Упражнения для выживших после детского рака — осведомлённость о поздних эффектах, кардиологическая оценка, рамка COG/SJLIFE

The Children's Oncology Group (COG) Long-Term Follow-Up Guidelines + St. Jude SJLIFE study established the modern survivorship framework: anthracyclines + radiation drive cardiac late effects with cumulative dose mattering meaningfully. Friedman 2010 captured the secondary cancer risk elevation. Khan 2024 meta-analysis established that exercise improves cardiometabolic + bone + psychological outcomes in childhood cancer survivors. The exercise priorities are therefore: gradual aerobic + resistance progression with cardiology clearance for high-dose anthracycline (>250 mg/m²) or chest radiation patients, bone-density-supportive resistance (radiation + steroid bone loss), breath/parasympathetic regulation, posture support, and screening-based individual treatment regimen awareness. AVOID maximal exercise without cardiology clearance if anthracycline >250 mg/m² or chest radiation history. Endocrine + fertility late effects per treatment regimen — endocrinology + fertility planning conversations matter as survivors age into adulthood.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain + bone-density support, wall-push-up for upper-body strength scaling, scapular-retraction for posture, cat-cow for spinal mobility, supine-knee-to-chest for low-back release, calf-raise-rehab for posterior-chain + bone-loading (radiation + steroid bone loss), ankle-pump for circulation, diaphragmatic-breathing for parasympathetic regulation + sleep + psychological adjunct, standing-march for cardio. The AI coach also knows the nutrition side — Mediterranean pattern + anti-inflammatory backbone (reduces CV risk elevated by anthracyclines + radiation), protein 1.2-1.4 g/kg/day for lean mass + bone health, calcium 1000-1500 mg + vitamin D 1000-2000 IU + DEXA per COG/St. Jude if high-dose steroids or radiation, iron + B12 + thyroid + vitamin D + lipid screening per individual COG protocol, alcohol AVOID excess (secondary cancer + cardiac + liver), weight management nuance (sarcopenic obesity pattern common — RD with oncology survivorship familiarity), antioxidant intake from food NOT mega-dose supplements (supplement megadoses may interfere with imaging or have unclear effects), fertility + endocrine nutrition (HPA + gonadal effects vary). CRITICAL: survivorship clinic (St. Jude SJLIFE model where available) + COG-affiliated long-term follow-up + cardiology if anthracycline >250 mg/m² or chest radiation + endocrinology + fertility specialist if family planning + 988 mental health crisis. This is NEVER a replacement for survivorship clinic care.