Assessing the physical activity of parents of children suffering from cancer: a cross-sectional study

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Niemeyer, Antonia Pahl, Albert Gollhofer, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4469182/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Nov, 2025 Read the published version in BMC Public Health → Version 1 posted 13 You are reading this latest preprint version Abstract Background Regular physical activity (PA) is essential for biopsychosocial health, but reduced PA during therapy for childhood cancer increases the burden of long-term side effects. Cancer and its therapy determine the everyday life of affected families, and parents spend plenty of time with their child in the hospital. Thus, we assumed that the restriction of the movement environment affects the parents' PA-behavior. Meanwhile, parents have a pronounced influence on their child's PA-behavior. This is the first study to investigate the PA and sitting time (ST) of parents before and during their child's cancer therapy. Methods Forty parents provided their consent and participated in the study between September 2021 and February 2022. Parental PA and ST were assessed before and during their child's cancer therapy in a cross-sectional design using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). The questionnaire was supplemented with additional self-generated questions. Analysis of variance was applied using IBM SPSS Statistics. The Ethics Committee of the University of Freiburg approved the study. Results The parents' PA-levels before their child's diagnosis corresponded with reference values of healthy adults. During their child's therapy, all dimensions of parental daily PA and the number of Metabolic Equivalent of Task (MET)-minutes of PA per week decreased significantly. Especially during inpatient stays, PA decreased (mean ± SD: from 3004.5 ± 2301.4 to 889.1 ± 1585.1; p < 0.001), with a significant increase in ST in minutes per workday (mean ± SD: from 329.3 ± 196.6 to 687.8 ± 268.8; p < 0.001). Conclusions This is the first study to show that the PA of parents of children suffering from cancer significantly decreases during cancer therapy. Considering that parental PA can significantly affect their child's behavior during and after completion of cancer therapy, exercise programs in pediatric oncology should expand and include parents to reduce inactivity-related long-term side effects. Trial registration: German Register of Clinical Trials No.: DRKS00026248, prospectively registered on 17/09/2021. Physical activity childhood cancer parents sitting time long-term side effects Figures Figure 1 Figure 2 Figure 3 Background Regular physical activity (PA) is essential for biopsychosocial health for people of any age [ 1 ]. Despite the general awareness of the positive effects of PA, only few people are sufficiently active. For adults, the World Health Organization (WHO) recommends regular PA of at least 150 or 75 minutes per week (min/W) with moderate or vigorous intensity or an equivalent combination [ 2 ]. Nearly one-third (27.5%) of the world's population and even 77% of the German population do not reach the recommended levels of PA to improve and protect their health [ 2 , 3 ]. As PA decreases, sitting time (ST) (e.g. during work and leisure time) increases, resulting in the development of various chronic diseases and motor deficits [ 4 – 6 ]. Although physical inactivity is a known health risk, there are still uncertainties about the amount of sedentary time needed to increase disease risk and all-cause mortality. Parents have a lasting influence on their children's PA-behavior, for example by acting as role models or being active themselves [ 7 ]. When a family is confronted with a child's cancer diagnosis, intensive and vital therapies, which are associated with several inpatient stays, suddenly determine everyday life [ 8 ]. In particular, during inpatient stays, children and adolescents experience a significant reduction in their PA-level [ 9 ]. This can lead to amplification of therapy- and disease-related long-term side effects [ 10 ]. Although there has been an increased expansion of sports therapy care structures for children and adolescents in German pediatric oncology centers in recent years, parents are not yet the focus. Because parents usually stay constantly at their child's side during therapy, it can be assumed that not only the patients themselves, but also their parents are affected by therapy- and daily structure-related movement restrictions [ 11 ]. Therefore, it appears crucial to promote parental health, especially during this period of therapy as well. Because parents' PA has a pronounced effect on their child's behavior, helping parents to sustain regular PA will enable them to support their child's PA level. Based on this background, this study aimed to assess for the first time the PA and ST of parents before and during their child's cancer therapy. Methods This cross-sectional study took place at the Division of Pediatric Hematology and Oncology of the Department of Pediatrics at the Medical Center of the University of Freiburg in Germany. This study was approved by the Ethics Committee of the University of Freiburg and conducted according to the Declaration of Helsinki (German Register of Clinical Trials No.: DRKS00026248). Participants and procedures Within a 6-month period (September 2021-February 2022), eligible parents were recruited at the pediatric oncology ward. Parents (18–65 years of age) with a child (< 18 years of age) who had been treated for cancer for at least four weeks and had been hospitalized for a second time were included in the study. In addition, regular accompaniment of their child during inpatient stays and care at home by the corresponding parent were required. Exclusion criteria included insufficient understanding of the questionnaire and missing consent to the survey. The questionnaire was applied at one time point after consent was obtained. Physical activity (PA) Intraindividual comparisons of parental PA before and during their child's cancer therapy were assessed by the International Physical Activity Questionnaire-Short Form (IPAQ-SF) [ 12 , 13 ]. The IPAQ-SF comprises seven items that measure the frequency (days per week), duration (minutes), and intensity (light, moderate and vigorous) of PA during an average week. For this primary endpoint, the metric outcome variable is the total activity in Metabolic Equivalent of Task in minutes per week (MET-min/W), calculated as the sum of the three activity domains multiplied by the respective estimated METs [ 14 ]. In addition, the reported times for moderate and vigorous PA are summed and expressed as MVPA-min/W. The PA levels were categorized as sufficient or insufficient based on the PA-guidelines of the WHO [ 2 ]. Sitting time (ST) The ST was analyzed by the IPAQ-SF. The question on the ST was developed as a separate indicator and is not part of the overall score for PA. The parents were asked to think about the total time in minutes per workday (min/WD) they spent sitting before and during their child's cancer therapy. Outcome measures Primary endpoint - PA Primarily, this study aimed to compare the parents' PA before diagnosis with the PA during their child's cancer therapy, consisting of inpatient (Hospital) and outpatient (Home) treatment phases. Secondary endpoints - ST Secondly, the extent to which parents' ST is