Physical activity barriers, preferences, and beliefs in childhood
Wilhelmenia L. Ross
Daniel J. Zheng
John T. Fahey
Kirsten K. Ness
Nina S. Kadan-Lottick
Received: 10 October 2017 / Accepted: 28 December 2017 / Published online: 27 January 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose Childhood cancer patients report low physical activity levels despite the risk for long-term complications that may
benefit from exercise. Research is lacking regarding exercise barriers, preferences, and beliefs among patients (1) on- and off-
therapy and (2) across the age spectrum.
Methods Cross-sectional study in the Yale Pediatric Hematology-Oncology Clinic (October 2013–October 2014). Participants
were ≥ 4 years old, > 1 month after cancer diagnosis at < 20 years, not acutely ill, expected to live > 6 months, and received
chemotherapy and/or radiation. Participants (or parents if < 13 years) completed a survey.
Results The 162 patients (99% participated) were 34% children (4.0–12.9 years), 31% adolescents (13.0–17.9 years), and 35%
adults (≥ 18 years). Most had leukemia/lymphoma (66%); 32% were on-therapy. On-therapy patients were more likely than off-
therapy patients (73 vs. 48%; p = 0.003) to report ≥ 1 barrier related to physical complaints, such as Bjust too tired^ (46 vs. 28%;
p = 0.021) or Bafraid^ of injury (22 vs. 9%; p = 0.027). The majority preferred walking (73%), exercising at home (91%),
exercising in the afternoon (79%), and a maximum travel time of 10–20 min (54%); preferences did not vary significantly by
therapy status or age. Most respondents (94%) recognized the benefits of exercise after cancer, but 50% of on- vs. 12% of off-
therapy patients believed Btheir cancer diagnosis made it unsafe to exercise regularly^ (p <0.001).
Conclusions Physical activity barriers pertaining to physical complaints and safety concerns were more pronounced in on-
therapy childhood cancer patients but persisted off-therapy. Preferences and beliefs were relatively consistent. Our data can
inform interventions in different patient subgroups.
Keywords Physical activity
Long-term follow-up care
More than 80% of children diagnosed with cancer will be
cured of their disease . However, cure comes with a cost.
During treatment, patients experience nausea, fatigue, dis-
turbed sleep, pain, anxiety, and depression [2, 3].
Furthermore, about 70% of childhood cancer survivors devel-
op late complications from treatment , including cardiomy-
opathy, obesity, insulin resistance, psychosocial distress, oste-
oporosis, and persistent fatigue [4–12]. In healthy populations,
physical activity has been shown to improve many of these
conditions , and thus would be beneficial to childhood
cancer patients both during and after therapy. To inform effec-
tive interventions for all childhood cancer patients, data is
needed regarding barriers, preferences, and beliefs related to
physical activity. Data is particularly lacking among on-
therapy patients and young children.
* Nina S. Kadan-Lottick
Section of Pediatric Hematology-Oncology, Yale School of
Medicine, PO Box 208064, 333 Cedar Street, LMP-2073, New
Haven, CT 06520-8064, USA
Department of Medicine, Boston Children’s Hospital, Boston, MA,
Department of Pediatrics, Boston Medical Center, Boston, MA, USA
Department of Psychology, University of Miami, Coral Gables, FL,
Yale School of Public Health, New Haven, CT, USA
Yale Center for Analytical Sciences, New Haven, CT, USA
Section of Pediatric Cardiology, Yale School of Medicine, New
Haven, CT, USA
Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN, USA
Yale Cancer Center, New Haven, CT, USA
Supportive Care in Cancer (2018) 26:2177–2184