TY - JOUR

T1 - Perceived barriers and facilitators to physical activity in childhood cancer survivors and their parents

T2 - A large-scale interview study from the International PACCS Study

AU - Larsen, Elna Hamilton

AU - Mellblom, Anneli Viktoria

AU - Larsen, Marie Hamilton

AU - Ruud, Ellen

AU - Thorsen, Lene

AU - Petersen, Natasha Nybro

AU - Larsen, Hanne Bækgaard

AU - Fridh, Martin Kaj

AU - Lie, Hanne Cathrine

N1 - Publisher Copyright: © 2022 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.

PY - 2023

Y1 - 2023

N2 - Background: Physical activity (PA) may reduce risks of late effects in childhood cancer survivors, yet many have low activity levels. Using the WHO's International Classification of Functioning, Disability, and Health for Children and Youths (ICF-CY) as a conceptual framework, we aimed to identify perceived barriers and facilitators to PA in young survivors and their parents. Design/methods: We conducted individual, semi-structured interviews with 63 survivors, aged 9–18 years, ≥1-year off treatment, and 68 parents, recruited from three pediatric oncology departments in Norway and Denmark. Interviews were analyzed inductively using thematic analysis to identify barriers and facilitators to PA, which were mapped onto the ICF-CY model components; body function/structures, activities, participation, and environmental and personal factors. Results: Two-thirds of the survivors described how treatment-related impairments of bodily functions (e.g., fatigue, physical weakness, reduced lung capacity) caused physical limitations, reducing opportunities to participate in PA, especially team sports and school physical education. This resulted in a perceived ability gap between survivors and peers, reducing motivation for PA. These PA barriers were moderated by environmental factors that facilitated or further hindered PA participation (family, peer, and school support). Similarily, personal factors also facilitated (acceptance, motivation, goal setting) or hindered (anxiety, low motivation, and lack of trust) PA participation. Conclusion: Treatment-related long-term or late effects represented significant barriers to PA as their functional consequences reduced survivors’ capacities and capabilities to be active. Environmental and personal factors acting as facilitators or further barriers to PA were identified. Applying the ICF-CY framework in clinical practice could help to enable PA participation.

AB - Background: Physical activity (PA) may reduce risks of late effects in childhood cancer survivors, yet many have low activity levels. Using the WHO's International Classification of Functioning, Disability, and Health for Children and Youths (ICF-CY) as a conceptual framework, we aimed to identify perceived barriers and facilitators to PA in young survivors and their parents. Design/methods: We conducted individual, semi-structured interviews with 63 survivors, aged 9–18 years, ≥1-year off treatment, and 68 parents, recruited from three pediatric oncology departments in Norway and Denmark. Interviews were analyzed inductively using thematic analysis to identify barriers and facilitators to PA, which were mapped onto the ICF-CY model components; body function/structures, activities, participation, and environmental and personal factors. Results: Two-thirds of the survivors described how treatment-related impairments of bodily functions (e.g., fatigue, physical weakness, reduced lung capacity) caused physical limitations, reducing opportunities to participate in PA, especially team sports and school physical education. This resulted in a perceived ability gap between survivors and peers, reducing motivation for PA. These PA barriers were moderated by environmental factors that facilitated or further hindered PA participation (family, peer, and school support). Similarily, personal factors also facilitated (acceptance, motivation, goal setting) or hindered (anxiety, low motivation, and lack of trust) PA participation. Conclusion: Treatment-related long-term or late effects represented significant barriers to PA as their functional consequences reduced survivors’ capacities and capabilities to be active. Environmental and personal factors acting as facilitators or further barriers to PA were identified. Applying the ICF-CY framework in clinical practice could help to enable PA participation.

KW - barriers and facilitators

KW - childhood cancer survivor

KW - ICF model

KW - late effects

KW - physical activity

U2 - 10.1002/pbc.30056

DO - 10.1002/pbc.30056

M3 - Journal article

C2 - 36251019

AN - SCOPUS:85139823386

VL - 70

JO - Pediatric Blood & Cancer

JF - Pediatric Blood & Cancer

SN - 1545-5009

IS - 1

M1 - e30056

ER -