influenced during their child's cancer therapy was examined. In addition, we used self-generated questions to identify physical complaints and the parents' interest in further exercise programs. Statistical analyses For the descriptive statistics and characterization of the parents and patients, we used percentages (%), arithmetic means, standard deviations (SD), medians (MD), and ranges. The intraindividual comparisons of parental PA-behavior before diagnosis, during inpatient and outpatient stays with their child were analyzed using a one-factor analysis of variance (ANOVA) with repeated measures. All analyses were conducted using IBM SPSS Statistics (version 23.0). The level of statistical significance was set at p < 0.05. Results Sample: A total number ( n ) of 83 parents were available for the survey during the study period (Fig. 1 ). The analysis included 40 parents (female: n = 31 (77.5%), male: n = 9 (22.5%)). The mean age was 40.1 years (range: 29–62 years). Of the parents, 45% ( n = 18) stated that they had suffered from new physical complaints since their child's diagnosis. Frequently mentioned complaints included tension, shoulder, head, and back pain, weight gain, and stomach pain. After providing certain conditions, 92.5% of the parents ( n = 37) could imagine taking part in an exercise program (Table 1). Most of the parents preferred a separate room to exercise in the hospital (87.5%, n = 35). The characteristics of the corresponding children are reported in additional file 1: Table S1. Table 1 Characteristics of the study cohort (n = 40 parents). Results in n (%), mean ± SD and range Characteristics of the parents ( n = 40) n (%) mean ± SD; range Age (years) 40.1 ± 8.2; 29–62 Body Mass Index (BMI; kg/m²): 25 ± 5.5; 18.9–42.2 overweight (including obesity, BMI ≥ 25 kg/m²) 19 (47.5) obesity (BMI ≥ 30 kg/m²) 6 (15) Gender: Male 9 (22.5) Female 31 (77.5) Physical complaints since the child's cancer diagnosis 18 (45) Interested in a clinic-internal exercise program 37 (92.5) PA of parents before and during their child's cancer therapy: Before the cancer diagnosis of the child, parental PA (mean ± SD in MET-min/W: 3004.5 ± 2301.4; MD: 2592) corresponded with reference values (Craig et al. [ 12 ]: MD: 2514 MET-min/W). Parental PA differed significantly during inpatient stays with their child compared to the time before the diagnosis. The PA values decreased during inpatient stays (Hospital: 889.1 ± 1585.1; MD: 231; p < 0.001). Even during outpatient stays, PA significantly decreased compared to that before diagnosis (Home: 1953.3 ± 1832.7; MD: 1546; p < 0.01). Likewise, significant differences between inpatient and outpatient stays existed, with an increase in PA at home ( p < 0.01) (Fig. 2 ). Comparison with PA-guidelines of the WHO: Table 2 Degree of compliance with the WHO PA-recommendations of parents of children suffering from cancer (n = 40; n (%)) in the periods before diagnosis, during inpatient (Hospital) and outpatient stays (Home) WHO PA-guidelines Before diagnosis Hospital Home fulfilled (sufficiently active) 21 (52.5) 2 (5) 10 (25) not fulfilled (not sufficiently active) 19 (47.5) 38 (95) 30 (75) Before the child's cancer diagnosis, 52.5% of parents fulfilled the WHO recommendations for PA (≥ 150 MVPA-min/W or ≥ 75 min/W of intensive PA) and 47.5% did not meet the criteria (Table 2). During inpatient stays with their child, 95% of parents were insufficiently active. When parents were at home with their child, this percentage dropped to 75% not meeting PA-guidelines. ST of parents before and during their child's cancer therapy: The parents' ST (mean ± SD in min/WD) demonstrated a significant difference in the periods before their child's cancer diagnosis compared with inpatient stays (Before diagnosis vs. Hospital: 329.3 ± 196.6 vs. 687.8 ± 268.8; p < 0.001). The ST doubles to more than 10 hours/WD (Hospital). At home, the ST decreased (Hospital vs. Home: 687.8 ± 268.8 vs. 322.1 ± 191.8; p < 0.001). The ST before diagnosis and during the outpatient period at home did not differ among the parents surveyed (Fig. 3 ). Discussion The present study examined for the first time the PA and ST of parents of children suffering from cancer before and during cancer therapy. The parental PA-level decreased significantly throughout their child's cancer therapy. The greatest reduction occurred during inpatient stays (Fig. 2 ). During this time, parents' PA was far from reference values according to Craig et al. [ 12 ], and nearly none of the parents met the guidelines of the WHO (Table 2). Compared with the German adult population [ 3 ], we demonstrated a greater degree of noncompliance with PA-recommendations during inpatient stays with the child (77% [ 3 ] vs. 95% (Table 2)). As PA decreased, the amount of time parents spent sitting during inpatient stays increased significantly. Assuming eight hours of sleep, the parents' ST accounted for at least half of the total waking time. Compared to the time before cancer diagnosis, ST doubled to more than 10 hours/WD (Fig. 3 ). A closer look at the parents' ST during hospital stays revealed that 85% of the parents spent more than eight hours/WD and 62.5% even 10 hours/WD sitting. Excessive sitting of more than eight hours per day has been linked to an increased risk of chronic diseases [ 4 – 6 , 15 ], and is positively associated with the risk of premature mortality [ 16 ]. Based on current studies, our study cohort would need to engage in at least 60 minutes per day of MVPA to avert adverse health effects due to sitting [ 15 , 17 ]. Furthermore, an inactive lifestyle of parents is supposed to have a negative impact on the health of children. The significant decrease in PA and the significant increase in the ST of parents during inpatient stays with their child are consistent with the results of Götte et al. [ 9 ]. The authors addressed the PA-behavior of children and adolescents with cancer before and during cancer therapy and found a pronounced decrease in PA, e.g. due to high amounts of bed rest [ 9 ]. The parents' lack of role model function was not examined and identified as one of the possible reasons. Especially during times of uncertainty, parents act as important role models for their children. Their inactivity can negatively affect their child's behavior. Conversely, the child's state of health can also influence the parents' level of activity and determine whether more or less activity is possible. If the child feels better, more parental time can be expected to be spent outside the hospital room, resulting in more activity and vice versa. The reduction in the parent's PA in our study could be due to the lack of alternative places to stay, move, and rest and the resulting habit of performing all activities of daily living, such as eating, playing, and watching TV, at the child's bedside. Other potential reasons for this inactivity could be the constant restriction due to the infusion stand and the resulting limited mobility of the child, exhaustion caused by insomnia [ 18 ], lack of time because of the increased caregiving task toward the sick child and (social) isolation to protect their child. In our cohort, PA increased slightly again during outpatient stays at home with the child, but did not reach the amount of PA at the time before diagnosis. In particular, parents' walking times at home (mean: 543.6 min/W) are estimated to be longer than those during inpatient stays (mean: 206.2 min/W). This result is consistent