Interactions among Physical activity Levels, Self-Efficacy, and Parental Anxiety in Children with Leukemia in China: a Cross-Sectional Study

Interactions among Physical activity Levels, Self-Efficacy, and Parental Anxiety in Children with Leukemia in China: a Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (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],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Interactions among Physical activity Levels, Self-Efficacy, and Parental Anxiety in Children with Leukemia in China: a Cross-Sectional Study Yongli Wang, Siyuan Tan, Shunhang Xu, Dongmei Jia, Hailing Yu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8374392/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: The quality of life of children with leukemia is often significantly compromised by the disease and its treatment. Evidence suggests that appropriate physical activity (PA)can improve the well-being of pediatric cancer patients. However, data on physical activity levels and influencing factors among children with leukemia in China remain scarce. This study aims to examine the relationship between physical activity levels, self-efficacy, and parental anxiety in this population, and to identify key factors influencing physical activity , so as to inform targeted intervention strategies and optimize health management. Methods: A cross-sectional study was conducted with 307 child–parent dyads recruited through convenience sampling from the pediatric hematology ward of Peking University People’s Hospital. Data were collected using general information questionnaires, the Chinese university of Hong Kong:Physical activity rating for children and youth, general self-efficacy scale, and the Hospital Anxiety and Depression Scale. SPSS 23.0 was used for statistical analysis. Results: The mean age of the children was 14.29±1.29 years. The average physical activity score was 2.82±2.31, indicating a low to moderate activity level. Self-efficacy scores averaged 17.55±5.66, while parental anxiety scores averaged 15.36±3.59. physical activity was positively correlated with self-efficacy ( r = 0.404, 95% CI[0.31,0.49], P < 0.01) and negatively correlated with parental anxiety (( r = -0.309, 95% CI[-0.41,-0.21], P < 0.01). Multiple linear regression revealed that child's self-efficacy, parental anxiety, duration of diagnosis,disease criticality, treatment duration, daily electronic usage time, parents' attitudes towards children's exercise during illness, income per month significantly influenced PA levels ( R² = 0.531, P < 0.01). Conclusion: Physical activity levels among children with leukemia are suboptimal and are positively associated with self-efficacy and negatively with parental anxiety. Healthcare providers should prioritize assessing physical activity and deliver tailored educational and psychosocial support to families. Personalized intervention strategies are warranted to enhance physical activity and improve quality of life in this vulnerable population. Biological sciences/Cancer Health sciences/Health care Health sciences/Medical research Health sciences/Oncology Biological sciences/Psychology Social science/Psychology Health sciences/Risk factors Physical activity Leukemia Hematologic Cancer Pediatric Self-Efficacy cross-sectional study Figures Figure 1 Introduction The Global Burden of Childhood Cancer Report indicates that leukemia accounts for approximately 30% of all pediatric malignancies[1-2]. According to China’s National Childhood Cancer Surveillance Annual Report (2022)[3], leukemia ranked first among newly diagnosed childhood cancers during 2019–2020, with a prevalence of 32.89%. These findings underscore leukemia's significant clinical and public health burden as a leading threat to child health. Although the 5-year survival rate for pediatric leukemia patients in China has reached 72%[4], the disease has a significant and long-term treatment burden[5]. During treatment, these children develop a variety of long-term chronic health problems, including physical complications such as decreased PA, osteoporosis, impaired cardiopulmonary function, and metabolic changes[6-7]; psychosocial problems such as anxiety, depression, and cancer-related fatigue[8]; and late-onset cardiovascular diseases such as cardiomyopathy and heart failure[9-10]. These issues significantly impede post-treatment growth, development, and social reintegration, jeopardizing overall health and quality of life. According to studies, pediatric leukemia survivors are seven times more likely to die from cardiovascular problems in later life than their healthy counterparts[11]. Research suggests that regular PA helps improve motor function and cardiorespiratory fitness in juvenile cancer patients. Exercising has also been proven to considerably lower all-cause mortality, recurrence rates, and the prevalence of long-term chronic health problems [12]. PA is defined as any physiological action produced by skeletal muscles that needs energy expenditure[13]. It enhances cardiopulmonary function and physical capacity through a variety of biological mechanisms. These benefits help to reduce physical dysfunction, shorten hospital stays, and improve long-term quality of life [14-15]. Studies in pediatric oncology have demonstrated the beneficial effects of structured exercise (e.g., aerobic and resistance training) on quality of life[16-17]. These studies have also identified multiple factors influencing PA (PA) levels in pediatric cancer patients. Such factors include hospital isolation and hygiene policies, length of hospital stay, and disease-related side effects (e.g., cancer-related fatigue, pain)[18]. Additional influencing factors are children’s screen time[19] self-efficacy[20], as well as parental support, and supervision[21]. However, research focusing specifically on PA in children with leukemia remains limited. Although a study from Hong Kong, China, has examined PA patterns in pediatric hematological malignancies [22], there is a notable lack of data on daily PA levels and associated correlates among children with leukemia in mainland China, particularly regarding the interrelationships between self-efficacy (individual factor), parental anxiety (family-level factor), and PA. Therefore, this study aims to (1) evaluate the current status of PA among children with leukemia; (2) explore the interrelationships among parental anxiety, children's self-efficacy, and their PA levels, and (3) identify factors influencing PA to provide a basis for developing targeted interventions. Methods Setting, Study Population, and Sample Selection This cross-sectional study was conducted at a large general hospital in Beijing between February and October 2024. Potential participants were recruited from the pediatric ward using a convenience sampling method. Inclusion criteria were as follows: (1) age between 13 and 18 years; (2) diagnosis of leukemia confirmed by cytomorphology, immunophenotyping, cytogenetics, and histochemical staining; (3) time since diagnosis ≥1 month; (4) medically stable with no contraindications for PA, as certified by a physician; (5) adequate communication skills to express personal views and preferences; and (6) provision of informed consent by a legal guardian. Exclusion criteria included the presence of severe organic brain syndrome or psychiatric disorders that could impair cognitive function. Sample size and calculation To ensure adequate statistical power, the sample size was calculated using G*Power 3.1 software for the multiple regression analysis. The parameters were set as follows: power at 0.80 [23], α = 0.05, and a moderate effect size of 0.15[24]. With 23 predictor variables included in the model and an estimated 20% attrition rate for invalid questionnaires, a minimum sample size of 200 participants was required. Ultimately, 307 children with leukemia were enrolled in this study. A total of 307 children with leukemia were enrolled, with a mean age of 14.29±1.29 years. Among them, 43.6% resided in towns and 56.4% in urban areas Measures General information Questionnaire The questionnaire was developed by the research team based on a review of relevant literature. It consisted of two sections: (1) Children’s general and disease-related characteristics, including demographic information (e.g., gender, age, and education level), leukemia subtype, time since diagnosis, disease risk stratification, treatment phase, and daily screen time. (2) Parent-related information, including parental education level, attitudes toward PA during the child’s treatment, and perceived benefits of exercise. The Chinese university of Hong Kong: Physical activity rating for children and youth, CUHK-PARCY The CUHK-PARCY was adapted from the Jackson Activity Coding[24] and Godin-Shephard Youth Activity Questionnaire [26]. It is an 11-point (0–10) rating scale that quantifies PA levels, with scores ranging from 0 (no PA) to 10 (vigorous exercise on most days). Scores of 0–2, 3–6, and 7–10 denote low, moderate, and high activity levels, respectively. Previously validated in studies on Chinese children in Hong Kong [22,27] , the scale exhibits good content validity (content validity index=90%) and test-retest reliability (r=0.86). Its Cronbach’s α coefficient in this study was 0.82. General Self-Efficacy Scale, GSES The GSES was originally developed by Schwarzer et al. in 1981 [28]. The initial 20-item version was later refined into a widely used 10-item scale. The Chinese version of the GSES, validated by Wang et al. in 2001 [29], demonstrated good reliability, with a Cronbach's alpha of 0.87, a test-retest reliability of 0.83 (p < 0.001), and a split-half reliability of 0.82 (p < 0.001), indicating strong psychometric properties and predictive validity. The scale uses a 4-point Likert format, ranging from 1 (“not at all true”) to 4 (“exactly true”). Total scores range from 10 to 40, with higher scores indicating greater self-efficacy. Scores are interpreted as follows: 1–10 (“very low”), 11–20 (“low”), 21–30 (“high”), and 31–40 (“very high”). In the present study, the overall Cronbach's alpha for the GSES was 0.740, while subscale coefficients ranged from 0.813 to 0.874. Hospital Anxiety and Depression Scale The Hospital Anxiety and Depression Scale, originally developed by Zigmond in 1983 [30], consists of two subscales designed to screen for symptoms of anxiety and depression. The Chinese version, adapted by Ye et al. in 1993[31], comprises 14 items—seven for anxiety and seven for depression—each rated on a 4-point Likert scale (0~3), with higher scores indicating greater symptom severity. Owing to its well-established psychometric properties, the anxiety subscale was employed in this study to assess anxiety levels among parents of children with leukemia. In the present sample, the anxiety subscale demonstrated good internal consistency, with a Cronbach's alpha of 0.799. Procedure This study was approved by the Ethics Committee of Peking University People’s Hospital (2024PHB097) and conducted in accordance with the Declaration of Helsinki. Data collection was performed