Barriers to physical activity among cancer pediatric cancer patients and survivors: a scoping review

Guimarães, Jean Augusto Coelho; Guerra, Paulo Henrique; Ueno, Deisy Terumi; Spósito, Letícia Aparecida Calderão; Sebastião, Emerson; Nakamura, Priscila Missaki

doi:10.1590/S1980-657420220005621

Jean Augusto Coelho Guimarães Corresponding author Jean Augusto Coelho Guimarães, Universidade Estadual Paulista, Instituto de Biociências, Programa de Pós-Graduação em Ciências da Motricidade, Departamento de Educação Física, Rio Claro, SP, Brazil. E-mail: jean13ef@gmail.com.

Universidade Estadual Paulista, Instituto de Biociências, Programa de Pós-Graduação em Ciências da Motricidade, Departamento de Educação Física, Rio Claro, SP, Brazil;

https://orcid.org/0000-0003-4125-7227

Paulo Henrique Guerra

Universidade Federal da Fronteira Sul, Chapecó, SC, Brazil;

Universidade de São Paulo, Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde, São Paulo, SP, Brazil;

https://orcid.org/0000-0003-4239-0716

Deisy Terumi Ueno

Universidade Estadual Paulista, Instituto de Biociências, Programa de Pós-Graduação em Ciências da Motricidade, Departamento de Educação Física, Rio Claro, SP, Brazil;

https://orcid.org/0000-0003-4334-1959

Letícia Aparecida Calderão Spósito

Universidade Estadual Paulista, Instituto de Biociências, Programa de Pós-Graduação em Ciências da Motricidade, Departamento de Educação Física, Rio Claro, SP, Brazil;

https://orcid.org/0000-0002-5008-2003

Emerson Sebastião

Northern Illinois University, Department of Kinesiology and Physical Education, Health and Exercise Research Group, Illinois, United States;

https://orcid.org/0000-0002-6320-7784

Priscila Missaki Nakamura

Universidade Estadual Paulista, Instituto de Biociências, Programa de Pós-Graduação em Ciências da Motricidade, Departamento de Educação Física, Rio Claro, SP, Brazil;

Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais, Muzambinho, MG, Brazil.

https://orcid.org/0000-0003-4993-4317

Associate Editor: Romulo A. Fernandes0000-0003-1576-8090, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Presidente Prudente, SP, Brazil. E-mail: romulo_ef@yahoo.com.br.

Corresponding author Jean Augusto Coelho Guimarães, Universidade Estadual Paulista, Instituto de Biociências, Programa de Pós-Graduação em Ciências da Motricidade, Departamento de Educação Física, Rio Claro, SP, Brazil. E-mail: jean13ef@gmail.com.

Reference	City (year of data collection)	Sample size	Age ( $\bar{x}$ )	Female (%)	Cancer type
Gilliam et al. 2013	Birmingham, United States of America (2010-2011)	105	8-16 (12.3)	51	Leukemia, Central Nervous System Tumor, Soft Tissue Sarcoma, Non-Hodgkin’s Lymphoma, Kidney Tumor, Neuroblastoma, Hodgkin's Lymphoma, Osteosarcoma, Other
Wright et al. 2013	Hamilton, Canada (2013)	96	13-18 (16.0)	39	Leukemia, Solid Tumor, Lymphoma, Central Nervous System Tumor
Götte et al. 2014	Müenster, Germany (2011-2012)	40	4-20 (13.2)	47	Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, Lymphoma, Bone Tumor, Ewing Sarcoma, Osteosarcoma
Wright, 2015	Hamilton, Canada (2015)	80	12-19 (15.0)	43	Leukemia, Lymphoma, Other
Mizhari et al. 2020	Sydney, Australia (2017-2018)	102	8-18 (12.8)	38	Acute Lymphoblastic Leukemia, Lymphomas, Wilms’ Tumor, Neuroblastoma, Acute Myeloid Leukemia, Other

