Moving Through Cancer: How Children and Teens Experience Physical Activity During and After Treatment

Table of Contents

• Key Points
• Why This Research Matters
• How the Research Was Conducted
• Key Findings: What the Studies Revealed
• What This Means for Patients and Families
• Study Limitations
• Recommendations for the Future
• Frequently Asked Questions
• Source Information

Key Points

• Physical activity is safe and doable for most pediatric cancer patients and survivors, with minimal to no adverse events reported.
• Physical activity can improve physical, emotional, social, and cognitive outcomes, but most young patients are less active than healthy peers.
• Fatigue, pain, reduced capacity, lack of opportunities, and feeling different from peers are common barriers to staying active.
• Support from family, friends, and healthcare providers helps; individualized, co-designed activity programs are recommended.
• The review included 27 qualitative studies with 798 participants; most were after treatment and only one study focused solely on leukemia.

Why This Research Matters

Cancer diagnosed during childhood or adolescence—defined as ages 0 to 19—is relatively rare, yet it affects an estimated 400,000 young people globally each year. The good news is that survival rates continue to climb: nearly 85% of those diagnosed now survive at least 5 years, and more than 70% survive 10 years or longer. However, survival often comes at a cost.

Pediatric cancer remains a leading cause of long-term health problems, including cardiopulmonary (heart and lung) conditions, secondary cancers, and premature death. During treatment, children and adolescents frequently report side effects such as nausea, pain, and fatigue. After treatment ends, many continue to experience adverse physical, psychosocial (emotional and social), and cognitive (thinking and memory) effects that can persist for years.

Physical activity (PA)—defined as any bodily movement produced by skeletal muscles that requires more energy than resting—has been shown to be a promising strategy to counteract many of these negative effects. Research has demonstrated that physical activity is:

• Doable during and beyond treatment
• Low-risk, with minimal to no adverse events reported
• Helpful for reducing the severity of some treatment-related side effects
• Beneficial for improving physical, psychosocial, and cognitive outcomes in both the short and long term

Greater physical activity has also been linked to reductions in illness, secondary cancers, and premature death. These benefits have been captured in numerous systematic reviews and meta-analyses and are reflected in official physical activity guidelines for this population.

Yet despite the clear benefits, most pediatric cancer patients and survivors engage in significantly less physical activity than their healthy peers. Adherence to physical activity programs is inconsistent, and few researchers have asked young patients themselves what outcomes matter most to them. This research gap leaves important questions unanswered: Why do young cancer patients and survivors struggle to stay active? What helps them? What gets in the way?

Qualitative research—which uses interviews, open-ended questions, and other methods that center on people's lived experiences—offers a powerful way to answer these questions. For example, one study by Larsen and colleagues interviewed 63 pediatric cancer survivors (and their parents) and uncovered the significant and pervasive negative impact that treatment-related long-term or late effects have on physical activity. Participants described how reduced physical capacity, lack of opportunities, and a perceived ability gap between themselves and their peers affected their motivation to be active. These relationships were further shaped—both positively and negatively—by environmental (surroundings), interpersonal (relationships), and individual factors.

While individual qualitative studies like this one are valuable, they are rarely used on their own to guide practice. Just as quantitative studies need to be pooled in systematic reviews, qualitative findings need to be systematically collected and synthesized. A notable earlier effort by Brown and colleagues identified 8 articles on barriers and facilitators to physical activity among pediatric cancer survivors, mapping the results onto a theoretical framework. However, most published reviews on this topic have focused primarily on quantitative data, and where qualitative studies were included, no formal meta-synthesis was performed. This review set out to fill that gap.

How the Research Was Conducted

The researchers used a rigorous approach called a meta-synthesis—a method that combines and interprets findings from multiple qualitative studies to develop a deeper, more nuanced understanding of a topic. The protocol was registered in advance in PROSPERO (registration number: CRD42023432809) to ensure transparency and accountability, and reporting followed the ENTREQ framework, an internationally recognized guideline for synthesizing qualitative research.

The Research Team's Perspective

It is important to know that the research team adopted a relativist perspective, meaning they recognized that reality is subjective, context-dependent, and shaped by individual and cultural viewpoints. The team views knowledge as pluralistic—emerging from diverse lived experiences and interpretations. Their goal was not to decide which perspective was "right" but to document, respect, and amplify the variety of voices in the literature. It is also worth noting that the research team holds a positive view of physical activity and has developed, delivered, and evaluated physical activity programs in pediatric oncology and other clinical populations. This professional commitment shaped how they interpreted the data.