by four trained nurses, including two master’s-prepared nurses and two bachelor’s-prepared nurses. Prior to enrollment, participants were fully informed of the study purpose, and written informed consent was obtained from all respondents. Questionnaires were distributed via one-on-one face-to-face interviews; participants completed the questionnaires independently after receiving detailed filling instructions, and all forms were collected on-site immediately upon completion. A total of 350 questionnaires were distributed, with 307 valid responses recovered, yielding an effective response rate of 87.71%. Strict confidentiality of all collected data was maintained throughout the study process. Statistical Analyses All data were managed using Microsoft Office Excel 2019 and analyzed with IBM SPSS Statistics 22.0. Analytical methods included descriptive statistics, independent samples t-tests, Pearson correlation analysis, and multiple linear regression. P <0.05 was considered statistically significant. Results Demographic and clinical characteristics of Children with Leukemia and Their Parents A total of 307 children with leukemia and their parents were included in this study. The mean age of the children was 14.29±1.29 years. Regarding education level, 38.4% had primary school education, and 66.1% were diagnosed with acute lymphoblastic leukemia. Disease risk stratification indicated 41.4% of patients were at intermediate risk. Among parents, 36.2% had attained junior college education or above, and 64.2% reported a monthly household income per capita exceeding 3,000 RMB. When assessing perceptions of PA benefits during treatment, 38.4% of parents demonstrated partial understanding, as shown in Table 1. The relationship between Physical activity levels, self-efficacy, and parental anxiety in children with leukemia The mean PA score of children with leukemia was 2.82 ± 2.31, corresponding to a low-to-moderate level. Specifically, 170 cases (55.38%) achieved a low-intensity score of 0~2, 107 cases (34.85%) a moderate-intensity score of 3~6, and 30 cases (9.77%) a high-intensity score of 7~9, Specific scores for individual questionnaire items are presented in Table 2. The total self-efficacy score of the pediatric leukemia patients was 17.55 ± 5.66, while the parental anxiety score reached 15.36 ± 3.59. Pearson correlation analysis revealed a significant positive correlation between self-efficacy and PA levels in these children ( r = 0.404, 95% CI[0.31,0.49], P < 0.01,Figure 1A). In contrast, a significant negative correlation was observed between parental anxiety scores and children’s PA levels ( r = -0.309, 95% CI[-0.41,-0.21], P < 0.01,Figure 1B). Factors Associated with Physical activity in Children with Leukemia Univariate analysis was performed to identify factors associated with PA levels in children with leukemia (Table 1). The results indicated that the following factors were statistically significant ( P <0.05): children's BMI, time since diagnosis, leukemia subtype, disease risk stratification, current treatment phase, daily screen time, children's attitudes toward PA, and their perception of exercise benefits, as well as parental education level, monthly household income, and parents' attitudes and perceived benefits regarding PA. Linear regression analysis of Physical activity levels in children with leukemia Multiple linear regression was employed to further identify factors influencing PA levels in children with leukemia. The PA score was used as the dependent variable, while 14 factors with statistical significance in the univariate analysis were included as independent variables. These comprised child-related factors (BMI, time since diagnosis, disease risk stratification, leukemia subtype, current treatment phase, perception of exercise benefits, daily electronic usage time, attitude toward PA during illness, and self-efficacy) and parent-related factors (the income per month (RMB) , education level, perception of exercise benefits, attitude toward PA during their child's illness, and anxiety). Dummy variables were created for multicategorical nominal variables, such as leukemia subtype(Table 4). Multicollinearity was assessed using tolerance and variance inflation factor (VIF). All independent variables showed tolerance values ranging from 0.53 to 0.93 (all >0.25) and VIF values between 1.08 and 1.89 (all <10.0), indicating no substantial multicollinearity. Moreover, child's self-efficacy,parental anxiety, duration of diagnosis, disease criticality,treatment duration, daily electronic usage time, parents' attitudes towards children's exercise during illness , education level, and the income per month (RMB) were found to be significant factors in the regression equation (Table 5). The F- test obtained F =27.0675, P <0.01, indicating that the fitted equation was significant. R 2 =0.551and adjusted R 2 =0.531, demonstrated that the eight independent variables explained 53.1% of the variance variability. Discussion To our knowledge, this is the first study to investigate PA levels in Chinese children with leukemia and to analyze their relationship with self-efficacy and parental anxiety. The findings presented herein not only deepen the understanding of PA characteristics in this pediatric population but also provide a theoretical foundation for the development of targeted interventions to enhance PA levels in future research and clinical practice. Children with leukemia exhibit low-to-moderate levels of PA, with a mean activity score of 2.82 ± 2.31. This phenomenon may be ascribed to the following factors. Rooted in traditional Chinese culture, the core philosophy of convalescence centers on physical rest, which holds that the body must conserve energy to combat pathogenic factors during illness; excessive physical exertion is believed to deplete vital qi and delay recovery[ 32 ]. This aligns with the findings of a prior study conducted in Hong Kong, China[ 22 ]. Such deeply ingrained parenting beliefs lead caregivers to perceive "minimal activity and maximal rest" as the optimal strategy for protecting children with leukemia. Consequently, parents tend to subconsciously restrict their children’s ambulation and outdoor activities, fearing that physical exertion may induce fatigue, trigger disease recurrence, or increase the risk of accidental injury[ 21 ].Furthermore, for families of children with leukemia, survival becomes the overriding priority, leading to the allocation of nearly all household resources toward medical treatment. Consequently, the potential benefits of PA are often overlooked, and investments in its promotion may even be deemed a non-essential expenditure[ 21 ]. This ultimately constrains the opportunities for children with leukemia to engage in PA. These findings underscore the necessity for healthcare providers in China to incorporate the culturally embedded family care model into the design of future interventions. The primary focus should be on dispelling parents’ ingrained adherence to the traditional notion that "rest ensures recovery" and re-establishing a family-based support and supervision framework to facilitate regular PA for these children. Previous research has shown that treatment-related adverse effects impair the PA of pediatric leukemia patients[ 22 , 33 ]. However, our data show that activity levels are dynamically influenced by the combination of treatment phase (which is closely related to time since diagnosis) and disease risk stratification, revealing unique associations. Time since diagnosis, which corresponds closely to treatment stage, directly affects physical tolerance. In the initial phase (coinciding with induction chemotherapy), the primary goal is rapid leukemic cell clearance. During rigorous chemotherapy, treatment-related toxicities (e.g., myelosuppression, tiredness, and infection) and disease load reduce physical tolerance and significantly limit mobility[ 34 ]. With the shift to remission or maintenance therapy, side effects decrease, and hematological and physical functions steadily improve [ 19 ][ 19 ], resulting in increased activity capacity and motivation to participate. Disease risk level further modulates activity levels by increasing physical burden and treatment intensity. Higher-risk cases are associated with greater tumor burden, more rapid disease progression, and more severe functional impairment. These children also require more intensive treatment regimens, which exacerbate side effects and elevate the risks of clinical instability and infection. Consequently, both patients and their caregivers exhibit heightened concerns regarding PA[ 10 ]. These findings indicate the importance of dynamic and customized exercise recommendations in clinical practice. For example, bed-based passive activities may be appropriate in the early stages of treatment, whereas light activities can be gradually introduced throughout remission. In addition, tiered risk management is critical. High-risk patients require careful safety assessment, with low-intensity activities introduced gradually after infection control and fatigue mitigation, to avoid both inappropriate restriction and overexertion. Our study identified that self-efficacy and daily screen time were significantly associated with PA participation among pediatric leukemia patients. Higher self-efficacy and shorter screen time were correlated with greater engagement in physical activities. This may be attributed to treatment-related physical decline and discomfort, which can lead to negative perceptions such as "inability to be active"[ 35 ]. Low self-efficacy directly reduces willingness to participate in physical activities. Meanwhile, excessive screen time not only displaces time that could be spent being active but also reinforces sedentary behavior, creating a vicious cycle of inactivity[ 36 ]. Additionally, some children may use digital devices to escape disease-related stress and pain, further reducing their motivation for PA. Future clinical interventions should focus on enhancing motivation through stepped activity programs that progress gradually and provide immediate feedback (e.g., sticker rewards, verbal praise, milestone cards) to improve engagement. Peer support and role modeling could also be incorporated to boost confidence and reduce feelings of isolation. Furthermore, family-based strategies are needed to establish healthy screen time limits and offer alternative activities, such as non-screen static activities (e.g., crafts) and dynamic activities (e.g., parent-child games, outdoor walks), to reduce reliance on digital devices while increasing the enjoyment of physical movement. This study found that higher levels of parental anxiety, lower perceived benefits of PA (PA) among parents, and lower household income were associated with reduced PA participation in children. This may be explained by excessive parental worry about disease risks and limited understanding of activity safety, which can diminish their motivation to encourage PA and even lead to overprotective restrictions due to fears of injury or clinical