with the findings of Winter et al. [ 19 ]: according to objective measures of step count, children with cancer have a higher activity level during outpatient compared to inpatient stays. Similarly, an increased number of the parents studied reached again the PA-recommendations of the WHO at home between hospital stays (Table 2). Like the parental PA, the ST changed again from inpatient to outpatient stays and decreased significantly (Fig. 3 ). A compensation of the low amount of PA and the high amount of ST during inpatient stays, by e.g. increased walking in the period at home, could explain these findings. In this context, especially hospitalization with the child affected by cancer seems to be a specific risk factor for inactivity. Therefore, the time out of hospital should be used to compensate for the losses of the family's PA. Moreover, 47.5% of our cohort already suffered from overweight (Table 1), which corresponds to the GEDA-data of 53.5% [ 20 ]. To reduce overweight, at least a combination of regular PA and a healthy diet is needed. Furthermore, almost half of the parents reported from new physical complaints since their child's cancer diagnosis (Table 1). These results were in line with the data from Wiener et al. [ 21 ]. The results showed a deterioration in the general health of 40% of parents after their child was diagnosed with cancer. Taken together, a considerable part of parents put their own health at risk during their child's illness due to insufficient PA and prolonged sitting. Finally, the results indicate an intensification and consolidation of family-oriented sports offerings during childhood cancer therapy. Clinics should be designed to be more active (e.g. with a sports program and a sports room as a place to retreat and relax) in order to create more incentives to exercise with the aim of leaving the hospital bed or room more often. Preventive interventions including a combination of knowledge transfer and supervised family-oriented exercise programs in pediatric cancer wards, are necessary to reduce the time spent sitting and increase the PA of affected families. Such programs bear the chance to reduce inactivity-related and other long-term side effects of childhood cancer patients and their families. This study has several limitations. First, retrospective surveys always carry the risk of bias due to subject recall with regard to the assessment of PA and ST at only one time point after start of cancer therapy [ 22 ]. Second, the use of self-reports to assess PA and ST is another limitation. Self-reports has been proven to be less valid than objective measurements, such as accelerometry [ 23 ]. Nevertheless, this form of questionnaire was the only way to capture parents' past activities to identify intraindividual changes. The questionnaire is used in nationwide epidemiological surveys. In addition, the third part of the activity questionnaire on the parents' current situation since the child's illness was developed and used for the first time for this study. It should be noted that these are self-generated questions and have not been tested for quality criteria. For future use, testing for objectivity, reliability and validity should be considered in advance in order to increase the methodological quality of the survey instrument. Last, having performed a monocentric study, the results cannot be generalized to the entire population of parents of children suffering from cancer. To increase data quality and validity, a multicenter approach with a larger number of subjects will be necessary. Conclusions The results of this cross-sectional study provide the first scientific evidence that parents experience a significant decrease in PA during their child's cancer therapy. The greatest decrease in PA occurs during inpatient stays, with a corresponding significant increase in ST. Appreciating that parental PA can significantly affect their child's behavior during and after completion of cancer therapy, future exercise programs in pediatric oncology should include parents to reduce inactivity-related long-term side effects of the whole family. Abbreviations ANOVA: Analysis of variance; BMI: Body Mass Index; IPAQ-SF: International Physical Activity Questionnaire-Short Form; MD: Median; MET: Metabolic Equivalent of Task; Min: Minute; MVPA: Moderate to vigorous physical activity; n : Number; PA: Physical activity; SD: Standard deviation; ST: Sitting time; W: Week; WD: Workday; WHO: World Health Organization Declarations Acknowledgements We thank all parents for their participation. Funding Open access funding was enabled and organized by Projekt DEAL. Availability of data and materials This article only includes summarized data of this study. The raw data is available from the corresponding author upon reasonable request. Authors' contributions CO recruited the parents, collected data, did the data analysis and interpretation and drafted the manuscript; the study was designed together with APU. APU and APA provided support in analyzing and interpreting the data and in writing the manuscript. CN and AG participated in the design of the study and revised the manuscript. APU carried out the medical clarification for the parents' participation in the study. All authors made contributions to the paper, are in agreement with the content and read the final manuscript. Ethics approval and consent to participate Ethics approval was given by the Ethics Committee of the University of Freiburg (Number: 21-1524). All participants signed written informed consent prior to inclusion. Consent for publication Not applicable. Competing interests The authors declare no conflicts of interest. Author details 1 Division of Pediatric Hematology and Oncology, Department of Pediatrics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, D-79106 Freiburg, Germany 2 Department of Sport and Sport Science, University of Freiburg, Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany 3 Department of Medicine I (Specialties: Hematology, Oncology, and Stem-Cell Transplantation), Faculty of Medicine, Medical Center – University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany References Krug S, Jordan S, Mensink GBM, Müters S, Finger JD, Lampert T. Körperliche Aktivität. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt. 2013; doi:10.1007/s00103-012-1661-6. World Health Organization. WHO guidelines on physical activity and sedentary behaviour. WHO, Geneva. 2020. RKI. Gesundheitsfördernde körperliche Aktivität in der Freizeit bei Erwachsenen in Deutschland. 