Journal of Cancer Survivorship

, Volume 6, Issue 1, pp 45–53

Physical activity among adult survivors of childhood lower-extremity sarcoma

  • Meredith A. Wampler
  • Mary Lou Galantino
  • Sujuan Huang
  • Laura S. Gilchrist
  • Victoria G. Marchese
  • G. Stephen Morris
  • David A. Scalzitti
  • Melissa M. Hudson
  • Kevin C. Oeffinger
  • Marilyn Stovall
  • Wendy M. Leisenring
  • Gregory T. Armstrong
  • Leslie L. Robison
  • Kirsten K. Ness



Adult survivors of childhood lower-extremity sarcoma are largely physically inactive, a behavior which potentially compounds their health burden. Altering this behavior requires understanding those factors that contribute to their physical inactivity. Therefore, this investigation sought to identify factors associated with inactivity in this subpopulation of cancer survivors.


Demographic, personal, treatment, and physical activity information from adult survivors of childhood lower-extremity sarcomas was obtained from the Childhood Cancer Survivor Study (CCSS) cohort. Generalized linear models were used to identify variables that best identified those individuals who were physically inactive.


Only 41% of survivors met Center for Disease Control (CDC) activity guidelines. Survivors were 1.20 (95% confidence intervals (CI) 1.11–1.30) more likely compared to CCSS sibling cohort and 1.12 (95% CI 1.10–1.15) times more likely than the general population to fail to meet CDC guidelines. Significant predictors of physical inactivity included female sex, hemipelvectomy surgery, and platinum and vinca alkaloid chemotherapy.


The primary findings of this study are that survivors of childhood onset lower-extremity sarcoma are (1) highly likely to be physically inactive and (2) less likely than their siblings or the general population to regularly exercise. This study has identified treatment-related risk factors associated with inactivity that will help health and wellness practitioners develop successful exercise interventions to help these survivors achieve recommended levels of physical activity for health.

Implications for cancer survivors

These results suggest that physical activity interventions for adult survivors of childhood lower-extremity sarcomas should be sex specific and responsive to unique physical late effects experienced by these survivors.


