Daily physical activities and sports in adult survivors of childhood cancer and healthy controls: a population-based questionnaire survey

Abstract

Background: Healthy lifestyle including sufficient physical activity may mitigate or prevent adverse long-term effects of childhood cancer. We described daily physical activities and sports in childhood cancer survivors and controls, and assessed determinants of both activity patterns.

Methodology/principal findings: The Swiss Childhood Cancer Survivor Study is a questionnaire survey including all children diagnosed with cancer 1976-2003 at age 0-15 years, registered in the Swiss Childhood Cancer Registry, who survived ≥5 years and reached adulthood (≥20 years). Controls came from the population-based Swiss Health Survey. We compared the two populations and determined risk factors for both outcomes in separate multivariable logistic regression models. The sample included 1058 survivors and 5593 controls (response rates 78% and 66%). Sufficient daily physical activities were reported by 52% (n = 521) of survivors and 37% (n = 2069) of controls (p<0.001). In contrast, 62% (n = 640) of survivors and 65% (n = 3635) of controls reported engaging in sports (p = 0.067). Risk factors for insufficient daily activities in both populations were: older age (OR for ≥35 years: 1.5, 95CI 1.2-2.0), female gender (OR 1.6, 95CI 1.3-1.9), French/Italian Speaking (OR 1.4, 95CI 1.1-1.7), and higher education (OR for university education: 2.0, 95CI 1.5-2.6). Risk factors for no sports were: being a survivor (OR 1.3, 95CI 1.1-1.6), older age (OR for ≥35 years: 1.4, 95CI 1.1-1.8), migration background (OR 1.5, 95CI 1.3-1.8), French/Italian speaking (OR 1.4, 95CI 1.2-1.7), lower education (OR for compulsory schooling only: 1.6, 95CI 1.2-2.2), being married (OR 1.7, 95CI 1.5-2.0), having children (OR 1.3, 95CI 1.4-1.9), obesity (OR 2.4, 95CI 1.7-3.3), and smoking (OR 1.7, 95CI 1.5-2.1). Type of diagnosis was only associated with sports.

Conclusions/significance: Physical activity levels in survivors were lower than recommended, but comparable to controls and mainly determined by socio-demographic and cultural factors. Strategies to improve physical activity levels could be similar as for the general population.

Figure 1. Participants of the Swiss Childhood Cancer Survivor Study.

Flow diagram of our study population starting from those eligible in the Swiss Childhood Cancer Registry to those included in the analysis.

Figure 2. Proportion of survivors and controls reporting daily activities and sports.

Proportions of persons 1) meeting (active) or not meeting (inactive) healthy recommendations for daily activities, and 2) participating (sports) or not participating (no sports) in sporting activities, for childhood cancer survivors compared to the weighted proportions of healthy controls (p<0.001 for daily activities, and p = 0.067 for sports, comparing survivors and controls). * Weighted proportions and numbers for controls: adjusted for age, gender, language region, and migration background.

Figure 3. Association of socio-demographic risk factors with two types of physical activity: daily activities and sports.

Effect sizes for two different outcomes assessing physical activity derived from two multivariable regression models with a combined dataset including childhood cancer survivors and healthy controls. Abbreviations: OR, Odds Ratio. * versus age <25 years. ^† versus vocational training. ^‡ versus normal weight.