Promoting Physical Activity Among Childhood Cancer Survivors: The Way Forward : Cancer Nursing

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Promoting Physical Activity Among Childhood Cancer Survivors: The Way Forward

Li, William Ho Cheung PhD, MPhil, RN; Cheung, Ankie Tan PhD, RN; Ho, Long Kwan PhD, RN; Chung, Joyce Oi Kwan PhD, RN

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Cancer Nursing 46(1):p 86-87, 1/2 2023. | DOI: 10.1097/NCC.0000000000001182
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An increasing body of evidence suggests that childhood cancer survivors benefit from physical activity both physiologically and psychologically.1 Moreover, substantial evidence suggests that regular physical activity of moderate intensity can ameliorate the adverse effects of cancer treatment; for example, it can reduce cancer-related fatigue, improve muscle strength and cardiovascular fitness, and enhance the quality of life.1 However, most childhood cancer survivors do not participate in adequate physical activity and are hence unable to reap these health benefits.2 Physical inactivity among childhood cancer survivors is an alarming issue and necessitates urgent attention as it may lead to poor health conditions and premature death. In 2020, we conducted a systematic review to evaluate the effects of physical activity interventions on improving the physical activity levels among childhood cancer survivors.3 Although most interventions reported in the literature showed promising effects on increasing physical activity among childhood cancer survivors, the high variability of the interventions and measures used precludes us from drawing definitive conclusions regarding the overall effectiveness of the interventions.2 Moreover, it remains uncertain which interventions are most effective and feasible for promoting physical activity among childhood cancer survivors.3

Integrating mobile technology into physical activity interventions may be a promising and flexible approach toward alleviating this alarming issue.3 Moreover, parental involvement is a crucial component in promoting health-related behaviors, including physical activity, in children.4 A growing body of evidence suggests the effectiveness of using motivational interviewing to improve parents’ abilities to promote various health-enhancing behaviors in their children.5 However, although motivational interviewing was proven effective in enhancing healthy behavior changes in various populations, no studies have examined its effects in promoting physical activity among childhood cancer survivors.

Our research team developed and implemented a mobile, instant messaging–delivered, brief motivational interviewing strategy for helping parents promote regular physical activity among 161 Chinese childhood cancer survivors aged 9 to 16 years.2 An accessor-blinded, randomized controlled trial was performed. Parents in the intervention group received brief motivational interviews through instant messaging applications (ie, WhatsApp/WeChat) based on a strategy menu over 6 months. In addition, parent-child dyads in both the intervention and control groups received a brief health advice session and were asked to visit a website containing information on physical activity. This study provides empirical evidence on the effectiveness and feasibility of brief motivational interviewing delivered to parents via instant messaging applications for promoting the adoption and maintenance of regular physical activity, reducing cancer-related fatigue, and improving muscle strength and quality of life among childhood cancer survivors.2

The Way Forward

Contemplating the past and looking forward to the future, there are some important considerations with respect to future research on promoting physical activity among childhood cancer survivors. First, although most previous interventional studies have demonstrated their effectiveness for promoting physical activity among childhood cancer survivors, the clinical effectiveness of these innovations remains uncertain. It is essential to document the minimally important differences that constitute a change in patient management and support the development of new evidence-based guidelines for clinical practice. Second, many previous studies have highlighted that most childhood cancer survivors do not meet the recommendations of the World Health Organization ( and Centers for Disease Control and Prevention (, which mention that such populations require at least 60 minutes of moderate to vigorous physical activity per day. However, it may be unrealistic to expect childhood cancer survivors to implement drastic changes in their physical activity practices once they embrace innovation and to meet such recommendations. The short- and long-term goals of physical activity interventions on outcomes should be considered in future research and recommendations. Third, there is a lack of consensus on how to quantify and report changes in physical activity. Recording physical activity in childhood cancer survivors using objective measurement tools is critical for future research. Finally, most previous studies on physical activity interventions followed their participants’ outcomes for only up to 12 months, perhaps due to constraints in resources, including finances. Therefore, it is uncertain whether the effects of physical activity interventions can be sustained over extended periods, especially after the recommended interventions are completed. Sustainability is an important consideration in the potential implementation of innovations in clinical practice.6 For any intervention that has a significant positive impact on health, the effects should be sustained for more than 1 year. Future studies should consider long-term follow-up of participants to address the aforementioned sustainability issues.


1. Chung OKJ, Li HCW, Chiu SY, et al. The impact of cancer and its treatment on physical activity levels and behavior in Hong Kong Chinese childhood cancer survivors. Cancer Nurs. 2014;37(3):E43–E51.
2. Cheung AT, Li WHC, Ho LLK, et al. Efficacy of mobile instant messaging–delivered brief motivational interviewing for parents to promote physical activity in pediatric cancer survivors: a randomized clinical trial. JAMA Netw Open. 2022;5(6):e2214600.
3. Cheung AT, Li WHC, Ho LLK, et al. Physical activity for pediatric cancer survivors: a systematic review of randomized controlled trials. J Cancer Surviv. 2021;15(6):876–889.
4. Cheung AT, Li WHC, Ho LLK, et al. Parental perspectives on promoting physical activity for their children surviving cancer: a qualitative study. Patient Educ Couns. 2021;104(7):1719–1725.
5. Wong EM, Cheng MM. Effects of motivational interviewing to promote weight loss in obese children. J Clin Nurs. 2013;22(17–18):2519–2530.
6. Chung OKJ, Li HCW, Chiu SY, et al. Sustainability of an integrated adventure-based training and health education program to enhance quality of life among Chinese childhood cancer survivors: a randomized controlled trial. Cancer Nurs. 2015;38(5):366–374.
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