Feasibility of 24-hour physical behavior monitoring with thigh-worn accelerometers after childhood cancer. The Swiss Childhood Cancer Survivor Study (SCCSS) - Activity

Feasibility of 24-hour physical behavior monitoring with thigh-worn accelerometers after childhood cancer – the Swiss Childhood Cancer Survivor Study (SCCSS) - Activity | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Feasibility of 24-hour physical behavior monitoring with thigh-worn accelerometers after childhood cancer – the Swiss Childhood Cancer Survivor Study (SCCSS) - Activity View ORCID Profile C Nigg , D Mohr , View ORCID Profile C Schindera , View ORCID Profile E Brack , View ORCID Profile CE Kuehni doi: https://doi.org/10.1101/2025.10.04.25337334 C Nigg 1 Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern , Switzerland Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for C Nigg D Mohr 1 Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern , Switzerland Find this author on Google Scholar Find this author on PubMed Search for this author on this site C Schindera 1 Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern , Switzerland 2 Department of Oncology/Haematology, University Children’s Hospital Basel UKBB , Basel, Switzerland Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for C Schindera E Brack 3 Division of Pediatric Hematology/Oncology, Inselspital, Bern University Hospital, University of Bern , Bern, Switzerland Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for E Brack CE Kuehni 1 Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern , Switzerland 3 Division of Pediatric Hematology/Oncology, Inselspital, Bern University Hospital, University of Bern , Bern, Switzerland Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for CE Kuehni For correspondence: claudia.kuehni{at}unibe.ch Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background A healthy lifestyle, including sufficient physical activity, limited sedentary behavior, and adequate sleep (24-hour physical behaviors) can mitigate late effect risks for childhood cancer survivors (CCS). Most research on 24-hour physical behaviors has been questionnaire-based, while device-based assessment is lacking. Here, we assess the feasibility of 24-hour physical behavior monitoring using thigh-worn accelerometers in an age-diverse CCS population. Methods SCCSS-Activity is nested in the Swiss Childhood Cancer Survivor Study (SCCSS), a nation-wide questionnaire-based cohort study. As part of the 2024/2025 mailing, we asked participants if they are willing to participate in an accelerometer-based sub-study. Participants wore an activPAL4® accelerometer continuously for eight days. We investigated feasibility using the following indicators: recruitment rate, acceptability and suitability of contact procedures and measurement scheduling, accelerometer return and adherence, summary reports, and overall impression. We analyzed quantitative data descriptively and conducted semi-structured interviews with nine participants. Results Of 367 CCS returning the baseline questionnaire (median: 14 years [IQR: 10-21]; 50% female), 157 (43%) expressed interest in the accelerometer study, 100 were enrolled as of June 2025, and 90 wore and returned the accelerometer, with all except two containing valid data. Participants wore the device for a median of seven days (IQR 7–8). Interview results indicated high acceptability and minimal burden. Conclusion Twenty-four-hour physical behavior assessment using thigh-worn accelerometers is feasible and well accepted among pediatric, adolescent, and adult CCS. This holds promise for future research to better understand and intervene on physical behaviors and to understand their compositional impact on CCS’ health. Highlights Thigh-worn accelerometry is feasible to assess 24-hour physical behaviors in survivors 43% of eligible survivors expressed interest in accelerometer participation 98% of participants provided valid accelerometry data Mailing-based recruitment and return procedures were effective and acceptable Survivors reported low burden and high acceptability of study participation Introduction Five-year childhood cancer survival rates in Switzerland approach 90% ( 1 ). Nevertheless, two-thirds of childhood cancer survivors (CCS) experience late effects related to their cancer or its treatment that can impair long-term health and quality of life ( 2 – 7 ). Health-promoting 24-hour physical behaviors, including sufficient physical activity and sleep, and limited sedentary behavior, can mitigate several of those late effects ( 8 ), and often occur together with other health-promoting behaviors (e.g., a healthy diet) ( 9 ) that also mitigate late effect risk. However, we showed previously that adult CCS engage in less exercise than healthy controls ( 10 ), especially if they have physical performance limitations (e.g., musculoskeletal or cardiorespiratory problems) ( 11 ), and that adolescent CCS tend to exceed screen time