deterioration[ 37 – 38 ]. Furthermore, families with lower incomes face greater financial stress, often needing to dedicate more resources to medical expenses, which reduces the time and energy available to facilitate their child's participation in activities[ 21 ]. These findings suggest that healthcare providers should enhance health education for parents regarding the benefits of PA, using accessible formats such as brochures and short videos. Peer support programs could also be introduced to share caregiving experiences, promote scientifically informed attitudes, and alleviate psychological burdens. Additionally, hospitals could collaborate with community partners to offer low-cost or free activity opportunities and guidance services for economically disadvantaged families, thereby mitigating financial barriers to PA participation. Implications for clinical practice This study has three notable strengths. First, it is the first systematic study in China to look at PA levels and multidimensional variables in children with leukemia, bringing new insights into this population's activity patterns within the Chinese cultural context. Second, the study integrates child-level factors (e.g., self-efficacy) and family-level factors (e.g., parental anxiety) into a single analytical framework. It thereby clarifies how individual psychological traits and familial environmental conditions synergistically shape children’s PA behaviors, laying a solid theoretical foundation for the development of integrated "child–family–healthcare" intervention models. Third, the findings immediately identify key clinical goals (for example, increasing activity motivation, improving parental benefit perception, and controlling screen time), providing practical direction for focused therapies. Limitations This study has several limitations. First, the use of convenience sampling and recruitment from a single general hospital may limit the generalizability of the findings due to restricted sample representativeness. Second, the study included only leukemia patients aged 13–18 years, excluding younger children; thus, differences in PA determinants across age groups could not be fully explored. Third, as a cross-sectional investigation, this study cannot capture dynamic changes or stage-specific patterns in PA participation, nor can it establish causal relationships among variables. Finally, the reliance on self-reported questionnaires for assessing PA levels may introduce subjective reporting bias. Future research would benefit from multicenter collaborations with expanded, heterogeneous samples to improve generalizability. Longitudinal approaches that employ objective monitoring tools (e.g., pedometers, accelerometers) are also critical for capturing temporal dynamics in activity and disease progression, thereby informing more targeted and timely intervention strategies. Conclusion This is the first comprehensive study to analyze PA levels among children with leukemia in China, alongside the impacts of children’s self-efficacy and parental anxiety. The findings indicate that children’s PA levels are influenced by disease criticality, including disease-related characteristics (i.e., duration of diagnosis, risk stratification, treatment duration), children’s self-efficacy, daily electronic usage time, parental anxiety, income per month (RMB), and parents' attitudes towards children's exercise during illness. Consequently, healthcare interventions aimed at increasing PA should be tailored to the child's disease risk and treatment phase, utilizing personalized and progressive exercise prescriptions to enhance participation willingness and self-efficacy. Simultaneously, parental involvement is crucial; efforts should focus on improving their recognition of the benefits of PA and their supervisory skills, guiding them toward scientific caregiving practices to alleviate anxiety and reduce the child's screen time. For low-income families, additional resource support is essential to comprehensively promote the child's engagement in PA. Abbreviations PA Physical activity GSES General Self-Efficacy Scale VIF Variance Inflation Factor Declarations Acknowledgments We would like to thank all participants and researchers for their contributions to this work. Author contributions Yongli Wang: Conceptualization, Methodology, Data review, Writing-original draft, and Writing-Reviewing and Editing; Siyuan Tan: Methodology, Data review and Data analyses; Shunhang Xu: Data review and Data analyses, Writing-Reviewing; Dongmei Jia: Data collection and Writing– original draft; Hailing Yu: Conceptualization, Data review and Writing-Editing; Furong Hou: Data collection and Editing. Funding This research received financial support from the Scientific Research and Development Fund of Peking University People's Hospital (RDN2024-11) . Data availability The data that underpin the findings of this research are obtainable upon request from the corresponding author. Ethics approval and consent to participate This study was conducted following approval by the Ethics Committee of Peking University People's Hospital (2024PHB097) and strictly adhered to the principles of informed consent, confidentiality, and benefit for pediatric leukemia patients and their parents. Consent for publication Not applicable. Conflict of interest statement No conflict of interest has been declared by the authors. References Wu, Y. et al. Global, regional, and national childhood cancer burden, 1990–2019: An analysis based on the Global Burden of Disease Study 2019. J. ADV. RES. 40 , 233–247 (2022). Jia, F., Li, Y., Hao, T. & Ma, G. Epidemiology of acute myeloid leukemia in children and adolescents (1990–2021): a global burden of disease study. SCI. NAT-HEIDELBERG . 112 (6), 86 (2025). Center, N. C. T. S. National children's tumor surveillance report 2022 (Xinhua News Agency, 2023). Zeng, H. et al. 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Tables Table 1 Univariate Analysis of Physical Activity Scores in Children with Leukemia （ n=307 ） Variables Number Score (Mean±SD) t/F P Children with Leukemia Gender Female 86 3.03±2.20 1.015 0.311 Male 221 2.74±2.34 Ethnic Han 274 2.82±2.29 0.087 0.931 Others 33 2.79±2.43 BMI Underweight 68 1.79±1.83 18.337 ＜0.001 Normal Weight 151 3.62±244 Overweight 42 3.07±2.07 Obesity 46 1.50±1.34 Education level Primary School 118 2.82±2.24 1.852 0.138 Junior High School 107 3.11±2.48 Senior High School 20 1.85±1.87 Others 61 2.67±2.18 Living environment Urban 134 3.10±2.41 2.621 0.074 Rural 173 2.83±2.23 Duration of diagnosis ≤6months 91 2.15±1.86 9.178 ＜0.001 7 months -1year 70 2.24±2.03 1 year~ 94 3.44±2.66 2 years~ 523 3.65±2.13 Cancer Diagnosis Acute lymphoblastic leukemia 203 2.72±2.13 1.401 0.075 Acute myeloid leukemia 88 3.24±2.62 others 16 1.75±2.21 Disease criticality Low risk 30 4.10±2.83 8.087 ＜0.001 Medium risk 127 2.92±2.36 High risk 99 2.23±2.06 unknown 51 2.73±1.76 Treatment duration First treatment after onset of illness 54 2.66±2.43 12.272 ＜0.001 After the first treatment 123 2.26±1.95 Maintenance chemotherapy 125 2.74±2.38 Completed chemotherapy 41 4.02±1.97 Daily Electronic Usage Time ＜1h 25 5.44±2.50 18.902 ＜0.001 1-2h 69 3.74±2.56 2-3h 45 2.47±2.17 3-4h 98 2.40±1.79 ＞4h 70 1.80±1.64 Attitude Towards Physical Activity During Illness Supportive 78 1.53±1.47 -6.383 ＜0.001 Opposed 185 3.41±2.42 Perception of Physical Activity Benefits Weak perception 116 2.30±1.98 12.934 ＜0.001 Moderate perception 118 2.64±2.29 High perception 73 3.95±2.44 Parents of Leukemia Children Education level Primary school or less 28 2.75±2.77 2.977 0.020 Middle school 104 2.90±2.49 High school 64 2.20±1.87 College and Above 101 3.01±2.29 Income per month (RMB) ＜2000 37 1.95±1.47 13.830 ＜0.001 2000~ 73 1.93±1.78 5000~ 140 2.17+2.18 8000~ 57 4.03±1.92 Parents' Attitudes Towards Children's Exercise During Illness Supportive 83 1.93±1.94 -4.417 ＜0.001 Opposed 216 3.21±2.36 Parents' Perception of Physical Activity Benefits Low perception 91 2.58±2.23 7.725 ＜0.001 Moderate perception 130 2.45±2.07 High perception 86 3.63±2.53 Table 2 Physical Activity Score Status of Children with Leukemia (n=307) Score Description numbers Frequency % 0 No physical activity at all; spend most of your time sitting or sleeping 35 11.4 1 I rarely participate in light activities that last longer than 20minutes 92 30.0 2 I sometimes participate in light activities that last longer than 20minutes once or twice a month 43 14.0 3 I participate in light activities that last longer than 20minutes only once or twice every week 30 9.8 4 I participate in light activities that last longer than 20minutes for 3 times a week 24 7.8 5 I participate in light activities that last longer than 20minutes almost everyday 40 13.0 6 I participate in moderate activities that last longer than 20minutes once or twice a week 13 4.2 7 I participate in moderate activities that last longer than 20minutes 3-5 times a week 18 5.9 8 I participate in moderate activities that last longer than 20minutes almost everyday 10 3.3 9 I participate in vigorous activities that last longer than 20minutes 3 times or less weekly 2 0.7 10 I participate in vigorous activities that last longer than 20minutes almost everyday 0 0 Table 3 Correlation of Children with Leukemia's Physical Activity Scores with Self-Efficacy and Parental Anxiety Levels （ r ， n=307 ） Dimensions Self-Efficacy Parental Anxiety Physical Activity Scores 0.404** -0.309** ** P <0.01 Table 4 Description of the assignment of independent variables Assignment method BMI of Children with Leukemia 1=Underweight；2=Normal Weight；3=Overweight；4=Obesity Duration of diagnosis 1=≤6months； 2=7 months -1year； 3=1 year~；4=2 years~ Disease criticality 1=Low risk；2=Medium risk；3=High risk；4=unknown Treatment duration （1） （2） （3） （4） First treatment after onset of illness X1= 1 X2=0 X3=0 X4=0 After the first treatment X1= 0 X2=1 X3=0 X4=0 Maintenance chemotherapy X1= 0 X2=0 X3=1 X4=0 Completed chemotherapy X1= 0 X2=0 X3=0 X4=1 Other X1= 0 X2=0 X3=0 X4=0 Perception of Exercise Benefits (Children with Leukemia / Parents) 1=Weak perception；2=Moderate perception；3=High perception Daily Electronic Usage Time 1=0-1h; 2=1-2h; 3=2-3h; 4=3-4h; 5=＞4h Attitude Towards Physical Activity During Illness(Children with Leukemia / Parents) 1=Opposed；2=Supportive Income per month (RMB) 1=<2000；2=2000~；3=5000~；4=8000~ Parent’s Education level 1=Primary school or less；2=Middle school；3=Middle school；4=College and Above Child's Self-Efficacy Entered as the raw value Parental anxiety Entered as the raw value Treatment duration need to set dummy variables; h is the abbreviation for "hour". Table 5 Multiple Linear Regression of Factors Influencing Physical Activity Scores in Children with Leukemia （ n =307 ） Item B SE β 95% CI t p child's self-efficacy 0.088 0.017 0.217 (0.055;0.122) 5.163 <0.001 parental anxiety -0.091 0.026 -0.141 (-1.533;-0.717) -3.441 <0.001 duration of diagnosis .363 .095 .170 (0.176;0.549) 3.832 <0.001 disease criticality -.443 .109 -.169 (-0.657;-0.229) -4.070 <0.001 treatment duration .271 .090 .131 (0.094;0.447) 3.019 0.003 daily electronic