examples and tangible steps to empower both children and their caregivers.

Understanding the Landscape: Why Exercise Matters for Children with Wilms Tumor

Before diving into specific exercises, it’s essential to grasp the fundamental benefits of physical activity for children navigating a Wilms tumor diagnosis. While the medical team focuses on eradicating the tumor, exercise complements their efforts by:

• Counteracting Treatment Side Effects: Chemotherapy and radiation can lead to fatigue, muscle weakness, and neuropathy. Targeted exercise can mitigate these effects, helping children regain strength and stamina.

• Boosting Mood and Mental Well-being: The emotional toll of illness is significant. Physical activity releases endorphins, reduces anxiety, and provides a sense of accomplishment, fostering a more positive outlook.

• Maintaining Healthy Weight: Some treatments can lead to weight gain or loss. Regular, appropriate exercise helps regulate metabolism and maintain a healthy body composition.

• Improving Bone Density: Certain medications can affect bone health. Weight-bearing exercises, even gentle ones, contribute to stronger bones.

• Enhancing Sleep Quality: Physical activity, especially earlier in the day, can promote deeper and more restorative sleep, crucial for recovery.

• Fostering Normalcy and Social Connection: Participating in age-appropriate activities can help children feel more like their peers, reducing feelings of isolation and promoting social interaction.

• Building Resilience and Confidence: Overcoming physical challenges, even small ones, builds self-efficacy and resilience, valuable traits for navigating long-term health journeys.

It’s critical to emphasize that all exercise programs for a child with Wilms tumor must be approved and supervised by their medical team, including their oncologist, surgeon, and physical therapist. This guide provides general recommendations, but individual needs and limitations will vary based on the stage of treatment, surgical approach, and overall health status.

Phase 1: Post-Surgery and Early Treatment – Gentle Movement and Restoration

The immediate period following surgery and the initial phases of chemotherapy or radiation demand a cautious and gradual approach to exercise. The focus here is on very gentle movement, preventing deconditioning, and promoting healing.

Breathing Exercises: The Foundation of Recovery

Even before a child can actively move, breathing exercises are crucial for lung function and preventing complications like pneumonia, especially after abdominal surgery.

How to Do It:

• Deep Diaphragmatic Breathing:
  • Action: Have the child lie on their back with a small, lightweight toy (like a teddy bear or a small plastic animal) placed on their abdomen. Instruct them to inhale slowly through their nose, making the toy rise, and then exhale slowly through pursed lips, making the toy fall.

  • Example: “Let’s make Teddy go for a ride on your tummy! Breathe in slowly through your nose, big breath, and watch Teddy go up. Now, slowly blow the air out like you’re blowing out a candle, and watch Teddy go down.”

  • Frequency: Start with 5-10 repetitions, 3-4 times a day, gradually increasing as tolerated.

• Incentive Spirometer Use (If Provided):

  • Action: Follow the instructions provided by the medical team. Generally, the child will inhale slowly and deeply through the mouthpiece, trying to raise a marker to a target level.

  • Example: “Remember what the nurse showed us with this tool? Let’s take a big, slow breath in, like you’re sucking up a milkshake, and make the ball go as high as you can!”

  • Frequency: Typically 10 repetitions every 1-2 hours while awake, or as advised by the medical team.

Gentle Range of Motion (ROM) Exercises: Preventing Stiffness

Prolonged bed rest or limited movement can lead to joint stiffness. Gentle, passive or active-assisted ROM exercises help maintain flexibility.

How to Do It:

• Ankle Pumps:
  • Action: While lying down, have the child gently point their toes away from them (plantarflexion) and then pull their toes towards them (dorsiflexion).

  • Example: “Let’s make your feet say ‘hello’ and ‘goodbye’! Point your toes to the wall, then pull them back to your nose.”

  • Frequency: 10-15 repetitions per ankle, 2-3 times a day.

• Knee Bends/Heel Slides:

  • Action: While lying on their back, have the child gently slide their heel towards their bottom, bending their knee, and then slide it back down. Ensure the movement is pain-free.

  • Example: “Imagine you’re making a little bridge with your leg. Slide your foot up, bend your knee, and then slide it back down flat.”

  • Frequency: 5-10 repetitions per leg, 2-3 times a day.

• Arm Raises:

  • Action: Lying on their back, have the child gently raise their arms overhead (if comfortable and not affecting surgical site), and then bring them back down to their sides.

  • Example: “Let’s reach for the sky, slowly! And then bring your hands back down to rest.”