recommendations ( 12 ). Findings from other studies confirm that CCS tend to be less physically active then healthy peers ( 13 ), have comparably high sedentary time as the general population ( 14 ), and commonly report sleep disturbances ( 15 ). Research in CCS focused on self-reported physical activity ( 16 – 20 ), which is prone to recall bias ( 21 ). Sedentary behavior has been less researched and predominantly operationalized as self-reported leisure screen-time ( 12 , 22 ), neglecting other relevant domains such as non-screen based sedentary activities or sedentary time at work. Sleep duration has also been neglected, with the few existing studies relying again on self-report ( 23 , 24 ). In the general population, triaxial accelerometers are increasingly used for device-based assessment of physical activity intensities, activity types, and biological state (sleep vs. awake) ( 25 ). Such comprehensive assessment allows assessing the compositional impact of physical activity, sleep, and sedentary behavior on health outcomes instead of focusing solely on one of those behaviors ( 26 ). The few studies with device-based assessment in CCS used hip-mounted accelerometers which were only worn during waking hours or pedometers, focusing on physical activity ( 13 , 27 , 28 ). This leaves a critical gap regarding device-based 24-hour physical behavior assessment in CCS. With the Swiss Childhood Cancer Survivor Study (SCCSS)-Activity, we aimed to assess the feasibility of 24-hour physical behavior assessment with thigh-worn accelerometers among an age-heterogenous CCS population. Methods Study design and study population The SCCSS-Activity is nested within the national Swiss Childhood Cancer Survivor Study (SCCSS), a population-based study of long-term outcomes among all children and adolescents registered in the Swiss Childhood Cancer Registry (ChCR). Detailed methods of the SCCSS are published elsewhere ( 29 ). The study is registered with Clinicaltrials.gov ( NCT03297034 ). The ChCR includes all individuals diagnosed before age 20 with leukemia, lymphoma, CNS tumors, malignant solid tumors, or Langerhans cell histiocytosis in Switzerland since 1976 ( 30 ). The SCCSS repeatedly surveys survivors starting five years post-diagnosis on physical, mental, and social health, health behaviors, and quality of life, with questionnaires in German, French, and Italian; for survivors aged 5–15 years, parents respond. For SCCSS-Activity, we included survivors who participated in the 2024-2025 SCCSS mailing and were interested in participating in an accelerometer-based study. SCCSS-Activity began in February 2025 and data collection is ongoing. Ethical approval for both SCCSS and SCCSS-Activity was granted by the ethics committee of the canton of Bern (KEK-BE: 166/2014, 2021-01462, 2024-02240). Study procedures SCCSS-Activity In the SCCSS questionnaire ( Figure 1 , step 1 ), we asked participants if they would be interested in wearing an accelerometer for one week to assess physical activity objectively (response options: yes/no). For participants responding “yes”, the SCCSS team forwarded contact details (phone, email, address) to the SCCSS study team. In case of missing responses, the SCCSS team contacted participants directly to inquire about their interest. Interested participants received study information, consent form, and a prepaid return envelope by mail consecutively depending on device availability ( Figure 1 , step 2 ). Earliest one week after the expected delivery of study materials, we followed up by phone or email to confirm participation. For participants for whom only a postal address was available, we requested phone/email information with the consent form and sent a reminder after two weeks if no response was received. When participants confirmed, we scheduled a measurement week that reflected their usual daily life ( Figure 1 , step 3 ). If the scheduled week was more than two weeks ahead, we scheduled a later call (e.g., after holidays). We mailed an accelerometer package including adhesives and replacements, illustrated mounting/dismounting instructions, a wear time protocol, a prepaid return envelope, and a return checklist ( Figure 1 , step 4 ). We instructed participants to mount the accelerometer immediately upon receipt ( Figure 1 , step 5 ), to wear it continuously for eight days, to remove it on the ninth day in the morning, and to mail it back the same day. The day after the package was due to be delivered at the participant, a study team member called to confirm mounting and to answer potential questions ( Figure 1 , step 6 ). After completion of the measurement period ( Figure 1 , step 7 ), we waited four working days to receive the accelerometer ( Figure 1 , step 8 ). If we had not received the device, we contacted participants by phone or email. We then downloaded the data ( Figure 1 , Step 9 ) and generated an individual summary report that displayed time spent physically active, sedentary