Daily physical activities and sports in adult survivors of childhood cancer and healthy controls: a population-based questionnaire survey

Corina S Rueegg, Nicolas X von der Weid, Cornelia E Rebholz, Gisela Michel, Marcel Zwahlen, Michael Grotzer, Claudia E Kuehni, Swiss Paediatric Oncology Group (SPOG), R Ammann, R Angst, M Beck Popovic, P Brazzola, U Caflisch, J Greiner, M Grotzer, H Hengartner, T Kühne, K Leibundgut, F Niggli, L Nobile Buetti, H Ozsahin, M Paulussen, J Rischewski, N von der Weid, Corina S Rueegg, Nicolas X von der Weid, Cornelia E Rebholz, Gisela Michel, Marcel Zwahlen, Michael Grotzer, Claudia E Kuehni, Swiss Paediatric Oncology Group (SPOG), R Ammann, R Angst, M Beck Popovic, P Brazzola, U Caflisch, J Greiner, M Grotzer, H Hengartner, T Kühne, K Leibundgut, F Niggli, L Nobile Buetti, H Ozsahin, M Paulussen, J Rischewski, N von der Weid

Abstract

Background: Healthy lifestyle including sufficient physical activity may mitigate or prevent adverse long-term effects of childhood cancer. We described daily physical activities and sports in childhood cancer survivors and controls, and assessed determinants of both activity patterns.

Methodology/principal findings: The Swiss Childhood Cancer Survivor Study is a questionnaire survey including all children diagnosed with cancer 1976-2003 at age 0-15 years, registered in the Swiss Childhood Cancer Registry, who survived ≥5 years and reached adulthood (≥20 years). Controls came from the population-based Swiss Health Survey. We compared the two populations and determined risk factors for both outcomes in separate multivariable logistic regression models. The sample included 1058 survivors and 5593 controls (response rates 78% and 66%). Sufficient daily physical activities were reported by 52% (n = 521) of survivors and 37% (n = 2069) of controls (p<0.001). In contrast, 62% (n = 640) of survivors and 65% (n = 3635) of controls reported engaging in sports (p = 0.067). Risk factors for insufficient daily activities in both populations were: older age (OR for ≥35 years: 1.5, 95CI 1.2-2.0), female gender (OR 1.6, 95CI 1.3-1.9), French/Italian Speaking (OR 1.4, 95CI 1.1-1.7), and higher education (OR for university education: 2.0, 95CI 1.5-2.6). Risk factors for no sports were: being a survivor (OR 1.3, 95CI 1.1-1.6), older age (OR for ≥35 years: 1.4, 95CI 1.1-1.8), migration background (OR 1.5, 95CI 1.3-1.8), French/Italian speaking (OR 1.4, 95CI 1.2-1.7), lower education (OR for compulsory schooling only: 1.6, 95CI 1.2-2.2), being married (OR 1.7, 95CI 1.5-2.0), having children (OR 1.3, 95CI 1.4-1.9), obesity (OR 2.4, 95CI 1.7-3.3), and smoking (OR 1.7, 95CI 1.5-2.1). Type of diagnosis was only associated with sports.

Conclusions/significance: Physical activity levels in survivors were lower than recommended, but comparable to controls and mainly determined by socio-demographic and cultural factors. Strategies to improve physical activity levels could be similar as for the general population.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Participants of the Swiss Childhood…
Figure 1. Participants of the Swiss Childhood Cancer Survivor Study.
Flow diagram of our study population starting from those eligible in the Swiss Childhood Cancer Registry to those included in the analysis.
Figure 2. Proportion of survivors and controls…
Figure 2. Proportion of survivors and controls reporting daily activities and sports.
Proportions of persons 1) meeting (active) or not meeting (inactive) healthy recommendations for daily activities, and 2) participating (sports) or not participating (no sports) in sporting activities, for childhood cancer survivors compared to the weighted proportions of healthy controls (p

Figure 3. Association of socio-demographic risk factors…

Figure 3. Association of socio-demographic risk factors with two types of physical activity: daily activities…