  • Frequency: 5-10 repetitions, 2-3 times a day.

Important Considerations for Phase 1:

• Listen to the Child: Pain is a strict indicator to stop. Never push through discomfort.

• Short Bouts: Keep exercise sessions very short, perhaps 5-10 minutes at a time, several times a day.

• Supine Position: Most exercises should be performed lying down to minimize strain on the surgical site.

• Avoid Abdominal Strain: Absolutely no sit-ups, crunches, or activities that put direct pressure or strain on the abdominal area.

• Monitor for Fatigue: Stop immediately if the child shows signs of excessive fatigue, dizziness, or nausea.

Phase 2: Early Ambulatory and Moderate Activity – Regaining Strength and Stamina

As the child recovers from surgery and tolerates initial treatment well, the focus shifts to regaining independent mobility, building foundational strength, and gradually increasing stamina. This phase typically begins when the medical team deems it safe for more upright and weight-bearing activities.

Walking: The Primary Form of Exercise

Walking is one of the most effective and accessible ways to rebuild strength and endurance.

How to Do It:

• Gradual Increase in Duration and Distance:
  • Action: Start with very short walks around the room, then gradually extend to the hallway, and eventually outdoors if permitted. Track distance or time.

  • Example: “Today, let’s try walking from your bed to the door and back. Tomorrow, maybe we can go to the end of the hallway.” Or, “Let’s try walking for 5 minutes, then we’ll rest, and then maybe try another 5 minutes.”

  • Frequency: Several short walks throughout the day, building up to 1-2 longer walks.

• Incorporate Playful Walking:

  • Action: Turn walking into a game. Count steps, walk to retrieve a favorite toy, or walk to a window to look outside.

  • Example: “Let’s see how many steps it takes to get to the sunny window! Or, ‘Can you walk like a robot? Now like a tiny mouse?'”

  • Frequency: As often as motivation allows, ensuring breaks are frequent.

Gentle Strengthening Exercises: Rebuilding Muscle

These exercises use body weight or light resistance to target major muscle groups.

How to Do It:

• Wall Push-ups:
  • Action: Stand facing a wall, about arm’s length away. Place hands flat on the wall at shoulder height and width. Bend elbows to lean towards the wall, then push back to the starting position. Keep the body straight.

  • Example: “Let’s pretend the wall is giving us a hug! Lean in, then push the wall away.”

  • Frequency: 2 sets of 5-10 repetitions, 2-3 times a week, with rest days in between.

• Chair Stands/Sit-to-Stands:

  • Action: Sit in a sturdy chair with feet flat on the floor. Use hands for support if needed. Stand up slowly, then slowly sit back down. Focus on controlled movement.

  • Example: “Let’s practice standing up tall and strong! Push through your feet, stand up like a superhero, then slowly sit back down.”

  • Frequency: 2 sets of 5-8 repetitions, 2-3 times a week.

• Modified Squats (Chair Assisted):

  • Action: Stand in front of a chair. Slowly lower your bottom as if you’re going to sit down, lightly touching the chair, then stand back up. Keep knees in line with ankles and chest lifted.

  • Example: “Imagine you’re going to sit on the chair, but just give it a little tap with your bottom and then stand back up. Keep your back straight!”

  • Frequency: 2 sets of 5-8 repetitions, 2-3 times a week.

• Leg Lifts (Lying Down):

  • Action: Lie on your back (if comfortable). Gently lift one leg a few inches off the bed or floor, keeping it straight, and hold for a few seconds before slowly lowering. Alternate legs.

  • Example: “Let’s lift one leg up, straight like a board, count to three, and then slowly put it back down.”

  • Frequency: 2 sets of 8-10 repetitions per leg, 2-3 times a week.

Important Considerations for Phase 2:

• Monitor for Pain and Fatigue: Continue to prioritize comfort and stop at the first sign of pain or excessive tiredness.

• Hydration: Ensure the child is well-hydrated before, during, and after exercise.

• Appropriate Footwear: If walking, ensure the child has supportive, comfortable shoes.

• Supervision: Close supervision is still essential to ensure proper form and safety.

• Balance Activities: As strength improves, introduce simple balance activities like standing on one leg with support, or walking heel-to-toe.

Phase 3: Active Treatment & Maintenance – Incorporating Play and Variety

Once the most intensive phases of treatment are complete, or during maintenance therapy, the goal shifts to integrating more diverse and enjoyable physical activities. The emphasis is on age-appropriate play, building stamina, and fostering a love for movement that can be sustained long-term.