and sleeping, and time spent in different activities (sleeping, sitting/lying, seated transportation, walking/running, and cycling). We sent this report together with an age-appropriate physical activity booklet ( 31 ) to the participants, and 20 CHF gift card to those who had worn the device at least 20 hours per day ( Figure 1 , step 10 ). To obtain feedback, we invited nine participants to a 10–15-minute semi-structured interview. We created an interview guide based on the study procedures ( Supplementary Table A.1 ), asking about clarity, problems, and missing information at each step of the study. Our goal was to capture insights beyond quantitative feasibility indicators and to improve study procedures. Two researchers conducted the first interview together and compared notes. Because their notes matched, one researcher conducted the remaining eight interviews. View this table: View inline View popup Download powerpoint Supplementary Table A.1. Semi-structured interview guide to inquire about participant’s perspectives regarding study procedures for SCCSS-Activity Download figure Open in new tab Figure 1. Study procedures SCCSS-Activity 24-hour physical behavior measurement We used activPAL4® devices (PAL Technologies, Glasgow, Scotland) to assess 24-hour physical behaviors. The activPAL® validly captures posture and activity type in children, adolescents, and adults ( 32 , 33 ). We instructed participants to attach the device to the front of the right thigh midway between knee and hip with PALpatch® adhesives. We pre-packed each accelerometer in a nitrile sleeve and sealed it with PALpatch® materials. Participants placed an Opsite Flexifix® adhesive over the device to ensure waterproofing and prevent detachment (e.g., when changing clothes). We used the PAL Software Suite (v9.1.2.2) to download data, generate event spirals showing activity types for participant reports, and export csv-files for further processing. We defined a valid dataset as ≥20 hours of wear time on at least four weekdays and one weekend day ( 34 , 35 ). Feasibility indicators We chose feasibility indicators along the steps of the study procedures, including recruitment capability, acceptability and suitability of contact initiation to schedule the measurement week, accelerometer sending and returning procedures, accelerometer adherence, individual summary reports, and participant’s overall impression. Table 1 provides a detailed overview of the feasibility categories, indicators, and data sources. View this table: View inline View popup Download powerpoint Table 1. Feasibility categories, data sources, indicators, and quantitative results of SCCSS-Activity Statistical and qualitative analysis We used descriptive analysis with median, interquartile range (IQR), minimum, maximum, and frequencies to assess feasibility indicators. To evaluate accelerometer adherence and wear time, we processed raw files in ActiPASS (v2025.04.2) ( 36 ) and imported the processed data into RStudio (v4.5.0) for all statistical analyses. To analyze participant interviews, we applied the framework method and created a summary based on input in the rows ( 37 ). Results Recruitment capability Figure 2 presents the flow diagram of the recruitment procedures. In the SCCSS 2024/2025 questionnaire, we traced and contacted 786 survivors. Of those, 367 participants returned the SCCSS questionnaire, and 157 (43%) were eligible and expressed interest in wearing an accelerometer. Interested survivors were between six and 32 years old (median: 14 years, IQR: 10-21 years); 78 (50%) were female. Of those, 104 (66%) came from the German-speaking part of Switzerland, 44 (28%) from the French-speaking, and 9 (6%) from the Italian-speaking part. Download figure Open in new tab Figure 2. Study population tree SCCSS-Activity As of June 2025, we sent the study information to and followed up with 125 participants; 100 confirmed participation, 13 refused participation, and 12 did not reply to contact efforts. Of those who refused, most had physical restrictions (e.g., having to wear thigh-high compression socks), which interfered with wearing the accelerometer. We sent accelerometers to 93 participants so far; 90 returned the accelerometer (see Table 1 ). We contacted a median of five eligible participants (IQR 1-9) per week. Acceptability and suitability of contact initiation and measurement week scheduling We followed up with participants earliest one week after the expected arrival of the study information, predominantly via phone. Table 1 shows the details. In interviews, participants reported that the information was understandable and sufficient for an informed decision. They valued the one-page version for children, which enabled them to decide themselves. One participant highlighted the importance of the note that no location tracking was involved. Two participants found the information long and repetitive, leading them to read it only superficially; they recommended adding