Figure 3. Association of socio-demographic risk factors with two types of physical activity: daily activities and sports.
Effect sizes for two different outcomes assessing physical activity derived from two multivariable regression models with a combined dataset including childhood cancer survivors and healthy controls. Abbreviations: OR, Odds Ratio. * versus age † versus vocational training. ‡ versus normal weight.
Figure 3. Association of socio-demographic risk factors…
Figure 3. Association of socio-demographic risk factors with two types of physical activity: daily activities and sports.
Effect sizes for two different outcomes assessing physical activity derived from two multivariable regression models with a combined dataset including childhood cancer survivors and healthy controls. Abbreviations: OR, Odds Ratio. * versus age † versus vocational training. ‡ versus normal weight.

References

    1. Gatta G, Zigon G, Capocaccia R, Coebergh JW, Desandes E, et al. Survival of European children and young adults with cancer diagnosed 1995–2002. European Journal of Cancer. 2009;45:992–1005.
    1. Jemal A, Siegel R, Xu J, Ward E. Cancer Statistics, 2010. CA Cancer J Clin. 2010;60:277–300.
    1. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, et al. Chronic Health Conditions in Adult Survivors of Childhood Cancer. New England Journal of Medicine. 2006;355:1572–1582.
    1. Alvarez JA, Scully RE, Miller TL, Armstrong FD, Constine LS, et al. Long-term effects of treatments for childhood cancers. Current Opinion in Pediatrics. 2007;19:23–31.
    1. Diller L, Chow EJ, Gurney JG, Hudson MM, Kadin-Lottick NS, et al. Chronic Disease in the Childhood Cancer Survivor Study Cohort: A Review of Published Findings. Journal of Clinical Oncology. 2009;27:2339–2355.
    1. Mertens AC, Liu Q, Neglia JP. Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2008;100:1368–1379.
    1. Reulen RC, Winter DL, Frobisher C, Lancashire ER, Stiller CA, et al. Long-term Cause-Specific Mortality Among Survivors of Childhood Cancer. JAMA: The Journal of the American Medical Association. 2010;304:172–179.
    1. San Juan AF, Chamorro-Viña C, Maté-Muñoz JL, Fernández del Valle M, Cardona C, et al. Functional capacity of children with leukemia. Int J Sports Med. 2008;29:163–167.
    1. Blaauwbroek R, Bouma M, Tuinier W, Groenier K, de Greef M, et al. The effect of exercise counselling with feedback from a pedometer on fatigue in adult survivors of childhood cancer: a pilot study. Supportive Care in Cancer. 2009;17:1041–1048.
    1. Hartman A, Winkel MLt, Beek RDv, Keizer-Schrama SMPFdM, Kemper HCG, et al. A randomized trial investigating an exercise program to prevent reduction of bone mineral density and impairment of motor performance during treatment for childhood acute lymphoblastic leukemia. Pediatric Blood & Cancer. 2009;53:64–71.
    1. Mayer EIE, Reuter M, Dopfer RE, Ranke MB. Energy Expenditure, Energy Intake and Prevalence of Obesity after Therapy for Acute Lymphoblastic Leukemia during Childhood. Hormone Research in Paediatrics. 2000;53:193–199.
    1. Meacham LR, Chow EJ, Ness KK, Kamdar KY, Chen Y, et al. Cardiovascular Risk Factors in Adult Survivors of Pediatric Cancer—A Report from the Childhood Cancer Survivor Study. Cancer Epidemiology Biomarkers & Prevention. 2010;19:170–181.
    1. San Juan AF, Fleck SJ, Chamorro-Viña C, Maté-Muñoz JL, Moral S, et al. Effects of an intrahospital exercise program intervention for children with leukemia. Med Sci Sports Exerc. 2007;39:13–21.
    1. San Juan AF, Wolin K, Lucía A. Physical Activity and Pediatric Cancer Survivorship. Recent Results Cancer Res. 2011;186:319–347.