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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-4469182","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":309980893,"identity":"dd404437-cd9a-471e-80bb-9b5623a94aa9","order_by":0,"name":"Carolin Ohnmacht","email":"data:image/png;base64,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","orcid":"","institution":"University Medical Center Freiburg","correspondingAuthor":true,"prefix":"","firstName":"Carolin","middleName":"","lastName":"Ohnmacht","suffix":""},{"id":309980894,"identity":"93514dc8-569d-4113-afa9-6f46f4fce57a","order_by":1,"name":"Charlotte M. Niemeyer","email":"","orcid":"","institution":"University Medical Center Freiburg","correspondingAuthor":false,"prefix":"","firstName":"Charlotte","middleName":"M.","lastName":"Niemeyer","suffix":""},{"id":309980898,"identity":"b3485c55-9573-4ec1-89cd-621aeb8139b8","order_by":2,"name":"Antonia Pahl","email":"","orcid":"","institution":"University Medical Center Freiburg","correspondingAuthor":false,"prefix":"","firstName":"Antonia","middleName":"","lastName":"Pahl","suffix":""},{"id":309980899,"identity":"0f1091f8-5362-4986-a5c2-1f662ea65a50","order_by":3,"name":"Albert Gollhofer","email":"","orcid":"","institution":"University of Freiburg","correspondingAuthor":false,"prefix":"","firstName":"Albert","middleName":"","lastName":"Gollhofer","suffix":""},{"id":309980900,"identity":"4b263968-ad91-403d-9bea-cceeef4a1dc5","order_by":4,"name":"Alexander Puzik","email":"","orcid":"","institution":"University Medical Center Freiburg","correspondingAuthor":false,"prefix":"","firstName":"Alexander","middleName":"","lastName":"Puzik","suffix":""}],"badges":[],"createdAt":"2024-05-23 23:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4469182/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4469182/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-25455-5","type":"published","date":"2025-11-17T15:58:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58144831,"identity":"7a929b38-0b00-4b90-94f2-4a3996804617","added_by":"auto","created_at":"2024-06-11 18:26:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56751,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of screening and study recruitment\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4469182/v1/5f823d5198d8d0b36f0d3f34.png"},{"id":58144833,"identity":"2957a339-fad4-4fff-b0c2-e9c4394bab73","added_by":"auto","created_at":"2024-06-11 18:26:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":71947,"visible":true,"origin":"","legend":"\u003cp\u003ePA in MET-min/W of parents of children suffering from cancer (n = 40; mean ± SD) in the periods before diagnosis, during inpatient (Hospital) and outpatient stays (Home); corresponding p-values (**: p \u0026lt; 0.01; ***: p \u0026lt; 0.001)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4469182/v1/01d885d198ea1d95f3876470.png"},{"id":58146023,"identity":"a534ce79-ff5e-4e38-8706-787719204a33","added_by":"auto","created_at":"2024-06-11 18:34:37","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":70471,"visible":true,"origin":"","legend":"\u003cp\u003eST in min/WD of parents of children suffering from cancer (\u003cem\u003en\u003c/em\u003e = 40; mean ± SD) in the periods before diagnosis, during inpatient (Hospital) and outpatient stays (Home); corresponding \u003cem\u003ep\u003c/em\u003e-value (***: \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4469182/v1/b2d8f1c74b1a09f52080122d.png"},{"id":96650969,"identity":"24bc390e-9e95-4658-a684-96957be5b228","added_by":"auto","created_at":"2025-11-24 16:13:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":897520,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4469182/v1/044e7b3f-4276-42df-990a-c36a8165299a.pdf"},{"id":58144834,"identity":"7421c423-f163-4e3a-9c8d-02fb87b49b3b","added_by":"auto","created_at":"2024-06-11 18:26:37","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":4913467,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-4469182/v1/2cd2e5c7d5fbfef062d13562.docx"},{"id":58144832,"identity":"7136889e-3ba8-4e51-ae30-c5dbb6607a6a","added_by":"auto","created_at":"2024-06-11 18:26:37","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":20515,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfiles.docx","url":"https://assets-eu.researchsquare.com/files/rs-4469182/v1/62db5f3406dbd12ea06f655d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing the physical activity of parents of children suffering from cancer: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eRegular physical activity (PA) is essential for biopsychosocial health for people of any age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite the general awareness of the positive effects of PA, only few people are sufficiently active. For adults, the World Health Organization (WHO) recommends regular PA of at least 150 or 75 minutes per week (min/W) with moderate or vigorous intensity or an equivalent combination [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Nearly one-third (27.5%) of the world's population and even 77% of the German population do not reach the recommended levels of PA to improve and protect their health [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As PA decreases, sitting time (ST) (e.g. during work and leisure time) increases, resulting in the development of various chronic diseases and motor deficits [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although physical inactivity is a known health risk, there are still uncertainties about the amount of sedentary time needed to increase disease risk and all-cause mortality.\u003c/p\u003e \u003cp\u003eParents have a lasting influence on their children's PA-behavior, for example by acting as role models or being active themselves [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. When a family is confronted with a child's cancer diagnosis, intensive and vital therapies, which are associated with several inpatient stays, suddenly determine everyday life [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In particular, during inpatient stays, children and adolescents experience a significant reduction in their PA-level [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This can lead to amplification of therapy- and disease-related long-term side effects [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough there has been an increased expansion of sports therapy care structures for children and adolescents in German pediatric oncology centers in recent years, parents are not yet the focus. Because parents usually stay constantly at their child's side during therapy, it can be assumed that not only the patients themselves, but also their parents are affected by therapy- and daily structure-related movement restrictions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, it appears crucial to promote parental health, especially during this period of therapy as well. Because parents' PA has a pronounced effect on their child's behavior, helping parents to sustain regular PA will enable them to support their child's PA level. Based on this background, this study aimed to assess for the first time the PA and ST of parents before and during their child's cancer therapy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional study took place at the Division of Pediatric Hematology and Oncology of the Department of Pediatrics at the Medical Center of the University of Freiburg in Germany. This study was approved by the Ethics Committee of the University of Freiburg and conducted according to the Declaration of Helsinki (German Register of Clinical Trials No.: DRKS00026248).