a short summary to accompany the full version. Most participants preferred phone calls to arrange participation and schedule the measurement week, citing efficiency and the chance to ask questions directly. One person preferred email, as it allowed replying at a convenient time. Supplementary Table A.2 summarizes each interview participant’s feedback across study procedures. View this table: View inline View popup Supplementary Table A.2. Framework matrix of participant interview summaries in SCCSS-Activity Accelerometer sending, mounting, and returning procedures As planned, the median time between sending and mounting the accelerometer was one day (IQR 1–2), and the median retrieval time was three days (IQR 2-4) ( Table 1 ). Of eight follow-ups due to delayed returns, six devices were already in transit, one was returned after a reminder, and one participant did not respond. During mailing the accelerometers back to the study center, four accelerometers were lost and one was damaged; most participants whose accelerometer got lost during volunteered for another measurement week. In interviews, participants found the illustrated instructions very helpful for mounting. Those with questions appreciated follow-up contact, while those without questions found the check-in neither useful nor disturbing. Return procedures were clear. Accelerometer adherence, problems, and adverse events In interviews, most participants reported no problems wearing the accelerometer in daily life, consistent with the quantitative data: the median number of days with valid wear time duration (≥20 hours) was seven days (IQR 7–8). Eighty-eight participants (98%) provided valid datasets (≥20 hours on at least 4 weekdays and one weekend day). Some reported the need to replace adhesives when they loosened or caused slight skin irritation; minor irritations upon removal were also noted but resolved quickly. Individual summary report All participants who returned the accelerometer were interested in receiving an individual summary of their 24-hour physical behaviors. In interviews, they found the summary exciting and understandable but suggested adding context by comparing results with the general population and with other survivors with similar cancer types or treatment. Several pediatric participants showed unusually high “seated transport” time as activity type, e.g., indicating that a participant was in a car or on a train while they were actually sitting in school. This was likely due to fidgeting while sitting; while it does not make a difference in overall sedentariness, parents requested a short explanation in the report. Participants also appreciated the accompanying physical activity brochure. Most parents and children reviewed it, some tried the suggestions, but most felt already physically active and did not use it further. Overall impression of interview participants Interview participants described the study as positive, exciting, practical, well organized, and understandable, with minimal burden. Follow-ups made them feel comfortable and well cared for, and they valued having both email and phone as contact options. One participant noted the study reminded them that they are healthy again and able to live an active lifestyle after cancer. Discussion Our study demonstrates that 24-hour physical behavior assessment with thigh-worn accelerometers is feasible among childhood cancer survivors of different age groups. Nearly half of eligible participants expressed interest in wearing the accelerometer, nearly all who wore the accelerometer returned valid data, and participants perceived study burden as minimal with high acceptability. Nearly half (43%) of eligible CCS expressed interest in participation, similar to other population-based studies. In the German MoMo study, 46% of children and adolescents asked on-site agreed to hip-worn accelerometry ( 38 ). In the UK Biobank study, 45% responded to an email invitation for wrist-worn devices ( 39 ). The Physical Activity in Childhood Cancer Survivors (PACCS) study, which recruited CCS in clinics for hip-worn accelerometry, achieved 59% ( 40 ). Considering our mailing-based approach, our rate reflects realistic uptake among survivors. Participants strongly accepted contact procedures, preferring phone over email. The median of two calls per participant shows that phoning survivors is feasible for confirming participation and scheduling a measurement week while allowing questions. Our accelerometer mailing procedures proved effective: Return rates were high, with only 5% of accelerometers lost or damaged, comparable to other studies ( 41 ). In-person distribution reduces loss ( 42 ), but requires greater resources when recruiting nationally. Four accelerometers broke through return envelopes during mailing, though the damaged envelopes were retrieved. We adapted mailing by using enforced padded envelopes (see Table 2 ), which should prevent future loss. Participants found illustrated