The Search Process

The team systematically searched three electronic databases: MEDLINE, PsycINFO, and SPORTDiscus. The first search was conducted on May 19, 2023, and an updated search followed on April 7, 2025. Search terms covered the population (children, adolescents, cancer, oncology) and physical activity (exercise, sports, yoga, endurance, strength). Importantly, the search did not restrict by data collection method, to ensure that all relevant qualitative studies would be captured.

The initial search produced 4,443 references, and the updated search added 823 more, for a total of 5,266 references. After removing 205 duplicates, 5,061 unique references were screened at the title and abstract level. From these, 501 full-text articles were deemed potentially relevant and reviewed in detail.

Who Was Included

Articles were included if they met all of the following criteria:

1. Used any experimental design (such as randomized controlled trials or controlled before-and-after studies) evaluating physical activity, or an observational design exploring physical activity
2. Used qualitative or mixed methods, with pediatric cancer patients' and/or survivors' experiences captured through qualitative methods (interviews, open-ended questions, etc.)
3. Included children and/or adolescents under 19 years of age, either during treatment or after treatment, at any point along the cancer trajectory

There were some important nuances in the eligibility rules. If a study included some participants over age 19, the mean (average) age of participants had to be under 19. Similarly, if a study gathered perspectives from both patients and parents, the mean age of the children with cancer had to be under 19. Articles were excluded if they were not in English, lacked a full text, did not report qualitative findings in the results section, or did not focus on physical activity as a topic or intervention. Grey literature (conference abstracts, unpublished theses, dissertations), books, opinion pieces, and reviews were also excluded.

Screening and Quality Checks

Three authors were trained in the screening process, and two independently screened citations in two stages: first by title/abstract, then by full text. At each stage, disagreements were resolved through discussion or by consulting a third author. To measure how consistently the reviewers agreed, the researchers calculated Cohen's kappa (κ), a statistical measure of inter-rater agreement. At the title/abstract stage, agreement was moderate (κ₁ = 0.76, κ₂ = 0.64). At the full-text stage, agreement was moderate to strong (κ₁ = 0.8, κ₂ = 0.8).

After full-text review, 27 articles met all eligibility criteria and were included in the synthesis. The remaining 474 articles were excluded for the following reasons:

• 411 articles did not present qualitative findings related to physical activity
• 34 articles did not include pediatric cancer patients or survivors
• 25 articles were not primary studies
• 3 articles had no full text available
• 1 article was not in English

Assessing Study Quality

One author independently appraised each included study using the Standards for Reporting Qualitative Research (SRQR), a 21-item checklist that assesses the transparency of qualitative research reporting across sections: title and abstract (2 items), introduction (2 items), methods (11 items), results (2 items), discussion (2 items), and other (2 items). Reporting completeness was not used as a reason to exclude any article—instead, it was used to identify gaps and inform recommendations.

How the Data Were Analyzed

The analysis proceeded in three phases. First, a meta-method analysis examined the methodological landscape of the included studies—their designs, sampling techniques, data collection procedures, and analysis approaches. Second, a meta-theory analysis examined whether and how studies used theories or conceptual frameworks. For both analyses, frequencies, percentages, averages, standard deviations, medians, and interquartile ranges were calculated as appropriate.

Third, a meta-data analysis was conducted: two authors reviewed the extracted qualitative findings multiple times, then independently coded the data (including direct participant quotes) using a hybrid approach. This involved deductive coding (using the research objectives and the original authors' interpretations as a framework) combined with inductive coding (allowing the raw data to generate new codes and insights). After coding, the authors met to group codes into subthemes and themes, and then organized those themes into higher-order categories. A third author served as a "critical friend" throughout this process, challenging assumptions and encouraging deeper reflection.

As a final step, all three lead authors met to review and discuss the summarized data, identify patterns, explore possible influences, and develop an overarching narrative of physical activity experiences among pediatric cancer patients and survivors.

Key Findings: What the Studies Revealed

The Studies at a Glance

The 27 included articles involved 798 pediatric participants in total, with individual sample sizes ranging from 3 to 128 participants (average = 29.6, standard deviation = 26.5). This wide range reflects the diversity of study designs and settings.