usage time -.655 .078 -.364 (-0.808;-0.503) -8.449 <0.001 parents' attitudes towards children's exercise during illness .709 .147 .233 (0.420;0.999) 4.819 <0.001 income per month (RMB) .593 .107 .233 (0.382;0.805) 5.523 <0.001 Note: 8 predictor variables initially enter the regression model. R =0.742， R 2 =0.551，after adjustment R 2 =0.531， F =27.675， P <0.01 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8374392","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":635840667,"identity":"9176b547-77c0-49e0-a0b6-9726fe1439ad","order_by":0,"name":"Yongli Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYDADPmbmA4wNDAwJQLYBcVrYmNkSSNXCwGNAnBaD42cPv+apuGPXxs7z7eHMtjt5DOzN2yQYau7g1nImL82a58yz5DZm3u2GG9ueFTPwHCuTYDj2DKcWswM5Zsa8bYeT2Zh5t0k+bDuc2CCRYybB2HAYt5bzb2BaeJ5BtMi/IaDlRo7xY6AWO6AWNsmNYFt48Guxv/HGjHHOmcMJwEA2N5xx7lliG09asUXCMdxaJPtzjD+8qThsz89/+NnDnrI7if3shzfe+FCDWwsQsEnxMDAkNoCihoHhAJgExw4ewPzxB9CBDDAto2AUjIJRMArQAQAMalkOYoFcCQAAAABJRU5ErkJggg==","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yongli","middleName":"","lastName":"Wang","suffix":""},{"id":635840668,"identity":"482a66f1-4fa5-4b86-8d36-4fef06ab4ffa","order_by":1,"name":"Siyuan Tan","email":"","orcid":"","institution":"Nursing School of Peking University","correspondingAuthor":false,"prefix":"","firstName":"Siyuan","middleName":"","lastName":"Tan","suffix":""},{"id":635840669,"identity":"30b04fd0-e02d-4ab8-8baa-bc711664a415","order_by":2,"name":"Shunhang Xu","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shunhang","middleName":"","lastName":"Xu","suffix":""},{"id":635840670,"identity":"6ee485f7-dc40-406f-9b87-a3c5bcce599f","order_by":3,"name":"Dongmei Jia","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dongmei","middleName":"","lastName":"Jia","suffix":""},{"id":635840671,"identity":"86c1a6b5-3be1-4a3e-b35a-083cf028d53e","order_by":4,"name":"Hailing Yu","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hailing","middleName":"","lastName":"Yu","suffix":""},{"id":635840673,"identity":"d47b9475-6c2a-4c16-8536-061d2e23c321","order_by":5,"name":"Furong Hou","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Furong","middleName":"","lastName":"Hou","suffix":""}],"badges":[],"createdAt":"2025-12-16 09:38:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8374392/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8374392/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109153452,"identity":"b1a2f84a-cf23-4de5-ae87-49c152bf9798","added_by":"auto","created_at":"2026-05-13 06:17:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":229561,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation analysis of the physical activity score and other factors. (A) Correlation analysis of Physical activity and Children’s Self-efficacy; (B) correlation analysis of Physical activity and Parental Anxiety\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8374392/v1/c6f9bdd9d8217111ba33c9ce.png"},{"id":109205265,"identity":"a4d83d7f-d0b4-4d46-90fb-0748cdaba629","added_by":"auto","created_at":"2026-05-13 15:03:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":606761,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8374392/v1/a0c6f0e0-d95e-4f8a-a03b-3e7f2e425da3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Interactions among Physical activity Levels, Self-Efficacy, and Parental Anxiety in Children with Leukemia in China: a Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe Global Burden of Childhood Cancer Report indicates that leukemia accounts for approximately 30% of all pediatric malignancies[1-2]. According to China\u0026rsquo;s National Childhood Cancer Surveillance Annual Report (2022)[3], leukemia ranked first among newly diagnosed childhood cancers during 2019\u0026ndash;2020, with a prevalence of 32.89%. These findings underscore leukemia\u0026apos;s significant clinical and public health burden as a leading threat to child health.\u003c/p\u003e\n\u003cp\u003eAlthough the 5-year survival rate for pediatric leukemia patients in China has reached 72%[4], the disease has a significant and long-term treatment burden[5]. During treatment, these children develop a variety of long-term chronic health problems, including physical complications such as decreased PA, osteoporosis, impaired cardiopulmonary function, and metabolic changes[6-7]; psychosocial problems such as anxiety, depression, and cancer-related fatigue[8]; and late-onset cardiovascular diseases such as cardiomyopathy and heart failure[9-10]. These issues significantly impede post-treatment growth, development, and social reintegration, jeopardizing overall health and quality of life. According to studies, pediatric leukemia survivors are seven times more likely to die from cardiovascular problems in later life than their healthy counterparts[11].\u003c/p\u003e\n\u003cp\u003eResearch suggests that regular PA helps improve motor function and cardiorespiratory fitness in juvenile cancer patients. Exercising has also been proven to considerably lower all-cause mortality, recurrence rates, and the prevalence of long-term chronic health problems [12]. PA is defined as any physiological action produced by skeletal muscles that needs energy expenditure[13]. It enhances cardiopulmonary function and physical capacity through a variety of biological mechanisms. These benefits help to reduce physical dysfunction, shorten hospital stays, and improve long-term quality of life [14-15].\u003c/p\u003e\n\u003cp\u003eStudies in pediatric oncology have demonstrated the beneficial effects of structured exercise (e.g., aerobic and resistance training) on quality of life[16-17]. These studies have also identified multiple factors influencing PA (PA) levels in pediatric cancer patients. Such factors include hospital isolation and hygiene policies, length of hospital stay, and disease-related side effects (e.g., cancer-related fatigue, pain)[18]. Additional influencing factors are children\u0026rsquo;s screen time[19] self-efficacy[20], as well as parental support, and supervision[21]. However, research focusing specifically on PA in children with leukemia remains limited. Although a study from Hong Kong, China, has examined PA patterns in pediatric hematological malignancies [22], there is a notable lack of data on daily PA levels and associated correlates among children with leukemia in mainland China, particularly regarding the interrelationships between self-efficacy (individual factor), parental anxiety (family-level factor), and PA.\u003c/p\u003e\n\u003cp\u003eTherefore, this study aims to (1) evaluate the current status of PA among children with leukemia; (2) explore the interrelationships among parental anxiety, children\u0026apos;s self-efficacy, and their PA levels, and (3) identify factors influencing PA to provide a basis for developing targeted interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eSetting, Study Population, and Sample Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was conducted at a large general hospital in Beijing between February and October 2024. Potential participants were recruited from the pediatric ward using a convenience sampling method. Inclusion criteria were as follows: (1) age between 13 and 18 years; (2) diagnosis of leukemia confirmed by cytomorphology, immunophenotyping, cytogenetics, and histochemical staining; (3) time since diagnosis \u0026ge;1 month; (4) medically stable with no contraindications for PA, as certified by a physician; (5) adequate communication skills to express personal views and preferences; and (6) provision of informed consent by a legal guardian. Exclusion criteria included the presence of severe organic brain syndrome or psychiatric disorders that could impair cognitive function.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size and calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure adequate statistical power, the sample size was calculated using G*Power 3.1 software for the multiple regression analysis. The parameters were set as follows: power at 0.80 [23], \u0026alpha; = 0.05, and a moderate effect size of 0.15[24]. With 23 predictor variables included in the model and an estimated 20% attrition rate for invalid questionnaires, a minimum sample size of 200 participants was required. Ultimately, 307 children with leukemia were enrolled in this study. A total of 307 children with leukemia were enrolled, with a mean age of 14.29\u0026plusmn;1.29 years. Among them, 43.6% resided in towns and 56.4% in urban areas\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral information Questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire was developed by the research team based on a review of relevant literature. It consisted of two sections: (1) Children\u0026rsquo;s general and disease-related characteristics, including demographic information (e.g., gender, age, and education level), leukemia subtype, time since diagnosis, disease risk stratification, treatment phase, and daily screen time. (2) Parent-related information, including parental education level, attitudes toward PA during the child\u0026rsquo;s treatment, and perceived benefits of exercise.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Chinese university of Hong Kong: Physical activity rating for children and youth, CUHK-PARCY\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CUHK-PARCY was adapted from the Jackson Activity Coding[24] and Godin-Shephard Youth Activity Questionnaire [26]. It is an 11-point (0\u0026ndash;10) rating scale that quantifies PA levels, with scores ranging from 0 (no PA) to 10 (vigorous exercise on most days). Scores of 0\u0026ndash;2, 3\u0026ndash;6, and 7\u0026ndash;10 denote low, moderate, and high activity levels, respectively. Previously validated in studies on Chinese children in Hong Kong\u0026nbsp;\u003csup\u003e[22,27]\u003c/sup\u003e, the scale exhibits good content validity (content validity index=90%) and test-retest reliability (r=0.86). Its Cronbach\u0026rsquo;s \u0026alpha; coefficient in this study was 0.82.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral Self-Efficacy Scale, GSES\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe GSES was originally developed by Schwarzer et al. in 1981 [28]. The initial 20-item version was later refined into a widely used 10-item scale. The Chinese version of the GSES, validated by Wang et al. in 2001 [29], demonstrated good reliability, with a Cronbach\u0026apos;s alpha of 0.87, a test-retest reliability of 0.83 (p \u0026lt; 0.001), and a split-half reliability of 0.82 (p \u0026lt; 0.001), indicating strong psychometric properties and predictive validity. The scale uses a 4-point Likert format, ranging from 1 (\u0026ldquo;not at all true\u0026rdquo;) to 4 (\u0026ldquo;exactly true\u0026rdquo;). Total scores range from 10 to 40, with higher scores indicating greater self-efficacy. Scores are interpreted as follows: 1\u0026ndash;10 (\u0026ldquo;very low\u0026rdquo;), 11\u0026ndash;20 (\u0026ldquo;low\u0026rdquo;), 21\u0026ndash;30 (\u0026ldquo;high\u0026rdquo;), and 31\u0026ndash;40 (\u0026ldquo;very high\u0026rdquo;). In the present study, the overall Cronbach\u0026apos;s alpha for the GSES was 0.740, while subscale coefficients ranged from 0.813 to 0.874.