instructions clear for mounting and dismounting. Although most did not view the check-in phone call as necessary, we kept it because it solved uncertainties (e.g., dismounting date) and helped address issues such as wrong addresses or delayed arrivals. When unnecessary, calls lasted less than a minute, keeping participant and staff burden minimal. View this table: View inline View popup Download powerpoint Table 2. Adaptations to the study procedures following the feasibility evaluation Accelerometer adherence was excellent: all but one participant returned valid accelerometer data. This compliance exceeds the average of 77% in accelerometer studies with children and adolescents ( 43 ). In Switzerland’s SOPHYA-study, 84% met wear time criteria (≥10 h/day on 3 weekdays and 1 weekend day) ( 44 ). In Germany’s Health Interview and Examination Survey (KIGGS), compliance reached 75% for adolescents and 78% for young adults ( 45 ). Our higher compliance likely stems from requesting continuous 24-hour wear, which increases adherence compared to waking-time only protocols ( 46 ). Other possible reasons include the greater effort required to remove thigh-worn accelerometers compared to belt-attached hip devices, their ability to be worn during water-based activities, or participants’ pride in showing such a sportive device to others. Overall, participants reported low study burden. This aligns with studies among adult cancer survivors, who found thigh-worn devices comfortable ( 47 ). In contrast, children and adolescents have reported lack of social conformity as a burden with hip-mounted accelerometers ( 48 ). Our participants did not report this, likely because thigh-mounted devices are easier to hide under clothing. Due to minor skin irritations, we exchanged the waterproof adhesive placed on top of the accelerometer against breathable tape, probably preventing such problems in the future (see Table 2 ). This study advances health behavior assessment with wearables by demonstrating the feasibility of 24-hour thigh-worn accelerometry among pediatric, adolescent, and adult CCS. Moving beyond physical activity, this approach enables also comprehensive assessment of device-based sedentary behavior and sleep in survivorship research ( 49 ). Limitations include potential self-selection bias, since we recruited only survivors who are already study participants of the SCCSS. We will assess differences between participants and non-participants once recruitment is complete. Because we included only recent SCCSS participants, our population was relatively young, limiting generalizability to older CCS who may find handling accelerometers less intuitive. Finally, we collected most data in spring, so we could not evaluate wearing comfort and compliance during hot temperatures. In conclusion, thigh-worn accelerometry is a feasible and acceptable method to assess 24-hour physical behaviors among pediatric, adolescent, and adult CCS. This holds promise for future research to better understand and intervene on physical behaviors and to understand their compositional impact on CCS’ health. Conflict of Interest statement CS reports a relationship to Swedish Orphan Biovitrum AB that includes travel reimbursement. This relationship has no association with the current study. CRediT Author Statement CN: Conceptualization, Methodology, Formal analysis, Investigation, Visualization, Funding acquisition, Writing – original draft, Writing – review and editing DM: Investigation, Project administration, Writing – review and editing CS: Funding acquisition, Writing -review and editing EB: Writing – review and editing CK: Conceptualization, Methodology, Supervision, Funding acquisition, Writing – review and editing Funding This study was financially supported by the Swiss Cancer League and Swiss Cancer Research (KLS/KFS-482501-2019, KLS/KFS-5711-01-2022, KFS-6346-02-2025), Kinderkrebshilfe Schweiz ( www.kinderkrebshilfe.ch ), Kinderkrebs Schweiz ( www.kinderkrebs-schweiz.ch ) Stiftung für krebskranke Kinder - Regio Basiliensis ( https://www.stiftung-kinderkrebs.ch ). Berne University Research Foundation funded the acquisition of accelerometers. Data availability statement The data that support the information of this manuscript were accessed on secured servers of the Institute of Social and Preventive Medicine at the University of Bern. Individual-level, fully anonymized, sensitive data can only be made available for researchers who fulfil the respective legal requirements. Requests of data from the Childhood Cancer Registry must be directed to the Childhood Cancer Registry of Switzerland ( https://www.childhoodcancerregistry.ch ). Requests of data from the Swiss Childhood Cancer Survivor Study (SCCSS) and SCCSS-Activity should be communicated to the study lead Claudia E. Kuehni ( claudia.kuehni{at}unibe.ch ). Acknowledgements We thank all survivors for participating in our study, the study team of the Childhood Cancer Research Group, the data managers of the Swiss Paediatric Oncology Group, and the team of the Swiss Childhood Cancer Registry. Abbreviations CCS childhood cancer survivors ChCR Swiss Childhood Cancer Registry ICCC3 International Classification of Childhood Cancer, third edition SCCSS Swiss Childhood Cancer Survivor Study References 1. ↵ Schindler M , Belle FN , Grotzer MA , Von Der Weid NX , Kuehni CE . Childhood cancer survival in Switzerland (1976–2013): Time-trends and predictors . Int J Cancer . 