Improving Physical Activity Behaviors Among Childhood Cancer Survivors Through an Educational Intervention: A Mixed-Methods Pre-Post Study.

Authors

Jiaoyang Cai, Yin Ting Cheung, Jiajia Zheng, Xiaoman Cai, Ching-Hon Pui, Melissa M Hudson, Hao Zhang

Published in

Pediatric blood & cancer. Pages e70575. Jul 28, 2026. Epub Jul 28, 2026.

Abstract

Childhood cancer survivors (CCS) are at increased risk of long-term cardiopulmonary and functional complications, but physical activity participation remains low. Scalable, evidence-based interventions integrated into routine survivorship care are limited, especially in low- and middle-income settings. This study evaluated the effectiveness of a brief, family-centered educational intervention in improving physical activity behaviors and exercise-related cognition among CCS in China.
We conducted a mixed-methods, single-arm educational intervention involving CCS and their caregivers. Baseline assessments (T0) and follow-up assessments conducted 1-3 months after the intervention (T1) evaluated three major outcome domains: (i) physical activity behaviors, assessed using the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and selected Physical Activity Questionnaire for Children/Adolescents (PAQ-C/A) items, including moderate-to-vigorous physical activity (MVPA) and total physical activity; (ii) exercise-related cognitive constructs, assessed using Health Belief Model (HBM)-based measures and selected Exercise Benefits/Barriers Scale (EBBS) items; and (iii) family support and parental awareness regarding exercise and treatment-related health risks. Semi-structured interviews were conducted to further explore perceptions and experiences related to physical activity participation.
A total of 106 CCS completed T0 and 78 (73.6%) completed T1; 18 participated in interviews. At baseline, most survivors reported low physical activity levels and exercise-related fatigue during vigorous activity. Following the intervention, physical activity behaviors improved significantly, with increases in weekly MVPA (from 98.5 to 172.3 min/week; p = 0.004), total physical activity (from 166.6 to 318.0 min/week; p < 0.001), and GLTEQ scores (from 40.4 to 56.0; p = 0.005). Exercise-related cognition also improved, including greater perceived severity of insufficient physical activity, and increased perceived energy and vitality benefits of exercise. Parental awareness of cardiopulmonary risk increased from 50.0% to 71.8% (p = 0.003). Family support behaviors improved, including parental encouragement (p = 0.016), family co-exercise (p = 0.006), and caregivers' own exercise habits (p = 0.008). Qualitative interviews highlighted the importance of medical guidance, family involvement, individualized exercise recommendations, and concerns regarding fatigue and safety.
A brief, family-centered educational intervention was associated with improved physical activity behaviors, enhanced exercise-related cognition, increased parental awareness, and stronger family support among childhood cancer survivors. These findings support the feasibility and potential value of integrating scalable exercise education into routine survivorship care.

PMID:
42517607
Bibliographic data and abstract were imported from PubMed on 28 Jul 2026.

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