Factors That Influence Physical Activity Behavior in Children and Adolescents During and After Cancer Treatment: A Qualitative Systematic Review of the Literature.

PURPOSE: The aim of this systematic review is to reveal the social, personal, and contextual factors that influence physical activity (PA) in children and adolescents during and after cancer treatment. METHOD: SPORTDiscus, Cochrane, Web of Science, PubMed, and FIS Education electronic database were systematically searched. RESULTS: The 13 included studies show that social support (parents, siblings, and friends) in particular is rated as important by cancer survivors; for example, doing PA together. Depending on the treatment status and state of health, particularities arise. During the acute treatment phase, parents issued more prohibitions regarding PA than after treatment. The state of health and concern about infections are described as inhibiting factors. Not all hospitals generally offer special exercise programs for cancer patients, and in some cases, only sporadic exercise sessions were conducted by specialized staff. In addition, the hospital atmosphere, such as cramped rooms, tends to be associated with demotivating effects. CONCLUSIONS: Both inhibiting and promoting factors in the area of social, personal, and contextual factors could be identified. The most fundamental factor for PA is the physical condition. Social factors, such as parents or friends, often have a motivating effect and can promote PA. Inhibiting factors are mainly context-related, such as an environment unsuitable for PA. Although the review highlights interesting aspects, further treatment-related and longitudinal studies could provide deeper insights.

Effects of an Exercise Intervention on Gait Function in Young Survivors of Osteosarcoma with Megaendoprosthesis of the Lower Extremity-Results from the Pilot Randomized Controlled Trial proGAIT.

Limb preservation with megaendoprosthesis in adolescents and young adults (AYA) with bone tumors is associated with functional limitations and gait abnormalities. The proGAIT trial evaluated the effectiveness of an exercise program on gait function and quality of life, functional scales (MSTS, TESS), functional mobility, and fatigue as secondary outcomes. Eleven AYA survivors of malignant osteosarcoma with a tumor endoprosthesis around the knee (mean age: 26.6 (±8.4) years) were randomized into an intervention group receiving an 8-week exercise program or into a control group. Gait function was assessed via 3D motion capture and analyzed using the Gait Profile Score (GPS) and the Gait Deviation Index (GDI). GDI and GPS scores of participants suggest deviations from a healthy reference group. The exercise intervention had small-to-medium positive effects on gait score GDI |d| = 0.50 (unaffected leg), |d| = 0.24 (affected leg), subjective functional scores TESS |d| = 0.74 and MSTS |d| = 0.49, and functional tests TUG and TUDS |d| = 0.61 and |d| = 0.52. None of these changes showed statistical significance. Promising intervention effects suggest that regular exercise could improve lower limb function and follow-up care for survivors; however, a powered RCT as a follow-up project needs to confirm the pilot findings.

Design and Evaluation of an Outdoor Exercise Program for Pediatric Cancer Survivors.

Exercise programs for young people after cancer are not part of regular oncological care. This study describes and evaluates a regional outdoor exercise program and presents data with regard to the promoting and inhibiting factors for participation among pediatric cancer survivors. Exercise options, number of participants, and the cohort were evaluated descriptively for one year. A self-developed questionnaire was used to evaluate satisfaction, mood, motivations, and barriers to exercise. Overall N = 26 survivors (14.6 ± 5.5 years) participated in at least one activity in 2019 including try-out days (N = 10) and active weekend camps (N = 2). No adverse events occurred in 302 physical activity hours. Twenty-one survivors participated in the survey. The largest motivational aspect to participate was "to try out a new sport" (83.9%). Survivors reported "good mood", and 'being happy' after exercising. The largest barrier was concern about 'not being able to keep up with others' (38.1%). Around one-third (try-out day) and 50% (active weekend camp) of survivors did not feel confident to continue exercising outside the supervised exercise oncology program. This survey shows high enthusiasm for this exercise program with different outdoor activities and suggests that similar interventions may be accepted by this population.