2017 ; 140 ( 1 ): 62 – 74 . OpenUrl CrossRef PubMed 2. ↵ Bhakta N , Liu Q , Ness KK , Baassiri M , Eissa H , Yeo F , et al. The cumulative burden of surviving childhood cancer: an initial report from the St Jude Lifetime Cohort Study (SJLIFE) . Lancet . 2017 ; 390 ( 10112 ): 2569 – 82 . OpenUrl CrossRef PubMed 3. Hammoud RA , Liu Q , Dixon SB , Onerup A , Mulrooney DA , Huang IC , et al. The burden of cardiovascular disease and risk for subsequent major adverse cardiovascular events in survivors of childhood cancer: a prospective, longitudinal analysis from the St Jude Lifetime Cohort Study . Lancet Oncol . 2024 ; 25 ( 6 ): 811 – 22 . OpenUrl CrossRef PubMed 4. Christen S , Roser K , Mader L , Otth M , Scheinemann K , Sommer G , et al. Incidence and prevalence of musculoskeletal health conditions in survivors of childhood and adolescent cancers: A report from the Swiss childhood cancer survivor study . Cancer Med . 2024 ; 13 ( 8 ): e7204 . OpenUrl 5. Weiss A , Sommer G , Kasteler R , Scheinemann K , Grotzer M , Kompis M , et al. Long-term auditory complications after childhood cancer: A report from the Swiss Childhood Cancer Survivor Study . Pediatr Blood Cancer . 2017 ; 64 ( 2 ): 364 – 73 . OpenUrl CrossRef PubMed 6. Kasteler R , Weiss A , Schindler M , Sommer G , Latzin P , Von Der Weid NX , et al. Long-term pulmonary disease among Swiss childhood cancer survivors . Pediatr Blood Cancer . 2018 ; 65 ( 1 ): e26749 . OpenUrl CrossRef 7. ↵ Whelan KF , Stratton K , Kawashima T , Waterbor JW , Castleberry RP , Stovall M , et al. Ocular late effects in childhood and adolescent cancer survivors: A report from the childhood cancer survivor study . Pediatr Blood Cancer . 2010 ; 54 ( 1 ): 103 – 9 . OpenUrl CrossRef PubMed Web of Science 8. ↵ Dixon SB , Liu Q , Chow EJ , Oeffinger KC , Nathan PC , Howell RM , et al. Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort . Lancet . 2023 ; 401 ( 10386 ): 1447 – 57 . OpenUrl PubMed 9. ↵ Rebholz CE , Rueegg CS , Michel G , Ammann RA , von der Weid NX , Kuehni CE , et al. Clustering of health behaviours in adult survivors of childhood cancer and the general population . Br J Cancer . 2012 ; 107 ( 2 ): 234 – 42 . OpenUrl CrossRef PubMed 10. ↵ Rueegg CS , Von Der Weid NX , Rebholz CE , Michel G , Zwahlen M , Grotzer M , et al. Daily Physical Activities and Sports in Adult Survivors of Childhood Cancer and Healthy Controls: A Population-Based Questionnaire Survey . PLoS One . 2012 ; 7 ( 4 ): e34930 . OpenUrl CrossRef PubMed 11. ↵ Rueegg CS , Gianinazzi ME , Michel G , Von Der Weid NX , Bergstraesser E , Kuehni CE . Do childhood cancer survivors with physical performance limitations reach healthy activity levels? Pediatr Blood Cancer . 2013 ; 60 ( 10 ): 1714 – 20 . OpenUrl PubMed 12. ↵ Schindera C , Weiss A , Hagenbuch N , Otth M , Diesch T , Von Der Weid N , et al. Physical activity and screen time in children who survived cancer: A report from the Swiss Childhood Cancer Survivor Study . Pediatr Blood Cancer . 2020 ; 67 ( 2 ). 13. ↵ Antwi GO , Jayawardene W , Lohrmann DK , Mueller EL . Physical activity and fitness among pediatric cancer survivors: a meta-analysis of observational studies . Support Care Cancer . 2019 ; 27 ( 9 ): 3183 – 94 . OpenUrl CrossRef PubMed 14. ↵ Aubert S , Barnes JD , Demchenko I , Hawthorne M , Abdeta C , Abi Nader P , et al. Global Matrix 4.0 Physical Activity Report Card Grades for Children and Adolescents: Results and Analyses From 57 Countries . J Phys Act Health . 2022 ; 19 ( 11 ): 700 – 28 . OpenUrl CrossRef PubMed 15. ↵ Merz EL , Tomfohr-Madsen L . Sleep Disruption in Pediatric Cancer Survivors . Am J Lifestyle Med . 2018 ; 12 ( 4 ): 311 – 23 . OpenUrl PubMed 16. ↵ Batra A , Kumari M , Paul R , Patekar M , Dhawan D , Bakhshi S . Quality of Life Assessment in Retinoblastoma: A Cross-Sectional Study of 122 Survivors from India . Pediatric Blood & Cancer . 2016 ; 63 ( 2 ): 313 – 7 . OpenUrl PubMed 17. Bansal M , Sharma KK , Vatsa M , Bakhshi S . Comparison of health-related quality of life of children during maintenance therapy with acute lymphoblastic leukemia versus siblings and healthy children in India . Leukemia & Lymphoma . 2013 ; 54 ( 5 ): 1036 – 41 . OpenUrl PubMed 18. Wright M , Bryans A , Gray K , Skinner L , Verhoeve A . Physical Activity in Adolescents following Treatment for Cancer: Influencing Factors . Leukemia Research and Treatment . 2013 ; 2013 : 1 – 7 . OpenUrl 19. Polgreen LE , Petryk A , Dietz AC , Sinaiko AR , Leisenring W , Goodman P , et al. Modifiable risk factors associated with bone deficits in childhood cancer survivors . BMC Pediatr . 