• Gender representation: 26 of 27 articles (96.3%) reported participants' gender/sex, comprising 440 boys/males and 352 girls/females—an overall female representation of approximately 44.1%. Across individual studies, the percentage of girls ranged widely, from 0% to 70%.
• Age: Average participant ages ranged from 5.6 to 17.4 years across studies.
• Treatment status: 16 articles (59.3%) included participants who were beyond (after) treatment, 10 articles (37.0%) included participants during treatment, and 1 article (3.7%) included a mix of both.
• Cancer types: 25 articles (92.6%) reported the types of cancer; of these, 24 (88.8%) included mixed diagnoses and 1 (3.8%) focused solely on leukemia.
• Disease stage: Only 4 articles (14.8%) reported recruiting participants across cancer stages 1–4.

Study Designs and Methods Used

Of the 27 articles, 14 were experimental, meaning they evaluated physical activity interventions. The nature of these interventions varied considerably:

• Physical activity only: 7 articles (50.0%)
• Multimodal programs combining physical activity with other components such as nutrition education or motivational support: 2 articles (14.3%)
• Active video gaming: 2 articles (14.3%)
• Wearable fitness trackers: 3 articles (21.4%)

The remaining 13 articles were observational, meaning physical activity was studied as it occurred naturally in routine practice, community programs, usability testing, or daily life. Of these, 11 articles (84.6%) focused on factors related to physical activity behavior, and 2 (15.4%) explored cancer-related experiences more broadly, with physical activity as a secondary focus.

In terms of methodological rigor, the review found some notable gaps:

• Only 8 articles (29.6%) explicitly specified the qualitative methodology they used (e.g., grounded theory, phenomenology)
• Only 7 articles (25.9%) reported adopting a guiding theory or model
• Interviews were the most common data collection approach, used in 20 articles

Quality of Reporting in the Included Studies

The SRQR assessment revealed a mixed picture of reporting completeness, ranging from "poorly reported" to "well-reported" across the 27 articles:

• Title and Abstract: Generally poorly reported. Only 8 articles (29.6%) mentioned qualitative or mixed methods in the title, and 18 (66.7%) did so in the abstract.
• Introduction: Well-reported. All 27 articles (100%) clearly stated their problem formulation and research questions.
• Methods: Varied widely. The most consistently reported item was description of the study participants (26 articles; 96.3%). The least reported item was researcher characteristics and reflexivity—the acknowledgment of how the researchers' own backgrounds and biases might have influenced the study—reported in only 6 articles (22.2%).
• Results: Well-reported. All 27 articles (100%) included synthesis and interpretation of findings, and 21 articles (77.8%) linked their findings to empirical data through direct participant quotations.
• Discussion: Well-reported. All 27 articles (100%) integrated their findings with prior work, and 23 articles (85.2%) acknowledged their limitations.
• Other: Mixed. Most articles (20; 74.1%) reported conflicts of interest.

The Six Themes

Through the meta-data analysis, the researchers identified six themes (with additional subthemes), organized into two overarching categories that capture the dominant ideas across all studies:

Category 1: Physical Activity Experiences. This category captures what physical activity actually feels like and means to young people during and beyond cancer treatment. Children and adolescents described a wide range of experiences, from enjoyment and a sense of accomplishment to frustration and fear. For many, physical activity was experienced as a reminder of what their bodies could no longer do—a source of grief and loss. For others, it was a way to reclaim a sense of normalcy, control, and identity beyond being a "cancer patient."

Category 2: Influencing Factors. This category encompasses the many factors that shape motivation for and engagement in physical activity. These influences operated at multiple levels:

• Individual factors: fatigue, pain, physical capacity, confidence, motivation, and personal interests
• Interpersonal factors: support (or lack of support) from family, friends, and healthcare providers; comparison with peers; and social connections through group activities
• Environmental factors: access to facilities, availability of adapted programs, transportation, and the physical setting (hospital, home, or community)

The summarized data collectively highlighted three overarching insights. First, there are varied influences that shape motivation for and engagement in physical activity. Second, there is a complex interplay between cancer and physical activity experiences—the disease and its treatment profoundly affect how young people view, approach, and participate in physical activity. Third, physical activity can confer a range of potential benefits spanning physical, emotional, and social domains—not just improved fitness, but also better mood, self-esteem, social connection, and a sense of achievement.