Cardiovascular Activities: Boosting Heart and Lung Health

These activities aim to elevate heart rate safely and improve endurance.

How to Do It:

• Brisk Walking/Light Jogging (If Cleared):
  • Action: Increase the pace of walking. If cleared by the medical team, introduce short intervals of light jogging, followed by walking recovery periods.

  • Example: “Let’s walk fast for 2 minutes, like we’re trying to catch a bus, then slow down for 3 minutes. We can do that 3 times!”

  • Frequency: 3-5 times a week, 20-30 minutes per session, including warm-up and cool-down.

• Cycling (Stationary or Regular Bike if Safe):

  • Action: For younger children, a tricyclce or balance bike. For older children, a stationary bike can be an excellent option for controlled, low-impact cardio. Outdoor cycling should only be considered if balance and coordination are good and the environment is safe.

  • Example: “Let’s pretend we’re racing around the park on our bike! Pedal fast for a little bit, then slow down.”

  • Frequency: 3-4 times a week, 15-25 minutes.

• Swimming/Water Play (If Incision is Healed and Cleared):

  • Action: Water provides a low-impact environment for exercise. Start with gentle splashing and kicking, progressing to swimming laps or playing water games. Crucially, ensure any surgical incisions are fully healed and there is no risk of infection, and chlorine/pool chemicals are tolerated.

  • Example: “Let’s kick our legs like a froggy in the water! Or, ‘Can you splash the water like a fish?'”

  • Frequency: 2-3 times a week, 20-30 minutes.

Strength Training with Light Resistance: Progressive Overload

As the child gains strength, light resistance can be introduced using resistance bands, light weights (e.g., small water bottles, canned goods), or bodyweight progressions.

How to Do It:

• Resistance Band Rows:
  • Action: Secure a light resistance band around a sturdy object at chest height. Have the child hold the ends of the band, stepping back to create tension. Pull the band towards their chest, squeezing shoulder blades together, then slowly release.

  • Example: “Imagine you’re rowing a boat! Pull the handles back towards your tummy, feel those muscles in your back work, then slowly let go.”

  • Frequency: 2 sets of 10-15 repetitions, 2-3 times a week.

• Bicep Curls (Light Weights):

  • Action: Have the child hold a very light weight (e.g., a small water bottle) in each hand, palms facing forward. Bend elbows to bring the weights towards their shoulders, then slowly lower.

  • Example: “Let’s make our arm muscles strong! Curl the bottle up, like you’re flexing, then slowly lower it down.”

  • Frequency: 2 sets of 10-15 repetitions, 2-3 times a week.

• Bodyweight Lunges (Modified):

  • Action: Stand tall. Take a small step forward with one leg, bending both knees to 90 degrees. Ensure the front knee stays behind the toes. Push back to the starting position. Keep the torso upright. Start with very shallow lunges if balance is a concern.

  • Example: “Take a big step forward like a giant, bend both knees, then push back to standing.”

  • Frequency: 2 sets of 8-12 repetitions per leg, 2-3 times a week.

Incorporating Play and Sports: Making Exercise Fun

The most effective exercise program for a child is one they enjoy and will stick with.

How to Do It:

• Outdoor Play:
  • Action: Encourage active play like tag, chasing bubbles, playing catch with a soft ball, riding scooters (if safe), or playing on a playground (avoiding excessive jumping or impact on the abdomen).

  • Example: “Let’s play ‘freeze tag’ in the yard! Or, ‘Can you throw this soft ball to me five times?'”

  • Frequency: Daily, as tolerated, integrating into typical play time.

• Dance Parties:

  • Action: Put on favorite music and encourage free-form dancing. This is a fantastic way to get cardiovascular exercise and release energy in a fun, non-structured way.

  • Example: “Let’s have a dance-off! Show me your best moves!”

  • Frequency: Daily, 10-20 minutes.

• Yoga or Pilates (Child-Friendly Versions):

  • Action: Many online resources offer gentle, child-friendly yoga or Pilates routines that focus on flexibility, core strength (without abdominal strain), and body awareness.

  • Example: “Let’s pretend we’re trees reaching for the sun with our arms, or cats stretching their backs.”

  • Frequency: 2-3 times a week, 15-20 minutes.

• Team Sports (with Medical Clearance and Modifications):

  • Action: If a child expresses interest in a team sport, discuss with the medical team. Modifications may be necessary (e.g., limited contact, reduced playing time). Non-contact sports like T-ball, swimming, or cycling might be safer initially.