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and procedures\u003c/h2\u003e \u003cp\u003eWithin a 6-month period (September 2021-February 2022), eligible parents were recruited at the pediatric oncology ward. Parents (18\u0026ndash;65 years of age) with a child (\u0026lt;\u0026thinsp;18 years of age) who had been treated for cancer for at least four weeks and had been hospitalized for a second time were included in the study. In addition, regular accompaniment of their child during inpatient stays and care at home by the corresponding parent were required. Exclusion criteria included insufficient understanding of the questionnaire and missing consent to the survey. The questionnaire was applied at one time point after consent was obtained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePhysical activity (PA)\u003c/h2\u003e \u003cp\u003eIntraindividual comparisons of parental PA before and during their child's cancer therapy were assessed by the International Physical Activity Questionnaire-Short Form (IPAQ-SF) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The IPAQ-SF comprises seven items that measure the frequency (days per week), duration (minutes), and intensity (light, moderate and vigorous) of PA during an average week. For this primary endpoint, the metric outcome variable is the total activity in Metabolic Equivalent of Task in minutes per week (MET-min/W), calculated as the sum of the three activity domains multiplied by the respective estimated METs [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In addition, the reported times for moderate and vigorous PA are summed and expressed as MVPA-min/W. The PA levels were categorized as sufficient or insufficient based on the PA-guidelines of the WHO [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSitting time (ST)\u003c/h2\u003e \u003cp\u003eThe ST was analyzed by the IPAQ-SF. The question on the ST was developed as a separate indicator and is not part of the overall score for PA. The parents were asked to think about the total time in minutes per workday (min/WD) they spent sitting before and during their child's cancer therapy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measures\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003ePrimary endpoint - PA\u003c/h2\u003e \u003cp\u003ePrimarily, this study aimed to compare the parents' PA before diagnosis with the PA during their child's cancer therapy, consisting of inpatient (Hospital) and outpatient (Home) treatment phases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eSecondary endpoints - ST\u003c/h2\u003e \u003cp\u003e Secondly, the extent to which parents' ST is influenced during their child's cancer therapy was examined.\u003c/p\u003e \u003cp\u003eIn addition, we used self-generated questions to identify physical complaints and the parents' interest in further exercise programs.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eFor the descriptive statistics and characterization of the parents and patients, we used percentages (%), arithmetic means, standard deviations (SD), medians (MD), and ranges. The intraindividual comparisons of parental PA-behavior before diagnosis, during inpatient and outpatient stays with their child were analyzed using a one-factor analysis of variance (ANOVA) with repeated measures. All analyses were conducted using IBM SPSS Statistics (version 23.0). The level of statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003eSample:\u003c/h2\u003e\n \u003cp\u003eA total number (\u003cem\u003en\u003c/em\u003e) of 83 parents were available for the survey during the study period (Fig.\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e). The analysis included 40 parents (female: \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;31 (77.5%), male: \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9 (22.5%)). The mean age was 40.1 years (range: 29\u0026ndash;62 years). Of the parents, 45% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18) stated that they had suffered from new physical complaints since their child\u0026apos;s diagnosis. Frequently mentioned complaints included tension, shoulder, head, and back pain, weight gain, and stomach pain. After providing certain conditions, 92.5% of the parents (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;37) could imagine taking part in an exercise program (Table\u0026nbsp;1). Most of the parents preferred a separate room to exercise in the hospital (87.5%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;35). The characteristics of the corresponding children are reported in additional file 1: Table S1.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cdiv align=\"left\"\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Characteristics of the study cohort (n = 40 parents). Results in n (%), mean \u0026plusmn; SD and range\u003c/div\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics of the parents (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD; range\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2; 29\u0026ndash;62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBody Mass Index (BMI; kg/m\u0026sup2;):\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5; 18.9\u0026ndash;42.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eoverweight (including obesity, BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u0026sup2;)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e19\u003c/em\u003e (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eobesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u0026sup2;)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6\u003c/em\u003e (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e9\u003c/em\u003e (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e31\u003c/em\u003e (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical complaints since the child\u0026apos;s cancer diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e18\u003c/em\u003e (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterested in a clinic-internal exercise program\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e37\u003c/em\u003e (92.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003ePA of parents before and during their child\u0026apos;s cancer therapy:\u003c/h2\u003e\n \u003cp\u003eBefore the cancer diagnosis of the child, parental PA (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD in MET-min/W: 3004.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2301.4; MD: 2592) corresponded with reference values (Craig et al. [\u003cspan\u003e12\u003c/span\u003e]: MD: 2514 MET-min/W). Parental PA differed significantly during inpatient stays with their child compared to the time before the diagnosis. The PA values decreased during inpatient stays (Hospital: 889.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1585.1; MD: 231; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Even during outpatient stays, PA significantly decreased compared to that before diagnosis (Home: 1953.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1832.7; MD: 1546; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Likewise, significant differences between inpatient and outpatient stays existed, with an increase in PA at home (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003eComparison with PA-guidelines of the WHO:\u003c/h2\u003e\n \u003cdiv\u003e\n \u003cdiv align=\"left\"\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Degree of compliance with the WHO PA-recommendations of parents of children suffering from cancer (n = 40; n (%)) in the periods before diagnosis, during inpatient (Hospital) and outpatient stays (Home)\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWHO PA-guidelines\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBefore diagnosis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003efulfilled\u003c/strong\u003e (sufficiently active)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e21\u003c/em\u003e (52.