2012 ; 12 ( 1 ): 40 . OpenUrl CrossRef PubMed 20. ↵ Ness KK , Leisenring WM , Huang S , Hudson MM , Gurney JG , Whelan K , et al. Predictors of inactive lifestyle among adult survivors of childhood cancer . Cancer . 2009 ; 115 ( 9 ): 1984 – 94 . OpenUrl CrossRef PubMed Web of Science 21. ↵ Nigg CR , Fuchs R , Gerber M , Jekauc D , Koch T , Krell-Roesch J , et al. Assessing physical activity through questionnaires – A consensus of best practices and future directions . Psychol Sport Exerc . 2020 ; 50 : 101715 . OpenUrl CrossRef 22. ↵ Lemay V , Caru M , Samoilenko M , Drouin S , Mathieu M-E , Bertout L , et al. Physical Activity and Sedentary Behaviors in Childhood Acute Lymphoblastic Leukemia Survivors . J Pediatr Hematol Oncol . 2020 ; 42 ( 1 ). 23. ↵ Fisher RS , Rausch JR , Ferrante AC , Prussien KV , Olshefski RS , Vannatta KA , et al. Trajectories of health behaviors across early childhood cancer survivorship . Psychooncology . 2019 ; 28 ( 1 ): 68 – 75 . OpenUrl PubMed 24. ↵ Daniel LC , Aggarwal R , Schwartz LA . Sleep in Adolescents and Young Adults in the Year After Cancer Treatment . J Adolesc Young Adult Oncol . 2017 ; 6 ( 4 ): 560 – 7 . OpenUrl PubMed 25. ↵ Stevens ML , Gupta N , Inan Eroglu E , Crowley PJ , Eroglu B , Bauman A , et al. Thigh-worn accelerometry for measuring movement and posture across the 24-hour cycle: a scoping review and expert statement . BMJ Open Sport Exerc . 2020 ; 6 ( 1 ): e000874 . OpenUrl 26. ↵ Hayes G , Browne LD , Dowd KP , MacDonncha C , Carson BP , Purtill H , et al. Adolescent Time Use and Cardiometabolic Health: A Cross-Sectional Compositional Analysis to Explore Associations Between 24-Hour Activity Behaviors and Biomarkers of Cardiometabolic Health . J Adolesc Health . 2025 ; 76 ( 6 ): 1043 – 54 . OpenUrl PubMed 27. ↵ Bratteteig M , Rueegg CS , Lie HC , Thorsen L , Larsen EH , Larsen MH , et al. Physical activity behaviors and screen time in young childhood cancer survivors: the Physical Activity in Childhood Cancer Survivors Study . J Cancer Surviv . 2024 . 28. ↵ Lie HC , Anderssen S , Rueegg CS , Raastad T , Grydeland M , Thorsen L , et al. The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an International Mixed Methods Study . JMIR Res Protoc . 2022 ; 11 ( 3 ): e35838 . OpenUrl 29. ↵ Kuehni CE , Rueegg CS , Michel G , Rebholz CE , Strippoli MPF , Niggli FK , et al. Cohort Profile: The Swiss Childhood Cancer Survivor Study . Int J Epidemiol . 2012 ; 41 ( 6 ): 1553 – 64 . OpenUrl CrossRef PubMed Web of Science 30. ↵ Michel G , von der Weid NX , Zwahlen M , Adam M , Rebholz C , Kuehni CE. The Swiss Childhood Cancer Registry: rationale, organisation and results for the years 2001-2005 . Swiss Med Wkly . 2007 ; 137 ( 3536 ): 502 – 9 . OpenUrl CrossRef PubMed 31. ↵ HEPA Schweiz . Bewegungsempfehlungen [Physical activity recommendations] 2025 [Available from: https://www.hepa.admin.ch/de/bewegungsempfehlungen . 32. ↵ Giurgiu M , Nigg C , Fiedler J , Timm I , Rulf E , Bussmann JBJ , et al. The Assessment of 24-Hr Physical Behavior in Children and Adolescents via Wearables: A Systematic Review of Laboratory Validation Studies . Journal for the Measurement of Physical Behaviour . 2022 ; 8 ( e001267 ): 1 – 14 . OpenUrl 33. ↵ Giurgiu M , Ketelhut S , Kubica C , Nissen R , Doster A-K , Thron M , et al. Assessment of 24-hour physical behaviour in adults via wearables: a systematic review of validation studies under laboratory conditions . Int J Behav Nutr Phys Act . 2023 ; 20 ( 1 ). 34. ↵ Blodgett JM , Ahmadi MN , Atkin AJ , Chastin S , Chan H-W , Suorsa K , et al. Device-measured physical activity and cardiometabolic health: the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium . Eur Heart J . 2024 ; 45 ( 6 ): 458 – 71 . OpenUrl CrossRef PubMed 35. ↵ Migueles JH , Cadenas-Sanchez C , Ekelund U , Delisle Nyström C , Mora-Gonzalez J , Löf M , et al. Accelerometer Data Collection and Processing Criteria to Assess Physical Activity and Other Outcomes: A Systematic Review and Practical Considerations . Sports Med . 2017 ; 47 ( 9 ): 1821 – 45 . OpenUrl CrossRef PubMed 36. ↵ Hettiarachchi P , Johansson P. ActiPASS (Version 2025.04) . 2025 . 37. ↵ Gale NK , Heath G , Cameron E , Rashid S , Redwood S . Using the framework method for the analysis of qualitative data in multi-disciplinary health research . BMC Med Res Methodol . 2013 ; 13 ( 1 ): 117 . OpenUrl CrossRef PubMed 38. ↵ Burchartz A , Manz K , Anedda B , Niessner C , Oriwol D , Schmidt S , et al. Measurement of physical activity and sedentary behavior by accelerometry among a nationwide sample of the KiGGS and MoMo study: a study protocol . JMIR Research Protocols . 2020 ; 9 ( 7 ): e14370 . OpenUrl 39. ↵ Doherty A , Jackson D , Hammerla N , Plötz T , Olivier P , Granat MH , et al. Large Scale Population Assessment of Physical Activity Using Wrist Worn Accelerometers: The UK Biobank Study . PLoS One . 