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHospital Anxiety and Depression Scale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Hospital Anxiety and Depression Scale, originally developed by Zigmond \u0026nbsp;in 1983 [30], consists of two subscales designed to screen for symptoms of anxiety and depression. The Chinese version, adapted by Ye et al. in 1993[31], comprises 14 items\u0026mdash;seven for anxiety and seven for depression\u0026mdash;each rated on a 4-point Likert scale (0~3), with higher scores indicating greater symptom severity. Owing to its well-established psychometric properties, the anxiety subscale was employed in this study to assess anxiety levels among parents of children with leukemia. In the present sample, the anxiety subscale demonstrated good internal consistency, with a Cronbach\u0026apos;s alpha of 0.799.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Peking University People\u0026rsquo;s Hospital (2024PHB097) and conducted in accordance with the Declaration of Helsinki. Data collection was performed by four trained nurses, including two master\u0026rsquo;s-prepared nurses and two bachelor\u0026rsquo;s-prepared nurses. Prior to enrollment, participants were fully informed of the study purpose, and written informed consent was obtained from all respondents. Questionnaires were distributed via one-on-one face-to-face interviews; participants completed the questionnaires independently after receiving detailed filling instructions, and all forms were collected on-site immediately upon completion. A total of 350 questionnaires were distributed, with 307 valid responses recovered, yielding an effective response rate of 87.71%. Strict confidentiality of all collected data was maintained throughout the study process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data were managed using Microsoft Office Excel 2019 and analyzed with IBM SPSS Statistics 22.0. Analytical methods included descriptive statistics, independent samples t-tests, Pearson correlation analysis, and multiple linear regression. \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic and clinical characteristics of Children with Leukemia and Their Parents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 307 children with leukemia and their parents were included in this study. The mean age of the children was 14.29\u0026plusmn;1.29 years. Regarding education level, 38.4% had primary school education, and 66.1% were diagnosed with acute lymphoblastic leukemia. Disease risk stratification indicated 41.4% of patients were at intermediate risk. Among parents, 36.2% had attained junior college education or above, and 64.2% reported a monthly household income per capita exceeding 3,000 RMB. When assessing perceptions of PA benefits during treatment, 38.4% of parents demonstrated partial understanding, as shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe relationship between Physical activity levels, self-efficacy, and parental anxiety in children with leukemia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean PA score of children with leukemia was 2.82 \u0026plusmn; 2.31, corresponding to a low-to-moderate level. Specifically, 170 cases (55.38%) achieved a low-intensity score of 0~2, 107 cases (34.85%) a moderate-intensity score of 3~6, and 30 cases (9.77%) a high-intensity score of 7~9, Specific scores for individual questionnaire items are presented in Table 2.\u003c/p\u003e\n\u003cp\u003eThe total self-efficacy score of the pediatric leukemia patients was 17.55 \u0026plusmn; 5.66, while the parental anxiety score reached 15.36 \u0026plusmn; 3.59. Pearson correlation analysis revealed a significant positive correlation between self-efficacy and PA levels in these children (\u003cem\u003er\u0026nbsp;\u003c/em\u003e= 0.404, 95% CI[0.31,0.49],\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.01,Figure 1A). In contrast, a significant negative correlation was observed between parental anxiety scores and children\u0026rsquo;s PA levels (\u003cem\u003er\u003c/em\u003e = -0.309,\u0026nbsp;95% CI[-0.41,-0.21],\u0026nbsp;\u003cem\u003eP \u0026lt;\u003c/em\u003e0.01,Figure 1B).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors Associated with Physical activity in Children with Leukemia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate analysis was performed to identify factors associated with PA levels in children with leukemia (Table 1). The results indicated that the following factors were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05): children\u0026apos;s BMI, time since diagnosis, leukemia subtype, disease risk stratification, current treatment phase, daily screen time, children\u0026apos;s attitudes toward PA, and their perception of exercise benefits, as well as parental education level, monthly household income, and parents\u0026apos; attitudes and perceived benefits regarding PA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLinear regression analysis of Physical activity levels in children with leukemia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultiple linear regression was employed to further identify factors influencing PA levels in children with leukemia. The PA score was used as the dependent variable, while 14 factors with statistical significance in the univariate analysis were included as independent variables. These comprised child-related factors (BMI, time since diagnosis, disease risk stratification, leukemia subtype, current treatment phase, perception of exercise benefits, daily electronic usage time, attitude toward PA during illness, and self-efficacy) and parent-related factors (the income per month (RMB) , education level, perception of exercise benefits, attitude toward PA during their child\u0026apos;s illness, and anxiety). Dummy variables were created for multicategorical nominal variables, such as leukemia subtype(Table 4).\u003c/p\u003e\n\u003cp\u003eMulticollinearity was assessed using tolerance and variance inflation factor (VIF). All independent variables showed tolerance values ranging from 0.53 to 0.93 (all \u0026gt;0.25) and VIF values between 1.08 and 1.89 (all \u0026lt;10.0), indicating no substantial multicollinearity. Moreover, child\u0026apos;s self-efficacy,parental anxiety, duration of diagnosis, disease criticality,treatment duration, daily electronic usage time, parents\u0026apos; attitudes towards children\u0026apos;s exercise during illness , education level, and the income per month (RMB) were found to be significant factors in the regression equation (Table 5). The\u003cem\u003e\u0026nbsp;F-\u003c/em\u003etest obtained \u003cem\u003eF\u003c/em\u003e=27.0675, \u003cem\u003eP\u003c/em\u003e \u0026lt;0.01, indicating that the fitted equation was significant. \u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=0.551and adjusted \u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=0.531, demonstrated that the eight independent variables explained 53.1% of the variance variability.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this is the first study to investigate PA levels in Chinese children with leukemia and to analyze their relationship with self-efficacy and parental anxiety. The findings presented herein not only deepen the understanding of PA characteristics in this pediatric population but also provide a theoretical foundation for the development of targeted interventions to enhance PA levels in future research and clinical practice.\u003c/p\u003e \u003cp\u003eChildren with leukemia exhibit low-to-moderate levels of PA, with a mean activity score of 2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31. This phenomenon may be ascribed to the following factors. Rooted in traditional Chinese culture, the core philosophy of convalescence centers on physical rest, which holds that the body must conserve energy to combat pathogenic factors during illness; excessive physical exertion is believed to deplete vital qi and delay recovery[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This aligns with the findings of a prior study conducted in Hong Kong, China[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Such deeply ingrained parenting beliefs lead caregivers to perceive \"minimal activity and maximal rest\" as the optimal strategy for protecting children with leukemia. Consequently, parents tend to subconsciously restrict their children\u0026rsquo;s ambulation and outdoor activities, fearing that physical exertion may induce fatigue, trigger disease recurrence, or increase the risk of accidental injury[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].Furthermore, for families of children with leukemia, survival becomes the overriding priority, leading to the allocation of nearly all household resources toward medical treatment. Consequently, the potential benefits of PA are often overlooked, and investments in its promotion may even be deemed a non-essential expenditure[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This ultimately constrains the opportunities for children with leukemia to engage in PA. These findings underscore the necessity for healthcare providers in China to incorporate the culturally embedded family care model into the design of future interventions. The primary focus should be on dispelling parents\u0026rsquo; ingrained adherence to the traditional notion that \"rest ensures recovery\" and re-establishing a family-based support and supervision framework to facilitate regular PA for these children.\u003c/p\u003e \u003cp\u003ePrevious research has shown that treatment-related adverse effects impair the PA of pediatric leukemia patients[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, our data show that activity levels are dynamically influenced by the combination of treatment phase (which is closely related to time since diagnosis) and disease risk stratification, revealing unique associations. Time since diagnosis, which corresponds closely to treatment stage, directly affects physical tolerance. In the initial phase (coinciding with induction chemotherapy), the primary goal is rapid leukemic cell clearance. During rigorous chemotherapy, treatment-related toxicities (e.g., myelosuppression, tiredness, and infection) and disease load reduce physical tolerance and significantly limit mobility[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. With the shift to remission or maintenance therapy, side effects decrease, and hematological and physical functions steadily improve [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e][\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], resulting in increased activity capacity and motivation to participate.