  • Example: “We can talk to the coach about you playing T-ball, but maybe just focusing on hitting and running the bases, and not as much fielding if your side is still sore.”

  • Frequency: As per the team’s schedule, ensuring the child can participate safely without overexertion.

Important Considerations for Phase 3:

• Individualized Approach: Continue to tailor activities to the child’s energy levels, interest, and ongoing treatment effects.

• Listen to Their Body: Emphasize the importance of listening to their own body and communicating discomfort or fatigue.

• Encourage, Don’t Force: Make exercise enjoyable and empower the child to choose activities they like within safe parameters.

• Vary Activities: Introduce variety to prevent boredom and work different muscle groups.

• Nutritional Support: Ensure adequate nutrition to support energy levels and recovery.

Long-Term Integration: Making Exercise a Lifestyle

The journey doesn’t end when treatment concludes. Establishing healthy exercise habits during and after Wilms tumor treatment sets the stage for a healthier future.

Building Routine and Consistency

How to Do It:

• Scheduled “Active Time”: Designate specific times each day or week for physical activity, just like homework or meal times.
  • Example: “Every day after school, we’ll have 30 minutes of ‘active play’ outside.”
• Family Involvement: Make exercise a family affair. Go for walks together, play active games in the park, or plan active outings.
  • Example: “On Saturdays, our family adventure is to explore a new walking trail!”
• Track Progress (Positively): Use a sticker chart, logbook, or simple app to track activity. Focus on celebrating effort and consistency rather than just performance.
  • Example: “Wow, you did 20 minutes of biking today! Let’s put a star on your chart for that.”

Addressing Potential Challenges

• Fatigue: Break exercise into shorter, more frequent bouts. Prioritize rest days.

• Pain/Discomfort: Immediately consult the medical team. Re-evaluate exercise intensity and type.

• Body Image Concerns: Focus on what the child’s body can do and celebrate strength and progress. Avoid comparisons.

• Fear of Injury: Gradual progression and proper supervision are key. Reassure the child that movement is beneficial.

• Lack of Motivation: Offer choices, make it playful, find activities they genuinely enjoy, and provide positive reinforcement.

The Role of Professionals

• Physical Therapists (PTs): Invaluable for assessing physical limitations, designing personalized exercise programs, teaching proper form, and addressing specific musculoskeletal issues. They can guide post-surgical recovery and help regain function.

• Occupational Therapists (OTs): Can help integrate physical activity into daily routines and address fine motor skills or energy conservation strategies.

• Child Life Specialists: Can help make exercise fun and engaging for children, addressing psychological barriers to participation.

• Oncologists: The primary point of contact for all medical clearances and overall guidance.

Safeguarding Your Child: Crucial Precautions

While exercise is beneficial, safety is paramount.

• Always Get Medical Clearance: This cannot be stressed enough. Never start a new exercise or increase intensity without the oncologist’s and surgeon’s explicit approval.

• Listen to the Body: Teach the child to recognize and communicate signs of pain, fatigue, dizziness, nausea, or shortness of breath.

• Avoid Contact Sports and Abdominal Impact: Until cleared by the medical team, activities that involve direct blows to the abdomen (e.g., soccer, basketball, hockey, martial arts) must be strictly avoided due to the risk to the remaining kidney.

• Monitor for Infection: Post-surgical sites or port sites are vulnerable. Report any redness, swelling, discharge, or fever immediately. Avoid public pools or certain activities if there is an increased infection risk.

• Hydration is Key: Ensure consistent fluid intake before, during, and after activity.

• Proper Warm-up and Cool-down: Gentle stretching and light activity before and after exercise prepare the body and aid recovery.

• Supervision: Always supervise exercise, especially in the early stages or when trying new activities.

• Environmental Safety: Choose safe environments for exercise, free from hazards.

• Adjust for Treatment Cycles: Recognize that energy levels will fluctuate with chemotherapy cycles. Be flexible and adjust exercise intensity and duration accordingly. Some days may be purely for rest.

• Sun Protection: If exercising outdoors, apply sunscreen and wear protective clothing, especially if undergoing radiation therapy, which can increase skin sensitivity.

Conclusion

Empowering a child with Wilms tumor to exercise is a profound act of care. It’s not just about physical rehabilitation; it’s about restoring a sense of agency, joy, and normalcy in a challenging time. By following this practical guide, collaborating closely with the medical team, and prioritizing safety and enjoyment, families can successfully integrate physical activity into their child’s life. Each gentle stretch, every step taken, and every moment of active play contributes to a stronger, healthier, and more resilient child, paving the way for a vibrant future.