Childhood cancer Physical activity Exercise Late effects Sedentary 


  1. 1.
    Heare T, Hensley MA, Dell'Orfano S. Bone tumors: osteosarcoma and Ewing's sarcoma. Curr Opin Pediatr. 2009;21:365–72.PubMedCrossRefGoogle Scholar
  2. 2.
    Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N, et al. SEER Cancer Statistics Review, 1975–2006, based on November 2008 SEER data submission. Bethesda, MD: National Cancer Institute (2009). Accessed 17 January 2011
  3. 3.
    Hosalkar HS, Dormans JP. Limb sparing surgery for pediatric musculoskeletal tumors. Pediatr Blood Cancer. 2004;42:295–310.PubMedCrossRefGoogle Scholar
  4. 4.
    Marina N, Gebhardt M, Teot L, Gorlick R. Biology and therapeutic advances for pediatric osteosarcoma. Oncologist. 2004;9:422–41.PubMedCrossRefGoogle Scholar
  5. 5.
    Carty CP, Dickinson IC, Watts MC, Crawford RW, Steadman P. Impairment and disability following limb salvage procedures for bone sarcoma. Knee. 2009;16:405–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Kadan-Lottick NS, Dinu I, Wasilewski-Masker K, Kaste S, Meacham LR, Mahajan A, et al. Osteonecrosis in adult survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2008;26:3038–45.PubMedCrossRefGoogle Scholar
  7. 7.
    Scully RE, Lipshultz SE. Anthracycline cardiotoxicity in long-term survivors of childhood cancer. Cardiovasc Toxicol. 2007;7:122–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Earl HM, Connolly S, Latoufis C, Eagle K, Ash CM, Fowler C, et al. Long-term neurotoxicity of chemotherapy in adolescents and young adults treated for bone and soft tissue sarcomas. Sarcoma. 1998;2:97–105.PubMedCrossRefGoogle Scholar
  9. 9.
    Kaste SC, Ahn H, Liu T, Liu W, Krasin MJ, Hudson MM, et al. Bone mineral density deficits in pediatric patients treated for sarcoma. Pediatr Blood Cancer. 2008;50:1032–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Lipshultz SE, Alvarez JA, Scully RE. Anthracycline associated cardiotoxicity in survivors of childhood cancer. Heart. 2008;94:525–33.PubMedCrossRefGoogle Scholar
  11. 11.
    Meacham LR, Chow EJ, Ness KK, Kamdar KY, Chen Y, Yasui Y, et al. Cardiovascular risk factors in adult survivors of pediatric cancer—a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev. 2010;19:170–81.PubMedCrossRefGoogle Scholar
  12. 12.
    Ness KK, Leisenring WM, Huang S, Hudson MM, Gurney JG, Whelan K, et al. Predictors of inactive lifestyle among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer. 2009;115:1984–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2010;4:87–100.PubMedCrossRefGoogle Scholar
  14. 14.
    Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, Vallance JK, et al. A longitudinal study of exercise barriers in colorectal cancer survivors participating in a randomized controlled trial. Ann Behav Med. 2005;29:147–53.PubMedCrossRefGoogle Scholar
  15. 15.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol. 2005;23:5814–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Rogers LQ, Hopkins-Price P, Vicari S, Pamenter R, Courneya KS, Markwell S, et al. A randomized trial to increase physical activity in breast cancer survivors. Med Sci Sports Exerc. 2009;41:935–46.PubMedCrossRefGoogle Scholar
  17. 17.
    Robison LL, Armstrong GT, Boice JD, Chow EJ, Davies SM, Donaldson SS, et al. The Childhood Cancer Survivor Study: a National Cancer Institute-supported resource for outcome and intervention research. J Clin Oncol. 2009;27:2308–18.PubMedCrossRefGoogle Scholar
  18. 18.
    The Secretariat/WHO International Association of Cancer Registries. International Classification of Diseases for Oncology. 3 rd Edition (ICD-O-3)th ed. Lyon Cedex, France: World Health Organization; 2000.Google Scholar
  19. 19.
    Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Questionnaire. (2003). Accessed 14 May 2001
  21. 21.
    Jones DA, Ainsworth BE, Croft JB, Macera CA, Lloyd EE, Yusuf HR. Moderate leisure-time physical activity: who is meeting the public health recommendations? A national cross-sectional study. Arch Fam Med. 1998;7:285–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Trost SG, Owen N, Bauman AE, Sallis JF, Brown W. Correlates of adults' participation in physical activity: review and update. Med Sci Sports Exerc. 2002;34:1996–2001.PubMedCrossRefGoogle Scholar
  23. 23.
    Warms CA, Belza BL, Whitney JD. Correlates of physical activity in adults with mobility limitations. Fam Community Health. 2007;30:S5–16.PubMedGoogle Scholar
  24. 24.
    Osterkamp LK. Current perspective on assessment of human body proportions of relevance to amputees. J Am Diet Assoc. 1995;95:215–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Katon W, Richardson L, Russo J, McCarty CA, Rockhill C, McCauley E, et al. Depressive symptoms in adolescence: the association with multiple health risk behaviors. Gen Hosp Psychiatry. 2010;32:233–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Derogatis LR. Brief Symptom Inventory (BSI) 18, Administration, Scoring, and Procedures Manual. Minneapolis, MN: NCS Pearson, Inc.; 2000.Google Scholar
  27. 27.
    McCullock C, Searle S. Generalized, linear, and mixed models. Wiley, NY: Wiley; 2001.Google Scholar
  28. 28.
    Deddens JA, Petersen MR, Lei X, (eds). Estimation of prevalence ratios when PROC GENMOD does not converge. SUGI Proceedings (Paper 270–28) 2003 March 30–April 2; Seattle, Washington.Google Scholar
  29. 29.
    Egede LE, Poston ME. Racial/ethnic differences in leisure-time physical activity levels among individuals with diabetes. Diabetes Care. 2004;27:2493–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Jones G, Sinclair L. Multiple health disparities among minority adults with mobility limitations: An application of the ICF framework and codes. Disabil Rehabil. 2008;30:901–15.PubMedCrossRefGoogle Scholar
  31. 31.
    Gilchrist L, Tanner L, Hooke MC. Measuring chemotherapy-induced peripheral neuropathy in children: development of the Ped-mTNS and pilot study results. Rehab Oncol. 2009;27:7–15.Google Scholar
  32. 32.
    Ramchandren S, Leonard M, Mody RJ, Donohue JE, Moyer J, Hutchinson R, et al. Peripheral neuropathy in survivors of childhood acute lymphoblastic leukemia. J Peripher Nerv Syst. 2009;14:184–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Reinders-Messelink HA, Van Weerden TW, Fock JM, Gidding CE, Vingerhoets HM, Schoemaker MM, et al. Mild axonal neuropathy of children during treatment for acute lymphoblastic leukaemia. Eur J Paediatr Neurol. 2000;4:225–33.PubMedCrossRefGoogle Scholar
  34. 34.
    Florin TA, Fryer GE, Miyoshi T, Weitzman M, Mertens AC, Hudson MM, et al. Physical inactivity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev. 2007;16:1356–63.PubMedCrossRefGoogle Scholar
  35. 35.
    Wright MJ, Galea V, Barr RD. Proficiency of balance in children and youth who have had acute lymphoblastic leukemia. Phys Ther. 2005;85:782–90.PubMedGoogle Scholar
  36. 36.
    Strath SJ, Bassett Jr DR, Ham SA, Swartz AM. Assessment of physical activity by telephone interview versus objective monitoring. Med Sci Sports Exerc. 2003;35:2112–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion. Physical Activity Guidelines for Americans: Children and Adolescents. (2008); updated 2008; cited 2011 January 17

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Meredith A. Wampler
    • 1
  • Mary Lou Galantino
    • 2
    • 10
  • Sujuan Huang
    • 3
  • Laura S. Gilchrist
    • 4
    • 11
  • Victoria G. Marchese
    • 5
    • 12
  • G. Stephen Morris
    • 6
  • David A. Scalzitti
    • 7
  • Melissa M. Hudson
    • 3
  • Kevin C. Oeffinger
    • 8
  • Marilyn Stovall
    • 6
  • Wendy M. Leisenring
    • 9
  • Gregory T. Armstrong
    • 3
  • Leslie L. Robison
    • 3
  • Kirsten K. Ness
    • 3
  1. 1.Harrison Medical Center, Outpatient RehabilitationBremertonUSA
  2. 2.Adjunct Research Scholar, University of PennsylvaniaPhiladelphiaUSA
  3. 3.St. Jude Children’s Research HospitalMemphisUSA
  4. 4.St. Catherine UniversityMinneapolisUSA
  5. 5.Penn State Hershey College of Medicine at The Pennsylvania State UniversityHersheyUSA
  6. 6.University of Texas M. D. Anderson Cancer CenterHoustonUSA
  7. 7.American Physical Therapy AssociationAlexandriaUSA
  8. 8.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  9. 9.Fred Hutchinson Cancer Research CenterSeattleUSA
  10. 10.Stockton UniversityStocktonUSA
  11. 11.Children’s Hospitals and Clinics of MinnesotaMinneapolisUSA
  12. 12.Lebanon Valley CollegeAnnvilleUSA

Personalised recommendations