\u003c/p\u003e \u003cp\u003eDisease risk level further modulates activity levels by increasing physical burden and treatment intensity. Higher-risk cases are associated with greater tumor burden, more rapid disease progression, and more severe functional impairment. These children also require more intensive treatment regimens, which exacerbate side effects and elevate the risks of clinical instability and infection. Consequently, both patients and their caregivers exhibit heightened concerns regarding PA[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These findings indicate the importance of dynamic and customized exercise recommendations in clinical practice. For example, bed-based passive activities may be appropriate in the early stages of treatment, whereas light activities can be gradually introduced throughout remission. In addition, tiered risk management is critical. High-risk patients require careful safety assessment, with low-intensity activities introduced gradually after infection control and fatigue mitigation, to avoid both inappropriate restriction and overexertion.\u003c/p\u003e \u003cp\u003eOur study identified that self-efficacy and daily screen time were significantly associated with PA participation among pediatric leukemia patients. Higher self-efficacy and shorter screen time were correlated with greater engagement in physical activities. This may be attributed to treatment-related physical decline and discomfort, which can lead to negative perceptions such as \"inability to be active\"[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Low self-efficacy directly reduces willingness to participate in physical activities. Meanwhile, excessive screen time not only displaces time that could be spent being active but also reinforces sedentary behavior, creating a vicious cycle of inactivity[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Additionally, some children may use digital devices to escape disease-related stress and pain, further reducing their motivation for PA. Future clinical interventions should focus on enhancing motivation through stepped activity programs that progress gradually and provide immediate feedback (e.g., sticker rewards, verbal praise, milestone cards) to improve engagement. Peer support and role modeling could also be incorporated to boost confidence and reduce feelings of isolation. Furthermore, family-based strategies are needed to establish healthy screen time limits and offer alternative activities, such as non-screen static activities (e.g., crafts) and dynamic activities (e.g., parent-child games, outdoor walks), to reduce reliance on digital devices while increasing the enjoyment of physical movement.\u003c/p\u003e \u003cp\u003eThis study found that higher levels of parental anxiety, lower perceived benefits of PA (PA) among parents, and lower household income were associated with reduced PA participation in children. This may be explained by excessive parental worry about disease risks and limited understanding of activity safety, which can diminish their motivation to encourage PA and even lead to overprotective restrictions due to fears of injury or clinical deterioration[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Furthermore, families with lower incomes face greater financial stress, often needing to dedicate more resources to medical expenses, which reduces the time and energy available to facilitate their child's participation in activities[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These findings suggest that healthcare providers should enhance health education for parents regarding the benefits of PA, using accessible formats such as brochures and short videos. Peer support programs could also be introduced to share caregiving experiences, promote scientifically informed attitudes, and alleviate psychological burdens. Additionally, hospitals could collaborate with community partners to offer low-cost or free activity opportunities and guidance services for economically disadvantaged families, thereby mitigating financial barriers to PA participation.\u003c/p\u003e\n\u003ch3\u003eImplications for clinical practice\u003c/h3\u003e\n\u003cp\u003eThis study has three notable strengths. First, it is the first systematic study in China to look at PA levels and multidimensional variables in children with leukemia, bringing new insights into this population's activity patterns within the Chinese cultural context. Second, the study integrates child-level factors (e.g., self-efficacy) and family-level factors (e.g., parental anxiety) into a single analytical framework. It thereby clarifies how individual psychological traits and familial environmental conditions synergistically shape children\u0026rsquo;s PA behaviors, laying a solid theoretical foundation for the development of integrated \"child\u0026ndash;family\u0026ndash;healthcare\" intervention models. Third, the findings immediately identify key clinical goals (for example, increasing activity motivation, improving parental benefit perception, and controlling screen time), providing practical direction for focused therapies.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. First, the use of convenience sampling and recruitment from a single general hospital may limit the generalizability of the findings due to restricted sample representativeness. Second, the study included only leukemia patients aged 13\u0026ndash;18 years, excluding younger children; thus, differences in PA determinants across age groups could not be fully explored. Third, as a cross-sectional investigation, this study cannot capture dynamic changes or stage-specific patterns in PA participation, nor can it establish causal relationships among variables. Finally, the reliance on self-reported questionnaires for assessing PA levels may introduce subjective reporting bias. Future research would benefit from multicenter collaborations with expanded, heterogeneous samples to improve generalizability. Longitudinal approaches that employ objective monitoring tools (e.g., pedometers, accelerometers) are also critical for capturing temporal dynamics in activity and disease progression, thereby informing more targeted and timely intervention strategies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis is the first comprehensive study to analyze PA levels among children with leukemia in China, alongside the impacts of children\u0026rsquo;s self-efficacy and parental anxiety. The findings indicate that children\u0026rsquo;s PA levels are influenced by disease criticality, including disease-related characteristics (i.e., duration of diagnosis, risk stratification, treatment duration), children\u0026rsquo;s self-efficacy, daily electronic usage time, parental anxiety, income per month (RMB), and parents' attitudes towards children's exercise during illness. Consequently, healthcare interventions aimed at increasing PA should be tailored to the child's disease risk and treatment phase, utilizing personalized and progressive exercise prescriptions to enhance participation willingness and self-efficacy. Simultaneously, parental involvement is crucial; efforts should focus on improving their recognition of the benefits of PA and their supervisory skills, guiding them toward scientific caregiving practices to alleviate anxiety and reduce the child's screen time. For low-income families, additional resource support is essential to comprehensively promote the child's engagement in PA.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cp\u003ePA Physical activity\u003c/p\u003e \u003cp\u003eGSES General Self-Efficacy Scale\u003c/p\u003e \u003cp\u003eVIF Variance Inflation Factor\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all participants and researchers for their contributions to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYongli Wang: Conceptualization, Methodology, Data review, Writing-original draft, and Writing-Reviewing and Editing; Siyuan Tan: Methodology, Data review and Data analyses; Shunhang Xu: Data review and Data analyses, Writing-Reviewing; Dongmei Jia: Data collection and Writing\u0026ndash; original draft; Hailing Yu: Conceptualization, Data review and Writing-Editing; Furong Hou: Data collection and Editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received financial support from the Scientific Research and Development Fund of Peking University People\u0026apos;s Hospital (RDN2024-11) .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that underpin the findings of this research are obtainable upon request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted following approval by the Ethics Committee of Peking University People\u0026apos;s Hospital (2024PHB097) and strictly adhered to the principles of informed consent, confidentiality, and benefit for pediatric leukemia patients and their parents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflict of interest has been declared by the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWu, Y. et al. 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The assessment of optimistic self-beliefs: Comparison of the Chinese, Indonesian, Japanese, and Korean versions of the general self-efficacy scale. \u003cem\u003ePsycholocia\u003c/em\u003e \u003cb\u003e40\u003c/b\u003e (5), 69\u0026ndash;88 (1997).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, C., Hu, Z. \u0026amp; Liu, T. Evidences for reliability and validity of the chinese version of general self-efficacy scale. \u003cem\u003eChin. J. Appl. Psychol.\u003c/em\u003e \u003cb\u003e1\u003c/b\u003e (01), 37\u0026ndash;40 (2001).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZigmond, A. S. \u0026amp; Snaith, R. P. The Hospital Anxiety and Depression Scale. \u003cem\u003eACTA PSYCHIAT SCAND.\u003c/em\u003e \u003cb\u003e67\u003c/b\u003e (6), 361\u0026ndash;370 (1983).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYe, W. \u0026amp; Xu, J. Application and evaluation of the general hospital anxiety and depression scale in general hospital patients. \u003cem\u003eChin. J. Behav. Med.\u003c/em\u003e \u003cb\u003e3\u003c/b\u003e (2), 17\u0026ndash;19 (1993).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, G., He, Z., Li, C., Yuan, R. \u0026amp; Hua, B. Construction on'tumor yin-yang qi transformation'model based on Huangdi Neijing and exploration on the academic implications of the method of regulating qi and detoxification. \u003cem\u003eChina J. Traditional Chin. Med. Pharm.\u003c/em\u003e \u003cb\u003e39\u003c/b\u003e (6), 2757\u0026ndash;2763 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHooke, M. C. et al. PA, the Childhood Cancer Symptom Cluster-Leukemia, and Cognitive Function: A Longitudinal Mediation Analysis. \u003cem\u003eCANCER NURS.\u003c/em\u003e \u003cb\u003e41\u003c/b\u003e (6), 434\u0026ndash;440 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu, W. W., Tang, C. C., Jou, S. T. \u0026amp; Yu, T. H. Associations Between Fatigue, Sleep Disturbance, PA, and Quality of Life for Children With Cancer: A Correlational Study. \u003cem\u003eCANCER NURS.\u003c/em\u003e \u003cb\u003e45\u003c/b\u003e (6), 421\u0026ndash;429 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetersen, N. N. et al. Childhood cancer survivors' and their parents' experiences with participation in a physical and social intervention during cancer treatment: A RESPECT study. \u003cem\u003eJ. ADV. NURS.