How do parents perceive physical activity in children with cancer?

The role of the family is critical to the encouragement of physical activity (PA) among childhood cancer survivors (CCS), according to a Singapore study. Apart from individuals and families, the community and society can also influence participation in PA.

“This study provides insight into the childhood cancer journey in relation to PA from the perspective of parents of CCS,” the researchers said. “Parents believe that PA is important and has positive benefits.”

The researchers recruited participants through a local charity via email, posters, and social media. They conducted 1-h semi-structured interviews online with seven parents. These interviews were recorded with consent, transcribed verbatim, and analysed using thematic analysis.

Parents stated that childhood cancer had negative effects on quality of life and participation in PA. They also described several PA determinants, which were analysed using the socioecological model. Some of these determinants acted as facilitators and others as barriers. [Singapore Med J 2025;66:314-320]

Individual factors such as gender, age, and personality influenced participation in PA, and each child had a unique way of coping with cancer. Some were resilient and had a positive outlook, while others were angry and in denial. [Health Educ Q 1988;15:351-377; Oncol Nurs Forum 2018;45:527-544]

“Certain social norms regarding the sick role define expectations of appropriate behaviour, such as the sick person being exempt from PA,” the researchers said. [Omega (Westport) 2021;83:470-486]

The sick role and psychological distress were significantly associated with practices that result in adverse health outcomes in CCS. Sedentary behaviour and eating habits learned during hospitalization could be brought into survivorship. [J Clin Oncol 2018;36:2190-2197]

Culture

Likewise, social norms and cultural beliefs may affect parenting styles and decisions. Previous studies showed that parents of chronically ill children had a tendency to be overprotective, leading to inadvertent restriction of PA. [BMC Pediatr 2014;14:313; BMC Pediatr 2009;9:1]

“It has been reported that parents may abandon their usual discipline strategies to make their child more comfortable: they may give more treats, snacks, or screen time,” the researchers said. [J Clin Oncol 2018;36:2190-2197]

Additionally, parenting stress predicted poor behaviour in children with cancer. Parents might find it difficult to re-establish discipline in the household after treatment. [J Pediatr 2020;218:166-177.e2; Eur J Cancer Care (Engl) 2016;25:616-637]

“Although parents in this study did not admit to being overly protective, they did express worry about the potential harm resulting from PA,” the researchers said. “This has implications for harnessing parental involvement as a part of potential intervention strategies.”

Community

Schools and the healthcare system can also help promote the importance of PA among families, the same way that safe neighbourhoods and accessibility to green spaces can encourage PA. [Sport Educ Soc 2015;20:1048-1064]

“Parental responses in the study reflected broader societal and cultural beliefs, for example, a strong emphasis on educational achievement and after-school classes over PA,” the researchers said.

“The prioritization of education over free play has been reported in Asian culture,” they added. [Childhood 2012;19:235-250; Eur Phy Educ Rev 2019;25:456-473; Qual Health Res 2016;26:1753-1760]

The choice of school also influences the activity levels, as pointed out in a previous study, which reported that children are more likely to engage in sport-related activities and have greater PA levels in schools with a strong sports culture. [Soc Sci Comput Rev 2019;doi:10.1177/0894439319893612]

“Promoting and providing increased opportunities for PA can ultimately reduce the risk of other long-term chronic illnesses, reduce the burden of care through maintaining a healthy lifestyle and improve the quality of life,” the researchers said.