Author	Instruments for collection	Validation of instruments	Time for collection
Gilliam et al. 2013	Questionnaires		≅ 20 min
Gilliam et al. 2013	1- Sociodemographic	1- nd
	2- Common Terminology Criteria for Adverse Events - version 3	2- Kappa coefficient and ICC r = 0.88 - 1.00
	3- Modified Leisure Score Index > Godin Leisure Time Exercise Questionnaire	3- r = 0.24 VO2max e 0.13 BF, p < 0.01²²
	4- PA scale (19 items)	4- α = 0.78 e r = 0.81, α = 0.84 (in this study)
	5- PA peer support (3 items)	5- α = 0.74 e r = 0.70, α = 0.88 (in this study)
	6- Perceived benefits to PA (13 items)	6- α = 0.92 e r = 0.65, α = 0.71 (in this study)
	7- Perceived barriers to PA (23 items)	7- α = 0.88 e r = 0.65, α = 0.86 (in this study)
	8- Self-efficacy to PA (5 items)	8- α = 0.85 e r = 0.89, α = 0.70 (in this study)
Wright et al. 2013	Questionnaires		nd
Wright et al. 2013	1- Leisure Score Index of Godin Leisure-Time Exercise Questionnaire	1- r = 0.81
	2- PRO Questionnaires for facilitators and barriers to PA	2- nd
	3- Fatigue Scale for Adolescents	3- α = 0.87²²
	4- Amherst Health and Activity Study Student Survey - adapted	4- r = 0.34 e 0.64 students-parents and PA, 0.04 a 0.21 students and PA
	Semi-structured interview
	5- Recorder	5- nd
	Measures	6- BMI - 70% to 80% sensitivity and positive predictive value, 95% high specificity²³
	6- Anthropometric - Clinical documents (patients) and self-report (non-patients)
Götte et al. 2014	Face to face interview	nd	≅ 18 min
Götte et al. 2014	1- Exercise values and beliefs during intensive care
	2- Barriers to exercise
	3- Motivations to exercise
	4- Encouragement of parents and doctors
	Medical information
	5- Electronic patient record technology
Wright, 2015	Questionnaires		nd
	1- Pediatric Outcomes Data Collection	1.1/1.2 - α = > 0.80
	1.1- Transfer and Basic Mobility
	1.2- Sports/Physical Functioning
Mizhari et al. 2020	Questionnaires		nd
Mizhari et al. 2020	1- Sociodemographic	1- nd
	2- Clinical variables	2- nd
	3- Leisure Score Index of Godin Leisure-Time Exercise Questionnaire	3- r = 0.84
	4- Barriers to exercise	4- Based on¹⁰
	5- Patient-Centered Assessment and Counseling for Exercise questionnaire	5- α = > 0.75²⁴
	6- Screen time questionnaire (purpose-designed)	6- nd
	Measures
	7- Aneroid sphygmomanometer (blood pressure)	7- nd
	8- 6-min walk test	8- Based on²⁵^-27
	8.1- Pulse oximeter (heart rate, oxygen saturation)
	8.2- Borg’s Scale (rate of perceived exertion 1-10)
	9- Anthropometric (bioimpedance InBody 570) and (digital stadiometer and weighed to BMI)	9- Based on²⁸

Barriers	Description
Individual	Dislike PA²⁰; find boring PA^17,¹⁸; moodiness and lack of energy^18,¹⁹; lack of self-discipline and skill¹⁸; lack of time^17,^18,²¹; lack of company¹⁸^-21; lack of instruction from doctors and parents²⁰; lack of social support from family and friends¹⁷^-18^-20; lack of knowledge on how to be physically active and teasing friends during PA^18,²¹; someone told them not to exercise and lack of self-awareness about exercise appearance¹⁸; fear of others opinion²⁰, experiences that diminished the pleasure if practicing PA, lack of reason for PA and school lessons¹⁹, rather watch TV²¹.
Physical	Fatigue^17,¹⁹^-21; pain^20,²¹; worry about injury²¹; balance issues¹⁹^-21; dizziness,nausea, risk of infections, gastrointestinal problems, lack of physical fitness, difficulties in dynamic movements, and limitations due to the tumor site, drowsiness¹⁹; overweight¹⁸ and general health²⁰.
Environmental	Lack of space to practice PA and lack of sports equipment^19,²¹; bad weather^18,^19,²¹; no gym access²¹.
Related to treatment/therapy	Time of treatment and medical-hospital routines¹⁹; late-effects²¹.

Barriers to physical activity among cancer pediatric cancer patients and survivors: a scoping review

Abstract