\u003c/em\u003e \u003cb\u003e78\u003c/b\u003e (11), 3806\u0026ndash;3816 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang, Y. et al. PA Levels and Factors Affecting Them in Hospitalized Children With Leukemia. \u003cem\u003eCANCER NURS.\u003c/em\u003e \u003cb\u003e48\u003c/b\u003e (6), E371\u0026ndash;E375 (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, Y., Xu, S., Yu, H., Liang, Y. \u0026amp; Jia, D. Interactions among dyadic coping, self-efficacy, and negative emotions in Chinese parents of children with leukemia. \u003cem\u003eBMC PSYCHOL.\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e (1), 198 (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu, Y. et al. Parents' perceptions of PA for their children with cancer: a qualitative meta-synthesis. \u003cem\u003eFRONT. PEDIATR.\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e, 1402516 (2025).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Univariate Analysis of Physical Activity Scores in Children with Leukemia\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=307\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"548\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore (Mean\u0026plusmn;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et/F\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChildren with Leukemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.03\u0026plusmn;2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.74\u0026plusmn;2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eHan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.82\u0026plusmn;2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.931\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eOthers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.79\u0026plusmn;2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.79\u0026plusmn;1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e18.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eNormal Weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.62\u0026plusmn;244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.07\u0026plusmn;2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.50\u0026plusmn;1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003ePrimary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.82\u0026plusmn;2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eJunior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.11\u0026plusmn;2.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eSenior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.85\u0026plusmn;1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.67\u0026plusmn;2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiving environment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.10\u0026plusmn;2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2.621\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;Rural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.83\u0026plusmn;2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026le;6months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.15\u0026plusmn;1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e9.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e7 months -1year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.24\u0026plusmn;2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e1 year~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.44\u0026plusmn;2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e2 years~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.65\u0026plusmn;2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eAcute lymphoblastic leukemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.72\u0026plusmn;2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eAcute myeloid leukemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.24\u0026plusmn;2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eothers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.75\u0026plusmn;2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisease criticality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eLow risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.10\u0026plusmn;2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e8.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eMedium risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.92\u0026plusmn;2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eHigh risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.23\u0026plusmn;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eunknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.73\u0026plusmn;1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eFirst treatment after onset of illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.66\u0026plusmn;2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e12.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eAfter the first treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.26\u0026plusmn;1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eMaintenance chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.74\u0026plusmn;2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eCompleted chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.02\u0026plusmn;1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDaily Electronic Usage Time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e＜1h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5.44\u0026plusmn;2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e18.902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e1-2h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.74\u0026plusmn;2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e2-3h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.47\u0026plusmn;2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e3-4h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.40\u0026plusmn;1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e＞4h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.80\u0026plusmn;1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttitude Towards Physical Activity During Illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eSupportive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.53\u0026plusmn;1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-6.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eOpposed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.41\u0026plusmn;2.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerception of Physical Activity Benefits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eWeak perception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.30\u0026plusmn;1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e12.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eModerate perception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.64\u0026plusmn;2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eHigh perception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.95\u0026plusmn;2.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParents of Leukemia Children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003ePrimary school or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.75\u0026plusmn;2.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.90\u0026plusmn;2.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.20\u0026plusmn;1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eCollege and Above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.01\u0026plusmn;2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome per month (RMB)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e＜2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.95\u0026plusmn;1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e13.830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e2000~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.93\u0026plusmn;1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e5000~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.17+2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e8000~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.03\u0026plusmn;1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParents\u0026apos; Attitudes Towards Children\u0026apos;s Exercise During Illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eSupportive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.93\u0026plusmn;1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-4.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eOpposed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.21\u0026plusmn;2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParents\u0026apos; Perception of Physical Activity Benefits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eLow perception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.58\u0026plusmn;2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e7.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eModerate perception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.45\u0026plusmn;2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eHigh perception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.63\u0026plusmn;2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eTable 2 Physical Activity Score Status of Children with Leukemia (n=307)\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"685\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eScore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 471px;\"\u003e\n \u003cp\u003eDescription\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003enumbers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eFrequency %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eNo physical activity at all; spend most of your time sitting or sleeping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eI rarely participate in light activities that last longer than 20minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eI sometimes participate in light activities that last longer than 20minutes once or twice a month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eI participate in light activities that last longer than 20minutes only once or twice every week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eI participate in light activities that last longer than 20minutes for 3 times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eI participate in light activities that last longer than 20minutes almost everyday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eI participate in moderate activities that last longer than 20minutes once or twice a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eI participate in moderate activities that last longer than 20minutes 3-5 times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eI participate in moderate activities that last longer than 20minutes almost everyday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eI participate in vigorous activities that last longer than 20minutes 3 times or less weekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eI participate in vigorous activities that last longer than 20minutes