Barriers and enablers to physical activity and aerobic fitness deficits among childhood cancer survivors

Abstract

Background: Physical activity and aerobic fitness are modifiable risk factors for cardiovascular disease (CVD) after childhood cancer. How survivors engage in physical activity remains unclear, potentially increasing CVD risk. We assessed survivors' physical activity levels, barriers and enablers, fitness, and identified predictors of fitness and physical activity stage of change. Methods: Childhood cancer survivors (CCS; 8-18 years old) ≥1 year post-treatment were assessed for aerobic fitness (6-min walk test), used to extrapolate VO 2max , and body composition (InBody 570). Survivors self-reported physical activity to determine stage of change (Patient-Centered Assessment and Counselling for Exercise). Physical activity and fitness were compared with guidelines and CVD-risk cut-points (VO 2max < 42 mL/kg/min: males; VO 2max < 35 mL/kg/min: females). Multiple regression and mediator-moderator analysis were used to identify fitness predictors and stage of change.Results: One hundred two survivors (12.8 ± 3.3 years) participated (46% acute lymphoblastic leukaemia). Forty percent of males (VO 2max = 43.3 ± 6.3 mL/kg/min) and 28% of females (VO 2max = 36.5 ± 5.9 mL/kg/min) were in the CVD-risk category, while 25% met physical activity guidelines. Most prevalent physical activity barriers were fatigue (52%), preferring television instead of exercise (38%), and lacking time (34%). Predictive factors for reduced fitness included being older, female, higher waist-to-height ratio, higher screen time, and moderated by lower physical activity (r 2 = 0.91, P < .001). Survivors with higher physical activity stage of change were male, lower body fat percentage, lower screen time, and lived with both parents (r = 0.42, P = .003). Conclusion:Aerobic fitness and physical activity of CCS is low compared with population norms, potentially increasing CVD risk. Addressing physical activity barriers and enablers, including reducing screen time, could promote regular physical activity, reducing CVD risk. K E Y W O R D Saerobic fitness, barriers, childhood cancer survivors, exercise, physical activity, survivorship, VO 2max

Factors influencing physical activity participation among people living with or beyond cancer: a systematic scoping review

“…Cancer patients perceived that exercise had the potential to minimize cancer-related treatment side effects, particularly fatigue. This perceived health benefit was reported by around 90% of participants in three cross-sectional studies [43,55,71]. Enhancing cardiovascular fitness, boosting energy, improving muscle strength and managing body weight were also notable physiological benefits that were perceived by cancer patients at mixed treatment stages (Table 1).…”

“…Enhancing cardiovascular fitness, boosting energy, improving muscle strength and managing body weight were also notable physiological benefits that were perceived by cancer patients at mixed treatment stages (Table 1). Approximately 90% of participants in cross-sectional studies by Mizrahi et al [71] and Rogers et al [55] believed that PA engagement built up their muscle strength. Across mixed cancer patient participants in qualitative studies, there was a common perception that exercise could prevent disease recurrence and improve their survival.…”

“…Qualitative and quantitative studies exhibited that perceived health benefits and positive previous experiences with exercise (exercise-related improvement in cancer symptoms) were strong facilitators to PA participation (Table 5). A cross-sectional study by Mizrahi et al [71] revealed that 99% of the cancer patient participants found perceived health benefits to be useful for enhancing their PA participation. Furthermore, having exercise in one's routine facilitated PA engagement among cancer patients.…”

“…Companionship was a common facilitator reported by patients across cancer types. In their qualitative and quantitative studies, Owusu et al [54] and Mizrahi et al [71] found that group exercising with significant others and/or other cancer patients who face similar challenges was a major facilitator among 80-95% of the participants.…”

Barriers to physical activity among cancer pediatric cancer patients and survivors: a scoping review

“…Because of the inclusion criteria adopted an additional seven studies were excluded (2 studies did not fit the design criteria and 4 studies due to the age of the participants included). Thereby, the descriptive synthesis of the present review comprised five studies [21][22][23][24][25] .…”