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2\u003c/em\u003e (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e10\u003c/em\u003e (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003enot fulfilled\u003c/strong\u003e (not sufficiently active)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e19\u003c/em\u003e (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e38\u003c/em\u003e (95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e30\u003c/em\u003e (75)\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\u003eBefore the child\u0026apos;s cancer diagnosis, 52.5% of parents fulfilled the WHO recommendations for PA (\u0026ge;\u0026thinsp;150 MVPA-min/W or \u0026ge;\u0026thinsp;75 min/W of intensive PA) and 47.5% did not meet the criteria (Table\u0026nbsp;2). During inpatient stays with their child, 95% of parents were insufficiently active. When parents were at home with their child, this percentage dropped to 75% not meeting PA-guidelines.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003eST of parents before and during their child\u0026apos;s cancer therapy:\u003c/h2\u003e\n \u003cp\u003eThe parents\u0026apos; ST (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD in min/WD) demonstrated a significant difference in the periods before their child\u0026apos;s cancer diagnosis compared with inpatient stays (Before diagnosis vs. Hospital: 329.3\u0026thinsp;\u0026plusmn;\u0026thinsp;196.6 vs. 687.8\u0026thinsp;\u0026plusmn;\u0026thinsp;268.8; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The ST doubles to more than 10 hours/WD (Hospital). At home, the ST decreased (Hospital vs. Home: 687.8\u0026thinsp;\u0026plusmn;\u0026thinsp;268.8 vs. 322.1\u0026thinsp;\u0026plusmn;\u0026thinsp;191.8; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The ST before diagnosis and during the outpatient period at home did not differ among the parents surveyed (Fig.\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study examined for the first time the PA and ST of parents of children suffering from cancer before and during cancer therapy. The parental PA-level decreased significantly throughout their child's cancer therapy. The greatest reduction occurred during inpatient stays (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). During this time, parents' PA was far from reference values according to Craig et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and nearly none of the parents met the guidelines of the WHO (Table\u0026nbsp;2). Compared with the German adult population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], we demonstrated a greater degree of noncompliance with PA-recommendations during inpatient stays with the child (77% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] vs. 95% (Table\u0026nbsp;2)). As PA decreased, the amount of time parents spent sitting during inpatient stays increased significantly. Assuming eight hours of sleep, the parents' ST accounted for at least half of the total waking time. Compared to the time before cancer diagnosis, ST doubled to more than 10 hours/WD (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A closer look at the parents' ST during hospital stays revealed that 85% of the parents spent more than eight hours/WD and 62.5% even 10 hours/WD sitting. Excessive sitting of more than eight hours per day has been linked to an increased risk of chronic diseases [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and is positively associated with the risk of premature mortality [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Based on current studies, our study cohort would need to engage in at least 60 minutes per day of MVPA to avert adverse health effects due to sitting [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Furthermore, an inactive lifestyle of parents is supposed to have a negative impact on the health of children. The significant decrease in PA and the significant increase in the ST of parents during inpatient stays with their child are consistent with the results of G\u0026ouml;tte et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The authors addressed the PA-behavior of children and adolescents with cancer before and during cancer therapy and found a pronounced decrease in PA, e.g. due to high amounts of bed rest [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The parents' lack of role model function was not examined and identified as one of the possible reasons. Especially during times of uncertainty, parents act as important role models for their children. Their inactivity can negatively affect their child's behavior. Conversely, the child's state of health can also influence the parents' level of activity and determine whether more or less activity is possible. If the child feels better, more parental time can be expected to be spent outside the hospital room, resulting in more activity and vice versa. The reduction in the parent's PA in our study could be due to the lack of alternative places to stay, move, and rest and the resulting habit of performing all activities of daily living, such as eating, playing, and watching TV, at the child's bedside. Other potential reasons for this inactivity could be the constant restriction due to the infusion stand and the resulting limited mobility of the child, exhaustion caused by insomnia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], lack of time because of the increased caregiving task toward the sick child and (social) isolation to protect their child.\u003c/p\u003e \u003cp\u003eIn our cohort, PA increased slightly again during outpatient stays at home with the child, but did not reach the amount of PA at the time before diagnosis. In particular, parents' walking times at home (mean: 543.6 min/W) are estimated to be longer than those during inpatient stays (mean: 206.2 min/W). This result is consistent with the findings of Winter et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]: according to objective measures of step count, children with cancer have a higher activity level during outpatient compared to inpatient stays. Similarly, an increased number of the parents studied reached again the PA-recommendations of the WHO at home between hospital stays (Table\u0026nbsp;2). Like the parental PA, the ST changed again from inpatient to outpatient stays and decreased significantly (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A compensation of the low amount of PA and the high amount of ST during inpatient stays, by e.g. increased walking in the period at home, could explain these findings. In this context, especially hospitalization with the child affected by cancer seems to be a specific risk factor for inactivity. Therefore, the time out of hospital should be used to compensate for the losses of the family's PA.\u003c/p\u003e \u003cp\u003eMoreover, 47.5% of our cohort already suffered from overweight (Table\u0026nbsp;1), which corresponds to the GEDA-data of 53.5% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. To reduce overweight, at least a combination of regular PA and a healthy diet is needed. Furthermore, almost half of the parents reported from new physical complaints since their child's cancer diagnosis (Table\u0026nbsp;1). These results were in line with the data from Wiener et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The results showed a deterioration in the general health of 40% of parents after their child was diagnosed with cancer. Taken together, a considerable part of parents put their own health at risk during their child's illness due to insufficient PA and prolonged sitting.