    1. Tillmann V, Darlington ASE, Eiser C, Bishop NJ, Davies HA. Male Sex and Low Physical Activity Are Associated With Reduced Spine Bone Mineral Density in Survivors of Childhood Acute Lymphoblastic Leukemia. Journal of Bone and Mineral Research. 2002;17:1073–1080.
    1. van Brussel M, van der Net J, Hulzebos E, Helders PJM, Takken T. The Utrecht Approach to Exercise in Chronic Childhood Conditions: The Decade in Review. Pediatric Physical Therapy. 2011;23:2–14.
    1. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the Crest of the Teachable Moment: Promoting Long-Term Health After the Diagnosis of Cancer. J Clin Oncol. 2005;23:5814–5830.
    1. Speck R, Courneya K, Mâsse L, Duval S, Schmitz K. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship. 2010;4:87–100.
    1. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, et al. American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors. Medicine & Science in Sports & Exercise. 2010;42:1409–1426.
    1. Naylor AS, Bull C, Nilsson MKL, Zhu C, Björk-Eriksson T, et al. Voluntary running rescues adult hippocampal neurogenesis after irradiation of the young mouse brain. Proceedings of the National Academy of Sciences. 2008;105:14632–14637.
    1. Haskell WL, Lee IM, Pate RR, Powel KE, Bair SN, et al. Physical Activity and Public Health: Updated Recommendation for Adults from the American College of Sports Medicine and the American Heart Association. Medicine & Science in Sports & Exercise. 2007;39:1423–1434.
    1. Samitz G, Egger M, Zwahlen M. Domains of physical activity and all-cause mortality: systematic review and dose–response meta-analysis of cohort studies. International Journal of Epidemiology. 2011;40:1382–1400.
    1. Stolley M, Restrepo J, Sharp L. Diet and Physical Activity in Childhood Cancer Survivors: A Review of the Literature. Annals of Behavioral Medicine. 2010;39:232–249.
    1. Florin TA, Fryer GE, Miyoshi T, Weitzman M, Mertens AC, et al. Physical Inactivity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study. Cancer Epidemiology Biomarkers & Prevention. 2007;16:1356–1363.
    1. Ness KK, Leisenring WM, Huang S, Hudson MM, Gurney JG, et al. Predictors of inactive lifestyle among adult survivors of childhood cancer. Cancer. 2009;115:1984–1994.
    1. Finnegan L, Wilkie D, Wilbur J, Campbell R, Zong S, et al. Correlates of Physical Activity in Young Adult Survivors of Childhood Cancers. Oncology Nursing Forum. 2007;34:E60–E69.
    1. Reeves M, Eakin EG, Lawler S, Demark-Wahnefried W. Health behaviours in survivors of childhood cancer. Australian Family Physician. 2007;36:95–96.
    1. Demark-Wahnefried W, Werner C, Clipp EC, Guill AB, Bonner M, et al. Survivors of childhood cancer and their guardians. Cancer. 2005;103:2171–2180.
    1. Cox CL, Montgomery M, Oeffinger KC, Leisenring W, Zeltzer L, et al. Promoting physical activity in childhood cancer survivors. Cancer. 2009;115:642–654.
    1. Järvelä LS, Niinikoski H, Lähteenmäki PM, Heinonen OJ, Kapanen J, et al. Physical activity and fitness in adolescent and young adult long-term survivors of childhood acute lymphoblastic leukaemia. J Cancer Surviv. 2010;4:339–345.
    1. Kuehni CE, Rueegg CS, Michel G, Rebholz CE, Strippoli MPF, et al. Cohort profile: The Swiss Childhood Cancer Survivor Study. International Journal of Epidemiology. 2011 ahead of print: doi: .
    1. Michel G, von der Weid NX, Zwahlen M, Adam M, Rebholz CE, et al. The Swiss Childhood Cancer Registry: rationale, organisation and results for the years 2001–2005. Swiss Medical Weekly. 2007;137:502–509.
    1. Feller M, Adam M, Zwahlen M, Brazzola P, Niggli F, et al. Family Characteristics as Risk Factors for Childhood Acute Lymphoblastic Leukemia: A Population-Based Case-Control Study. PLoS ONE. 2010;5:e13156.