2017 ; 12 ( 2 ): e0169649 . OpenUrl CrossRef PubMed 40. ↵ Bratteteig M , Anderssen SA , Rueegg CS , Ruud E , Torsvik IK , Kriemler S , et al. Device-measured physical activity and cardiovascular disease risk in adolescent childhood cancer survivors. A physical activity in childhood cancer survivors (PACCS) study . Frontiers in Pediatrics . 2022 ; 10 . 41. ↵ Yang L , Griffin S , Chapman C , Ogilvie D . The feasibility of rapid baseline objective physical activity measurement in a natural experimental study of a commuting population . BMC Public Health . 2012 ; 12 ( 1 ): 841 . OpenUrl PubMed 42. ↵ Pulsford RM , Brocklebank L , Fenton SAM , Bakker E , Mielke GI , Tsai L-T , et al. The impact of selected methodological factors on data collection outcomes in observational studies of device-measured physical behaviour in adults: A systematic review . Int J Behav Nutr Phys Act . 2023 ; 20 ( 1 ). 43. ↵ Howie EK , Straker LM . Rates of attrition, non-compliance and missingness in randomized controlled trials of child physical activity interventions using accelerometers: A brief methodological review . J Sci Med Sport . 2016 ; 19 ( 10 ): 830 – 6 . OpenUrl PubMed 44. ↵ Bringolf-Isler B , Schindler C , Kayser B , Suggs LS , Probst-Hensch N . Objectively measured physical activity in population-representative parent-child pairs: parental modelling matters and is context-specific . BMC Public Health . 2018 ; 18 ( 1 ). 45. ↵ Manz K , Burchartz A , Niessner C , Kolb S , Schienkiewitz A , Mensink GBM . The Challenge of Incomplete Data in Accelerometer Studies: Characteristics of Nonparticipation and Noncompliance in a Nationwide Sample of Adolescents and Young Adults in Germany . J Phys Act Health . 2023 ; 20 ( 3 ): 226 – 38 . OpenUrl PubMed 46. ↵ Tudor-Locke C , Barreira TV , Schuna JM , Mire EF , Chaput J-P , Fogelholm M , et al. Improving wear time compliance with a 24-hour waist-worn accelerometer protocol in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) . Int J Behav Nutr Phys Act . 2015 ; 12 ( 1 ): 11 . OpenUrl CrossRef PubMed 47. ↵ Hidde MC , Crisafio ME , Gomes E , Lyden K , Leach HJ . An Evaluation of Participant Perspectives and Wear-Time Compliance for a Wrist-Worn Versus Thigh-Worn Accelerometer in Cancer Survivors . J Phys Act Health . 2023 ; 20 ( 2 ): 129 – 33 . OpenUrl PubMed 48. ↵ McCann DA , Knowles ZR , Fairclough SJ , Graves LEF . A protocol to encourage accelerometer wear in children and young people . Qualitative Research in Sport, Exercise and Health . 2016 ; 8 ( 4 ): 319 – 31 . OpenUrl 49. ↵ Koenig C , Ammann RA , Brack E . Non-invasive wearable devices in paediatric cancer care: Advancing personalized medicine, addressing challenges and shaping the future . EJC Paediatric Oncology . 2025 ; 5 : 100220 . View the discussion thread. Back to top Previous Next Posted October 07, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. 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Share Feasibility of 24-hour physical behavior monitoring with thigh-worn accelerometers after childhood cancer – the Swiss Childhood Cancer Survivor Study (SCCSS) - Activity C Nigg , D Mohr , C Schindera , E Brack , CE Kuehni medRxiv 2025.10.04.25337334; doi: https://doi.org/10.1101/2025.10.04.25337334 Share This Article: Copy Citation Tools Feasibility of 24-hour physical behavior monitoring with thigh-worn accelerometers after childhood cancer – the Swiss Childhood Cancer Survivor Study (SCCSS) - Activity C Nigg , D Mohr , C Schindera , E Brack , CE Kuehni medRxiv 2025.10.04.25337334; doi: https://doi.org/10.1101/2025.10.04.25337334 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Oncology Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (300) Cardiovascular Medicine (4436) Dentistry and Oral Medicine (444) Dermatology (382) Emergency Medicine (608) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1509) Epidemiology (15229) Forensic Medicine (30) Gastroenterology (1124) Genetic and Genomic Medicine (6600) Geriatric Medicine (668) Health Economics (997) Health Informatics (4538) Health Policy (1368) Health Systems and Quality Improvement (1613) Hematology (542) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15916) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (146) Nephrology (667) Neurology (6599) Nursing (346) Nutrition (998) Obstetrics and Gynecology (1144) Occupational and Environmental Health (957) Oncology (3333) Ophthalmology (974) Orthopedics (369) Otolaryngology (420) Pain Medicine (436) Palliative Medicine (130) Pathology (663) Pediatrics (1693) Pharmacology and Therapeutics (691) Primary Care Research (711) Psychiatry and Clinical Psychology (5447) Public and Global Health (9232) Radiology and Imaging (2198) Rehabilitation Medicine and Physical Therapy (1370) Respiratory Medicine (1196) Rheumatology (593) Sexual and Reproductive Health (712) Sports Medicine (530) Surgery (712) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a00e71fdc80e52ad',t:'MTc3OTY0ODE5OQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();