\u003c/p\u003e \u003cp\u003eFinally, the results indicate an intensification and consolidation of family-oriented sports offerings during childhood cancer therapy. Clinics should be designed to be more active (e.g. with a sports program and a sports room as a place to retreat and relax) in order to create more incentives to exercise with the aim of leaving the hospital bed or room more often. Preventive interventions including a combination of knowledge transfer and supervised family-oriented exercise programs in pediatric cancer wards, are necessary to reduce the time spent sitting and increase the PA of affected families. Such programs bear the chance to reduce inactivity-related and other long-term side effects of childhood cancer patients and their families.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, retrospective surveys always carry the risk of bias due to subject recall with regard to the assessment of PA and ST at only one time point after start of cancer therapy [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Second, the use of self-reports to assess PA and ST is another limitation. Self-reports has been proven to be less valid than objective measurements, such as accelerometry [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Nevertheless, this form of questionnaire was the only way to capture parents' past activities to identify intraindividual changes. The questionnaire is used in nationwide epidemiological surveys. In addition, the third part of the activity questionnaire on the parents' current situation since the child's illness was developed and used for the first time for this study. It should be noted that these are self-generated questions and have not been tested for quality criteria. For future use, testing for objectivity, reliability and validity should be considered in advance in order to increase the methodological quality of the survey instrument. Last, having performed a monocentric study, the results cannot be generalized to the entire population of parents of children suffering from cancer. To increase data quality and validity, a multicenter approach with a larger number of subjects will be necessary.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e The results of this cross-sectional study provide the first scientific evidence that parents experience a significant decrease in PA during their child's cancer therapy. The greatest decrease in PA occurs during inpatient stays, with a corresponding significant increase in ST. Appreciating that parental PA can significantly affect their child's behavior during and after completion of cancer therapy, future exercise programs in pediatric oncology should include parents to reduce inactivity-related long-term side effects of the whole family.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANOVA: Analysis of variance; BMI: Body Mass Index; IPAQ-SF: International Physical Activity Questionnaire-Short Form; MD: Median; MET: Metabolic Equivalent of Task; Min: Minute; MVPA: Moderate to vigorous physical activity; \u003cem\u003en\u003c/em\u003e: Number; PA: Physical activity; SD: Standard deviation; ST: Sitting time; W: Week; WD: Workday; WHO: World Health Organization\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all parents for their participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOpen access funding was enabled and organized by Projekt DEAL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article only includes summarized data of this study. The raw data is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCO recruited the parents, collected data, did the data analysis and interpretation and drafted the manuscript; the study was designed together with APU. APU and APA provided support in analyzing and interpreting the data and in writing the manuscript. CN and AG participated in the design of the study and revised the manuscript. APU carried out the medical clarification for the parents\u0026apos; participation in the study. All authors made contributions to the paper, are in agreement with the content and read the final manuscript.\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was given by the Ethics Committee of the University of Freiburg (Number: 21-1524). All participants signed written informed consent prior to inclusion.\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\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDivision of Pediatric Hematology and Oncology, Department of Pediatrics, Medical Center \u0026ndash; University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstra\u0026szlig;e 1, D-79106 Freiburg, Germany\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDepartment of Sport and Sport Science, University of Freiburg, Freiburg, Schwarzwaldstra\u0026szlig;e 175, 79117 Freiburg, Germany\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eDepartment of Medicine I (Specialties: Hematology, Oncology, and Stem-Cell Transplantation), Faculty of Medicine, Medical Center \u0026ndash; University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKrug S, Jordan S, Mensink GBM, M\u0026uuml;ters S, Finger JD, Lampert T. K\u0026ouml;rperliche Aktivit\u0026auml;t. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt. 2013; doi:10.1007/s00103-012-1661-6.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. WHO guidelines on physical activity and sedentary behaviour. WHO, Geneva. 2020.\u003c/li\u003e\n\u003cli\u003eRKI. Gesundheitsf\u0026ouml;rdernde k\u0026ouml;rperliche Aktivit\u0026auml;t in der Freizeit bei Erwachsenen in Deutschland. RKI-Bib1 (Robert Koch-Institut). 2017; doi:10.17886/RKI-GBE-2017-027.\u003c/li\u003e\n\u003cli\u003eBailey DP, Hewson DJ, Champion RB, Sayegh SM. Sitting time and risk of cardiovascular disease and diabetes: A systematic review and meta-analysis. Am J Prev Med. 2019;57(3):408-16.\u003c/li\u003e\n\u003cli\u003evan Dyck D, Cerin E, De Bourdeaudhuij I, Hinckson E, Reis RS, Davey R, Sarmiento OL, Mitas J, Troelsen J, MacFarlane D. International study of objectively-measured physical activity and sedentary time with body mass index and obesity: IPEN adult study. Int J Obesity. 2015;39(2):199\u0026ndash;207.\u003c/li\u003e\n\u003cli\u003eOwen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: The population health science of sedentary behavior. Exerc Sport Sci Rev. 2010;38:105-113.\u003c/li\u003e\n\u003cli\u003eWelk GJ, Wood K, Morss G. Parental influences on physical activity in children: An exploration of potential mechanisms. Pediatric Exercise Science. 2003;15(1):19-33.\u003c/li\u003e\n\u003cli\u003eDopfer R. Familienorientierte h\u0026auml;matoonkologische Rehabilitation. Monatsschrift Kinderheilkunde. 2011;159:642-649. \u003c/li\u003e\n\u003cli\u003eG\u0026ouml;tte M, Kesting S, Winter C, Rosenbaum D, Boos J. Comparison of self-reported physical activity in children and adolescents before and during cancer treatment. Pediatr Blood Cancer. 2014;61(6):1023\u0026ndash;1028.\u003c/li\u003e\n\u003cli\u003eLipshultz SE, et al.. Long-term cardiovascular toxicity in children, adolescents and young adults who receive cancer therapy: American Heart Association. Circulation. 2013;128(17):1927-1995.\u003c/li\u003e\n\u003cli\u003eKlassen AF, Klaassen R, Dix D, Pritchard S, Yanofsky R, O\u0026rsquo;Donnell M, Sung L. Impact of caring for a child with cancer on parents\u0026rsquo; health-related quality of life. Journal of Clinical Oncology. 2008;26, 5884-5889.