Importantly, the researchers noted that articles without direct participant quotations did not yield insights that differed from those that included quotations. This suggests that the authors' interpretations in those studies were consistent with the broader body of evidence, strengthening confidence in the overall findings.

What This Means for Patients and Families

This meta-synthesis carries several important messages for children and adolescents living with and beyond cancer, as well as for their families and healthcare teams.

Physical activity is not a "one-size-fits-all" prescription. The findings make clear that physical activity experiences are deeply personal and shaped by each individual's circumstances, including their type of cancer, treatment stage, physical capacity, and social environment. A program that works for one teen may not work for another. This means that physical activity recommendations should be individualized—ideally co-designed with the young person and their family—to ensure they are accessible, meaningful, and feasible.

Both benefits and barriers are real. While the potential benefits of physical activity—physical, emotional, and social—are well documented in this synthesis, so too are the significant barriers. Fatigue, pain, reduced physical capacity, lack of opportunities, and feeling different from peers are not minor obstacles; they are powerful forces that shape whether a young person feels motivated or discouraged. Families should know that struggling to stay active during or after treatment is not a personal failure—it is a predictable response to an incredibly challenging situation.

Support matters. The synthesis highlights the critical role of support from family, friends, and healthcare providers. Positive encouragement, realistic goal-setting, and opportunities to be active with others who understand the cancer experience can make a meaningful difference. If your child is struggling with physical activity, know that you are not alone—and that asking for help from an oncology provider, physical therapist, or specialized exercise program is a reasonable and valuable step.

Study Limitations

This meta-synthesis provides a comprehensive and nuanced understanding of physical activity experiences among pediatric cancer patients and survivors, but several limitations should be kept in mind when interpreting the findings.

Missing or unclear data. The researchers noted that reporting completeness varied widely across the included articles, ranging from "poorly reported" to "well-reported." Notably, few studies reported researcher characteristics and reflexivity, and fewer than a third explicitly specified their qualitative methodology or guiding theory. This makes it harder to fully contextualize individual study findings.

Limited scope of some studies. Only 4 of the 27 articles reported the cancer stage of participants, and only 1 article focused on a single cancer type (leukemia). Cancer type and stage can significantly affect physical capacity and treatment side effects, so the findings may not be equally applicable across all diagnoses.

Underrepresentation of certain perspectives. Although the overall sample included a reasonable balance of boys and girls (approximately 44.1% female), individual studies varied widely in gender representation, from 0% to 70%. This means some studies may not reflect the experiences of both genders equally.

Treatment status imbalance. More than half of the included articles (59.3%) focused on participants beyond treatment. While this is helpful for understanding survivorship, it means relatively fewer studies captured the unique challenges of being physically active during active treatment.

Language and publication bias. Only English-language articles were included, and grey literature (conference abstracts, unpublished theses, dissertations) was excluded. It is possible that relevant findings published in other languages or in non-traditional formats were missed, and studies with positive or notable findings may be more likely to be published than those with neutral or null results.

Interpretation is shaped by the research team. As the authors openly acknowledged, their analysis was shaped by their own perspectives—they hold a positive view of physical activity and have professional experience designing and delivering physical activity programs for this population. While the team took steps to amplify diverse voices from the data, their interpretive lens is inherently part of the synthesis process.

Recommendations for the Future

Based on the identified knowledge gaps, the researchers offered several recommendations for future research and practice.

For researchers:

1. Prioritize methodological rigor. Future qualitative studies should clearly specify their methodology, report researcher characteristics and reflexivity, and follow established reporting guidelines such as SRQR or ENTREQ. This will strengthen confidence in findings and make future syntheses more meaningful.
2. Integrate theory. Fewer than one-third of the included articles used a guiding theory or model. Applying established behavior-change or implementation-science frameworks could help identify why and for whom physical activity programs work.
3. Use co-designed approaches. The findings emphasize that pediatric cancer patients and survivors have valuable insights about what is meaningful, accessible, and feasible. Involving them as partners in designing, implementing, and evaluating physical activity programs is essential to ensure relevance and uptake.
4. Broaden the evidence base. More studies are needed that include participants during active treatment, capture diverse cancer diagnoses and stages, and explore physical activity experiences in a wider range of settings and cultural contexts.

