Applied theory of planned behavior to explore associated factor of physical activity level among Chinese childhood cancer survivors

Fengjiao Xu^#^{1

2}, Yiqing Weng^#¹, Danni Lv^{3

4}, Hui Zheng⁵, Jieni Xiong^{3

4}, Li Zhang¹, Feng Lu⁶, Xia Guo⁶, Weisong Cai⁷, Qian Wang⁷, Yang Li⁸, Meiling Zeng⁹, Xiuli Yuan¹⁰, Meng Yi¹⁰, Libin Jin¹¹, Junqing Mao^{3

4}, Xiaojun Xu¹², Zhipeng Shen¹³, Shouhua Zhang¹⁴, Kehao Li¹⁴, Xin Chen¹⁵, Qun Gao¹⁶, Xianying Lu¹⁶, Tao Fang¹⁶, Yunxia Liu¹⁷, Linjie Li^{3

4}, Beijia Wang¹, Rui Zhou¹, Renjun Gu¹, Mohan Yang², Mengdie Zhang¹, Binghui Miao¹, Ju Gao¹⁸, Jinhu Wang^{19

20}, Hongmei Wang²¹

Affiliations

¹ Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China.
² Department of Nursing, School of Medicine, Shaoxing University, Zhejiang, China.
³ Department of Surgical Oncology, Children'S Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
⁴ Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
⁵ Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
⁶ Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
⁷ Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China.
⁸ Pediatric Hematology and Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
⁹ Department of Pediatric, The First Hospital of Chenzhou, Hunan, Chenzhou, China.
¹⁰ Department of Hematology and Oncology, Shenzhen Children'S Hospital, Shenzhen, Guangdong, China.
¹¹ Department of Orthopedics, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
¹² Division of Hematology/Oncology, Children'S Hospital of Zhejiang University School of Medicine, Hangzhou, China.
¹³ Department of Neurosurgery, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
¹⁴ Department of General Surgery, The Affiliated Children'S Hospital of Nanchang University, Nanchang, 330000, China.
¹⁵ Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
¹⁶ Department of General Surgery, Anhui Children'S Hospital, Hefei, Anhui, China.
¹⁷ Department of Oncology, The Third Hospital of Hangzhou, Affiliated Hangzhou Clinical College, Anhui Medical University, Hangzhou, China.
¹⁸ Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China. gaoju651220@126.com.
¹⁹ Department of Surgical Oncology, Children'S Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China. wjh@zju.edu.cn.
²⁰ Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China. wjh@zju.edu.cn.
²¹ Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China. rosa@zju.edu.cn.

^# Contributed equally.

PMID: 40011414
DOI: 10.1007/s11764-025-01768-7

Applied theory of planned behavior to explore associated factor of physical activity level among Chinese childhood cancer survivors

Fengjiao Xu et al. J Cancer Surviv. 2025.

. 2025 Feb 26.

doi: 10.1007/s11764-025-01768-7. Online ahead of print.

Authors

Affiliations

¹ Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China.
² Department of Nursing, School of Medicine, Shaoxing University, Zhejiang, China.
³ Department of Surgical Oncology, Children'S Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
⁴ Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
⁵ Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
⁶ Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
⁷ Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China.
⁸ Pediatric Hematology and Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
⁹ Department of Pediatric, The First Hospital of Chenzhou, Hunan, Chenzhou, China.
¹⁰ Department of Hematology and Oncology, Shenzhen Children'S Hospital, Shenzhen, Guangdong, China.
¹¹ Department of Orthopedics, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
¹² Division of Hematology/Oncology, Children'S Hospital of Zhejiang University School of Medicine, Hangzhou, China.
¹³ Department of Neurosurgery, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
¹⁴ Department of General Surgery, The Affiliated Children'S Hospital of Nanchang University, Nanchang, 330000, China.
¹⁵ Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
¹⁶ Department of General Surgery, Anhui Children'S Hospital, Hefei, Anhui, China.
¹⁷ Department of Oncology, The Third Hospital of Hangzhou, Affiliated Hangzhou Clinical College, Anhui Medical University, Hangzhou, China.
¹⁸ Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China. gaoju651220@126.com.
¹⁹ Department of Surgical Oncology, Children'S Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China. wjh@zju.edu.cn.
²⁰ Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China. wjh@zju.edu.cn.
²¹ Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China. rosa@zju.edu.cn.