    1. Robison LL, Mertens AC, Boice JD. Study design and cohort characteristics of the Childhood Cancer Survivor Study: a multi-institutional collaborative project. Med Pediatr Oncol. 2002;38:229–239.
    1. Hawkins M, Lancashire E, Winter D, Frobisher C, Reulen R, et al. The British Childhood Cancer Survivor Study: Objectives, methods, population structure, response rates and initial descriptive information. Pediatric Blood & Cancer. 2008;50:1018–1025.
    1. Liebherr R, Marquis J, Storni M, Wiedenmayer G. Gesundheit und Gesundheitsverhalten in der Schweiz 2007 - Schweizerische Gesundheitsbefragung. Neuchâtel: Bundesamt für Statistik; 2010.
    1. Germann U. Abschlussbericht zur Volkszählung 2000. Neuchâtel: Bundesamt für Statistik; 2005.
    1. Godin G, Jobin J, Bouillon J. Assessement of leisure time exercise behavior by self-report: a concurrent validity study. Can J Public Health. 1986;77:359–362.
    1. Mäder U, Martin BW, Schutz Y, Marti B. Validity of Four Short Physical Activity Questionnaires in Middle-Aged Persons. Medicine & Science in Sports & Exercise. 2006;38:1255–1266.
    1. Kuehni CE, Strippoli MPF, Rueegg CS, Rebholz CE, Bergstraesser E, et al. Educational achievement in Swiss childhood cancer survivors compared with the general population. Cancer. 2012;118:1439–1449.
    1. World Health Organization. Physical status: The use and interpretation of anthropometry. Geneva, Switzerland: World Health Organization; 1995.
    1. Steliarova-Foucher E, Stiller C, Lacour B, Kaatsch P. International Classification of Childhood Cancer, third edition. Cancer. 2005;103:1457–1467.
    1. Westerterp K. Assessment of physical activity: a critical appraisal. European Journal of Applied Physiology. 2009;105:823–828.
    1. Wynder EL, Higgins IT, Harris RE. The wish bias. Journal of Clinical Epidemiology. 1990;43:619–621.
    1. Mäkinen T, Kestilä L, Borodulin K, Martelin T, Rahkonen O, et al. Effects of childhood socio-economic conditions on educational differences in leisure-time physical activity. The European Journal of Public Health. 2010;20:346–353.
    1. Ness KK, Hudson MM, Ginsberg JP, Nagarajan R, Kaste SC, et al. Physical Performance Limitations in the Childhood Cancer Survivor Study Cohort. Journal of Clinical Oncology. 2009;27:2382–2389.
    1. Thornton J. Overcoming the protected child syndrome: Kids, exercise and chronic illness. Physician Sportsmed. 1997;25:97–100.
    1. San Juan AF, Chamorro-Viña C, Moral S, Fernández del Valle M, Madero L, et al. Benefits of Intrahospital Exercise Training after Pediatric Bone Marrow Transplantation. Int J Sports Med. 2008;29:439–446.
    1. Barr-Anderson DJ, AuYoung M, Whitt-Glover MC, Glenn BA, Yancey AK. Integration of Short Bouts of Physical Activity Into Organizational Routine: A Systematic Review of the Literature. American Journal of Preventive Medicine. 2011;40:76–93.
    1. US Department of Health and Human Services. Healthy people 2010. Washington, DC: Government Printing Office; 2000.
    1. US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Washington, DC: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.
    1. Winter C, Müller C, Hoffmann C, Boos J, Rosenbaum D. Physical activity and childhood cancer. Pediatric Blood & Cancer. 2009;54:501–510.
    1. Oeffinger K, Hudson MM. Long term complications following childhood and adolescent cancer: foundations for providing the risk based health care for survivors. CA Cancer J Clin. 2004;54:208–236.
    1. Butterfield RM, Park ER, Puleo E, Mertens A, Gritz ER, et al. Multiple risk behaviors among smokers in the childhood cancer survivors study cohort. Psycho-Oncology. 2004;13:619–629.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner