Protein Supplementation and Resistance Training in Childhood Cancer Survivors

Matthew R. Krull; Carrie R. Howell; Robyn E. Partin; Jennifer Lanctot; Sean Phipps; James L. Klosky; Ginger Carney; Daniel A. Mulrooney; Leslie L. Robison; Melissa M. Hudson; Kirsten K. Ness


Med Sci Sports Exerc. 2020;52(10):2069-2077. 

In This Article

Abstract and Introduction


Purpose: Muscle weakness, low lean body mass, and poor physical performance are prevalent among adult survivors of childhood cancer (survivors). We evaluated the feasibility and effects of resistance training with and without protein supplementation on lean body mass and muscle strength among survivors.

Methods: This double-blind placebo-controlled trial enrolled survivors ≥18 to <45 yr old. Participants were randomized to resistance training with protein supplement (21 g whey protein per day, 90 kcal) (RT + S) or resistance training with placebo (sucrose, 90 kcal) (RT + P). Participants received educational materials, access to a local fitness center, and a tailored resistance training program with tapered supervision. Participant retention and adherence were used to evaluate feasibility. Lean body mass and muscle strength were assessed at baseline and 24 wk, using dual x-ray absorptiometry, and dynamometer testing or one-repetition maximum testing, respectively. Mean changes were compared with two-way ANOVA.

Results: Of 70 participants randomized, 57 completed the 24-wk intervention (24 in RT + S, 33 in RT + P). The RT + S group completed 74.8% and the RT + P group completed 67.0% of exercise sessions. Mean ± SD age for those who completed was 33.1 ± 7.0 yr, 67% were White and 47% female. There were no differences in change in lean mass (RT + S, 1.05 ± 2.34 kg; RT + P, 0.13 ± 2.19 kg; P = 0.10) or strength (grip RT + S, 1.65 ± 4.17 kg; RT + P, 1.63 ± 4.47 kg; P = 0.98; mean leg press RT + S, 58.4 ± 78.8 kg; RT + P, 51.0 ± 65.1 kg; P = 0.68) between groups. Both lean mass (P = 0.03) and strength (grip P = 0.003, leg press P < 0.001) increased over time.

Conclusions: Supervised resistance training among survivors with protein supplementation is feasible but not more effective at increasing total lean body mass than resistance training alone.


Five-year survival rates among children newly diagnosed with cancer exceed 85%; estimates indicate that the number of survivors of childhood cancer living in the United States will surpass 500,000 in 2020.[1,2] However, cure is not without consequences; many survivors experience medical late effects as a result of cancer or its treatment. By age 45 yr, over 95% of childhood cancer survivors have at least one chronic health condition, including 36.5% with obesity, 22.6% with hypertension, and 50.9% with dyslipidemia.[3] In addition, nearly 8% of childhood cancer survivors are frail,[4] a phenotype characterized by low lean body mass and muscle weakness.

Fortunately, recent evidence indicates that lifestyle factors, including protein intake and resistance training, are associated with greater lean body mass and muscle strength in childhood cancer survivors.[5] This suggests that survivors may have the opportunity to influence long-term health outcomes by adopting lifestyles that include a healthy diet and regular exercise. Resistance training with protein supplementation is a proven strategy for increasing muscle mass and strength in healthy populations.[6] This strategy has demonstrated efficacy to improve muscle mass and strength in frail populations, including older adults and adults with cancer.[7–9] It is possible a resistance training program may be beneficial in young adult survivors of childhood cancer.

The objectives of this study were to evaluate the feasibility and preliminary effectiveness of resistance training with (RT + S) and without protein supplementation (RT + P) on lean body mass, muscle strength, walking speed, self-reported exhaustion, and physical activity levels in young adult survivors of childhood cancer with low lean body mass.