^# Contributed equally.

PMID: 40011414
DOI: 10.1007/s11764-025-01768-7

Abstract

Objective: Low physical activity (PA) levels are common among childhood cancer survivors (CCS) and have a serious negative impact on their physical recovery and long-term health. This study aimed to explore the factors that contribute to low levels of PA from the perspective of children themselves and how these factors affect their PA.

Methods: In this cross-sectional survey, CCS were recruited by purposive sampling from several children's medical centers nationwide. The online questionnaires, which involved three valid scales (the Godin Leisure-Time Exercise Questionnaire, Theory of Planned Behavior (TPB) construct, and Physical Activity Self-efficacy), were used for data collection from July 2021 to January 2023. The Wilcoxon rank-sum test, Chi-square or Fisher's exact test, and logistic regression analysis were used to analyze the factors associated with PA in CCS. The associations between CCS' PA level and cognitive variables (TPB construct and self-efficacy) were evaluated using path analysis.

Results: Among the 1350 eligible participants, ultimately 964 of them submitted valid questionnaires. According to the leisure time index (LSI) scores, 59.34% of Chinese CCS reached the recommendation level of moderate-vigorous physical activity (MVPA) (LSI ≥ 24). Attending school, diagnosis, time since discharge, behavioral intention, and self-efficacy were associated with MVPA levels in CCS. Path analysis showed that intention and self-efficacy exerted a direct effect on CCS' PA, whereas the direct impact of perceived behavioral control on MVPA was not significant. The overall model fit indices of the TPB extended model incorporating self-efficacy showed the model fits the data well (RMSEA = 0.000, CFI = 1.000, NFI = 1.001, and TLI = 1.009).

Conclusion: Compared to healthy populations, the level of MVPA participation among Chinese CCS was relatively lower. Improving self-efficacy is essential for increasing participation in CCS' physical activities. The extended TPB model with self-efficacy is appropriate for explaining MVPA participation in CCS.

Implications for cancer survivors: This study highlights the critical need to address low physical activity levels among childhood cancer survivors (CCS), as insufficient engagement in moderate-vigorous physical activity (MVPA) may hinder their recovery and longterm health outcomes. The findings underscore the pivotal role of self-efficacy in promoting MVPA participation, with both direct and indirect effects on activity behaviors. Interventions targeting CCS should prioritize strategies to enhance self-efficacy-such as goal-setting, skill-building, and psychosocial support-to foster sustained engagement in physical activity. Additionally, the validated extended theory of planned behavior (TPB) model provides a framework for designing tailored, survivor-centered programs that address behavioral, social, and environmental barriers. Clinicians and caregivers should adopt multidimensional approaches integrating self-efficacy enhancement, peer/community support, and accessible physical activity opportunities to mitigate long-term health risks and improve quality of life for CCS.

Keywords: Cancer survivor; Children; Exercise; Physical activity; Self-efficacy; Theory of planned behavior.

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Conflict of interest statement

Declarations. Ethics approval: This study complied with the principles of the Helsinki Declaration on human research. Consent for participation or signature confirmation was required for this study in order to ensure that every patient was willing to participate. No potentially identifiable human images or data are presented in this study. Consent to participate: All the participants’ parents provided signed informed consent before the surveys were conducted. Competing interests: The authors declare no competing interests.

References

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Applied theory of planned behavior to explore associated factor of physical activity level among Chinese childhood cancer survivors

Affiliations

Applied theory of planned behavior to explore associated factor of physical activity level among Chinese childhood cancer survivors

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Miscellaneous