For healthcare providers and program developers:

1. Ask about physical activity. Simply asking young patients and survivors about their physical activity experiences—what they enjoy, what discourages them, and what would help—can reveal important opportunities for support.
2. Address barriers at multiple levels. Because barriers exist at individual, interpersonal, and environmental levels, solutions should too. This might include providing adapted equipment, facilitating peer support, or connecting families with accessible community-based programs.
3. Emphasize benefits beyond fitness. The physical, emotional, and social benefits of physical activity are all meaningful. Highlighting how being active can improve mood, build friendships, and restore a sense of confidence may be just as motivating as talking about physical fitness.

For patients and families:

If you or your child is living with or beyond cancer, remember that there is no "right way" to be active. Find activities that feel manageable and enjoyable, set realistic goals, and lean on your support network. If physical activity feels overwhelming, start small—short walks, gentle stretches, or an activity you loved before treatment. Progress may be slow, but it is still progress. Most importantly, speak up about what you need: healthcare providers can only help if they understand what you are experiencing.

Frequently Asked Questions

Is physical activity safe for children and teens during or after cancer treatment?

Yes, in research with young cancer patients and survivors, physical activity was described as doable and low-risk, with minimal to no adverse events reported. However, every child's situation is different, so it is important to talk with your oncology provider or physical therapist before starting or changing activity to make sure it is appropriate for your child.

What benefits can physical activity provide for young cancer patients and survivors?

Physical activity may help reduce the severity of some treatment side effects and improve physical, emotional, social, and thinking outcomes in the short and long term. Young people described benefits like better mood, self-esteem, social connection, and a sense of achievement, not just improved fitness. Greater physical activity has also been linked to fewer long-term health problems.

Why do some children and teens struggle to stay active during or after cancer treatment?

Common barriers include fatigue, pain, reduced physical capacity, lack of opportunities, and feeling different from peers. These obstacles can strongly shape motivation. Struggling to stay active is not a personal failure; it is a predictable response to a very challenging situation, and support can help overcome these barriers.

How can family and friends help a young cancer patient be more physically active?

Support from family, friends, and healthcare providers makes a meaningful difference. Positive encouragement, realistic goal-setting, and opportunities to be active with others who understand the cancer experience can help. Asking an oncology provider, physical therapist, or specialized exercise program for guidance is also a valuable step.

What should we do if physical activity feels overwhelming for our child?

Start small with short walks, gentle stretches, or an activity your child enjoyed before treatment. Set realistic goals and remember progress may be slow but still counts. Speak up about what your child needs, because healthcare providers can only help when they understand what your family is experiencing.

Do young cancer patients and survivors get enough physical activity compared to healthy peers?

Most pediatric cancer patients and survivors are significantly less active than their healthy peers, and participation in physical activity programs is often inconsistent. This gap exists despite clear benefits, which is why researchers emphasize that activity programs should be personalized and co-designed with young people to make them more appealing and feasible.

What are the limitations of the research on physical activity in young cancer patients?

Only 4 of 27 studies reported participants' cancer stage, and only one focused on a single cancer type, leukemia. Most studies involved children after treatment rather than during active treatment. Only English-language articles were included, and reporting quality varied, so findings may not apply equally to every diagnosis or situation.

When should parents of a child or teen with cancer seek a second opinion about physical activity recommendations?

For a child or teen living with or beyond cancer, physical activity can bring physical, emotional, and social benefits, yet many struggle to stay active because of fatigue, pain, reduced physical capacity, and a perceived gap with peers. If a recommended activity program feels unrealistic, ignores these barriers, or does not reflect what your child enjoys, seeking a second opinion can help. A specialist can review the activity plan and suggest an individualized, co-designed approach that fits your child's treatment stage, capabilities, and preferences. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

Original article title: Exploring physical activity experiences among children and adolescents during and beyond cancer treatment: a meta-synthesis of qualitative research.

Authors: Wurz A, Price J, Oser M, Filiatrault M, Conlan H, Grimshaw SL.

Journal: BMC Cancer (2026) 26:326

DOI: https://doi.org/10.1186/s12885-025-15490-1

Publication type: Open Access systematic review

Registration: PROSPERO protocol CRD42023432809

This patient-friendly article is based on peer-reviewed research. The original findings have been translated and summarized to make them accessible to patients, families, and the general public while preserving all numerical data, study details, and conclusions from the source publication.