\u003c/li\u003e\n\u003cli\u003eCraig CL, Marshall AL, Sh\u0026ouml;str\u0026ouml;m M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003). International Physical Activity Questionnaire: 12-Country Reliability and Validity. Med Sci Sports Exerc. doi: 10.1249/01.MSS.0000078924.61453.FB\u003c/li\u003e\n\u003cli\u003eIPAQ Downloads. German, self-administered. Short Format Word. AustrianGerman_Long selfIPAQ.doc\u003c/li\u003e\n\u003cli\u003eIPAQ Scoring Protocol, rev. Vers. 2005. Guidelines for Data Processing and Analysis of the IPAQ https://docs.google.com/viewer?a=v\u0026amp;pid=sites\u0026amp;srcid=ZGVmYXVsdGRvbWFpbnx0aGVpcGFxfGd4OjE0NDgxMDk3NDU1YWRlZM. Accessed 3 Jun 2021.\u003c/li\u003e\n\u003cli\u003eEkelund U, Brown WJ, Steene-Johannessen J, Fagerland MW, Owen N, Powell KE et al. Do the associations of sedentary behaviour with cardiovascular disease mortality and cancer mortality differ by physical activity level? A systematic review and harmonised meta-analysis of data from 850.060 participants. Br J Sports Med. 2019;53(14):886-894.\u003c/li\u003e\n\u003cli\u003ePatel AV, Bernstein L, Deka A, Feigelson HS, Campbell PT, Gapstur SM, Colditz GA, Thun MJ. Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am J Epidemiol. 2010;172:419-429. doi:10.1093/aje/kwq155.\u003c/li\u003e\n\u003cli\u003ePrince SA, LeBlanc AG, Colley RC et al. Measurement of sedentary behaviour in population health surveys: a review and recommendations. PeerJ. 2017;5:e4130.\u003c/li\u003e\n\u003cli\u003eBrown RT, Wiener L, Kupst MJ, Brennan T, Behrman R, Compas BE, Zeltzer L. Single parenting and children with chronic illness: An understudied phenomenon. Journal of Pediatric Psychology. 2008;33:408-421.\u003c/li\u003e\n\u003cli\u003eWinter C, M\u0026uuml;ller C, Brandes M. et al. Level of activity in children undergoing cancer treatment. Pediatr Blood Cancer. 2009;53:438-443.\u003c/li\u003e\n\u003cli\u003eRobert Koch-Institut. Gesundheitsverhalten Erwachsener in Deutschland. \u0026Uuml;bergewicht und Adipositas bei Erwachsenen in Deutschland \u0026ndash; Ergebnisse der Studie GEDA 2019/2020-EHIS. Journal of Health Monitoring: 2022;23-30.\u003c/li\u003e\n\u003cli\u003eWiener L, Viola A, Kearney J, Mullins LL, Sherman-Bien S, Zadeh S, Farkas-Patenaude A, Pao M. Impact of Caregiving for a Child with Cancer on Parental Health Behaviors, Relationship Quality, and Spiritual Faith: Do Lone Parents Fare Worse? Journal of Pediatric Oncology Nursing. 2016;33(5):378-386.\u003c/li\u003e\n\u003cli\u003eKohler S, Leitzmann M. M\u0026ouml;glichkeiten und Herausforderungen bei der Erhebung von k\u0026ouml;rperlicher Aktivit\u0026auml;t in der Epidemiologie. Public Health Forum. 2013;21:8.e1-8.e3.\u003c/li\u003e\n\u003cli\u003eShephard RJ. Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med. 2003;37:197-206.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Physical activity, childhood cancer, parents, sitting time, long-term side effects","lastPublishedDoi":"10.21203/rs.3.rs-4469182/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4469182/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRegular physical activity (PA) is essential for biopsychosocial health, but reduced PA during therapy for childhood cancer increases the burden of long-term side effects. Cancer and its therapy determine the everyday life of affected families, and parents spend plenty of time with their child in the hospital. Thus, we assumed that the restriction of the movement environment affects the parents' PA-behavior. Meanwhile, parents have a pronounced influence on their child's PA-behavior. This is the first study to investigate the PA and sitting time (ST) of parents before and during their child's cancer therapy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e Forty parents provided their consent and participated in the study between September 2021 and February 2022. Parental PA and ST were assessed before and during their child's cancer therapy in a cross-sectional design using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). The questionnaire was supplemented with additional self-generated questions. Analysis of variance was applied using IBM SPSS Statistics. The Ethics Committee of the University of Freiburg approved the study.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e The parents' PA-levels before their child's diagnosis corresponded with reference values of healthy adults. During their child's therapy, all dimensions of parental daily PA and the number of Metabolic Equivalent of Task (MET)-minutes of PA per week decreased significantly. Especially during inpatient stays, PA decreased (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD: from 3004.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2301.4 to 889.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1585.1; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a significant increase in ST in minutes per workday (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD: from 329.3\u0026thinsp;\u0026plusmn;\u0026thinsp;196.6 to 687.8\u0026thinsp;\u0026plusmn;\u0026thinsp;268.8; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis is the first study to show that the PA of parents of children suffering from cancer significantly decreases during cancer therapy. Considering that parental PA can significantly affect their child's behavior during and after completion of cancer therapy, exercise programs in pediatric oncology should expand and include parents to reduce inactivity-related long-term side effects.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eGerman Register of Clinical Trials No.: DRKS00026248, prospectively registered on 17/09/2021.\u003c/p\u003e","manuscriptTitle":"Assessing the physical activity of parents of children suffering from cancer: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 18:26:32","doi":"10.21203/rs.3.rs-4469182/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-03T12:19:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-31T14:54:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-28T13:41:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326774828869802078954170400026274963432","date":"2024-05-28T13:02:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155296160906621809459976250586093390208","date":"2024-05-28T06:39:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288577413314753165723589109224270156030","date":"2024-05-27T13:20:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-27T12:28:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43379354746350973008334743379676170039","date":"2024-05-27T10:32:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-27T09:37:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-27T08:57:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-25T13:21:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-25T13:21:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-05-23T23:21:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7950f913-fad8-4c56-b942-7cd80410e491","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:10:13+00:00","versionOfRecord":{"articleIdentity":"rs-4469182","link":"https://doi.org/10.1186/s12889-025-25455-5","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-11-17 15:58:59","publishedOnDateReadable":"November 17th, 2025"},"versionCreatedAt":"2024-06-11 18:26:32","video":"","vorDoi":"10.1186/s12889-025-25455-5","vorDoiUrl":"https://doi.org/10.1186/s12889-025-25455-5","workflowStages":[]},"version":"v1","identity":"rs-4469182","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4469182","identity":"rs-4469182","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}