almost everyday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 471px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCorrelation of Children with Leukemia\u0026apos;s Physical Activity Scores with Self-Efficacy and Parental Anxiety Levels\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003er\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e，\u003c/strong\u003e\u003cstrong\u003en=307\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"95%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eDimensions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eSelf-Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eParental Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;Physical Activity Scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e0.404**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e-0.309**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e**\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 \u0026nbsp; Description of the assignment of independent variables\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssignment method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eBMI of Children with Leukemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003e1=Underweight；2=Normal Weight；3=Overweight；4=Obesity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eDuration of diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003e1=\u0026le;6months；\u0026nbsp;2=7\u0026nbsp;months -1year；\u0026nbsp;3=1 year~；4=2\u0026nbsp;years~\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eDisease criticality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003e1=Low risk；2=Medium risk；3=High risk；4=unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eTreatment duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003e（1）\u0026nbsp; \u0026nbsp;\u0026nbsp;（2）\u0026nbsp; \u0026nbsp;\u0026nbsp;（3）\u0026nbsp; \u0026nbsp;\u0026nbsp;（4）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eFirst treatment after onset of illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003eX1= 1 \u0026nbsp; \u0026nbsp; X2=0 \u0026nbsp; \u0026nbsp; \u0026nbsp; X3=0 \u0026nbsp; \u0026nbsp; X4=0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eAfter the first treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003eX1= 0 \u0026nbsp; \u0026nbsp; X2=1 \u0026nbsp; \u0026nbsp; \u0026nbsp; X3=0 \u0026nbsp; \u0026nbsp; X4=0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eMaintenance chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003eX1= 0 \u0026nbsp; \u0026nbsp; X2=0 \u0026nbsp; \u0026nbsp; \u0026nbsp; X3=1 \u0026nbsp; \u0026nbsp; X4=0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eCompleted chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003eX1= 0 \u0026nbsp; \u0026nbsp; X2=0 \u0026nbsp; \u0026nbsp; \u0026nbsp; X3=0 \u0026nbsp; \u0026nbsp; X4=1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003eX1= 0 \u0026nbsp; \u0026nbsp; X2=0 \u0026nbsp; \u0026nbsp; \u0026nbsp; X3=0 \u0026nbsp; \u0026nbsp; X4=0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePerception of Exercise Benefits (Children with Leukemia / Parents)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003e1=Weak perception；2=Moderate perception；3=High perception\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eDaily Electronic Usage Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003e1=0-1h; 2=1-2h; 3=2-3h; 4=3-4h; 5=＞4h\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eAttitude Towards Physical Activity During Illness(Children with Leukemia / Parents)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003e1=Opposed；2=Supportive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eIncome per month (RMB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003e1=\u0026lt;2000；2=2000~；3=5000~；4=8000~\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eParent\u0026rsquo;s Education level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003e1=Primary school or less；2=Middle school；3=Middle school；4=College and Above\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eChild\u0026apos;s Self-Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003eEntered as the raw value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eParental anxiety\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 394px;\"\u003e\n \u003cp\u003eEntered as the raw value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTreatment duration\u0026nbsp;need to set dummy variables; h is the abbreviation for \u0026quot;hour\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp id=\"_Toc37687804\"\u003e\u003cstrong\u003eTable 5 Multiple Linear Regression of Factors Influencing Physical Activity Scores in Children with Leukemia\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e=307\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e95%\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003echild\u0026apos;s self-efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e(0.055;0.122)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eparental anxiety\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e(-1.533;-0.717)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-3.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eduration of diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e(0.176;0.549)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003edisease criticality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e(-0.657;-0.229)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-4.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003etreatment duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e.271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e(0.094;0.447)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003edaily electronic usage time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-.655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e(-0.808;-0.503)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-8.449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eparents\u0026apos; attitudes towards children\u0026apos;s exercise during illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e(0.420;0.999)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e4.819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eincome per month (RMB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e(0.382;0.805)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e5.523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: 8 predictor variables initially enter the regression model.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eR\u003c/em\u003e=0.742，\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e=0.551，after adjustment \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e=0.531，\u003cem\u003eF\u003c/em\u003e=27.675，\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Physical activity, Leukemia, Hematologic Cancer, Pediatric, Self-Efficacy, cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-8374392/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8374392/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe quality of life of children with leukemia is often significantly compromised by the disease and its treatment. Evidence suggests that appropriate physical activity (PA)can improve the well-being of pediatric cancer patients. However, data on physical activity levels and influencing factors among children with leukemia in China remain scarce. This study aims to examine the relationship between physical activity levels, self-efficacy, and parental anxiety in this population, and to identify key factors influencing physical activity , so as to inform targeted intervention strategies and optimize health management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study was conducted with 307 child–parent dyads recruited through convenience sampling from the pediatric hematology ward of Peking University People’s Hospital. Data were collected using general information questionnaires, the Chinese university of Hong Kong:Physical activity rating for children and youth, general self-efficacy scale, and the Hospital Anxiety and Depression Scale. SPSS 23.0 was used for statistical analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe mean age of the children was 14.29±1.29 years. The average physical activity score was 2.82±2.31, indicating a low to moderate activity level. Self-efficacy scores averaged 17.55±5.66, while parental anxiety scores averaged 15.36±3.59. physical activity was positively correlated with self-efficacy (\u003cem\u003er \u003c/em\u003e= 0.404, 95% CI[0.31,0.49], \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.01) and negatively correlated with parental anxiety ((\u003cem\u003er\u003c/em\u003e = -0.309, 95% CI[-0.41,-0.21], \u003cem\u003eP \u0026lt;\u003c/em\u003e0.01). Multiple linear regression revealed that child's self-efficacy, parental anxiety, duration of diagnosis,disease criticality, treatment duration, daily electronic usage time, parents' attitudes towards children's exercise during illness, income per month significantly influenced PA levels (\u003cem\u003eR²\u003c/em\u003e= 0.531, \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003ePhysical activity levels among children with leukemia are suboptimal and are positively associated with self-efficacy and negatively with parental anxiety. Healthcare providers should prioritize assessing physical activity and deliver tailored educational and psychosocial support to families. Personalized intervention strategies are warranted to enhance physical activity and improve quality of life in this vulnerable population.\u003c/p\u003e","manuscriptTitle":"Interactions among Physical activity Levels, Self-Efficacy, and Parental Anxiety in Children with Leukemia in China: a Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-13 06:17:50","doi":"10.21203/rs.3.rs-8374392/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-05-04T12:47:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-17T11:43:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-16T14:06:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-16T14:01:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-12-16T09:19:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2f9fa41b-07a2-47c2-ab7d-ed4ed1f5bc07","owner":[],"postedDate":"May 13th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"13","date":"2026-05-04T12:47:18+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":67672899,"name":"Biological sciences/Cancer"},{"id":67672900,"name":"Health sciences/Health care"},{"id":67672901,"name":"Health sciences/Medical research"},{"id":67672902,"name":"Health sciences/Oncology"},{"id":67672903,"name":"Biological sciences/Psychology"},{"id":67672904,"name":"Social science/Psychology"},{"id":67672905,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-05-13T06:17:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-13 06:17:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8374392","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8374392","identity":"rs-8374392","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}