# Sedentary behavior and physical activity in survivors of childhood hodgkin lymphoma: a cross-sectional study

## TL;DR

This study uses wearable devices to assess physical activity and sedentary behavior in adult survivors of childhood Hodgkin lymphoma, finding that most meet moderate activity guidelines but few do vigorous activity.

## Contribution

The study is novel in using objective device-based monitoring to evaluate physical activity and sedentary behavior in Hodgkin lymphoma survivors.

## Key findings

- Participants spent a median of 704.8 minutes per day in sedentary behavior and 115 minutes in moderate-to-vigorous physical activity.
- Men and younger participants spent less time in light physical activity compared to women and older participants.
- Only 14% of participants met the recommended weekly vigorous physical activity guidelines.

## Abstract

Hodgkin lymphoma (HL) is one of the most common cancers during adolescence. Advances in treatment have achieved survival rates exceeding 90%. However, long-term treatment-related sequelae, including cardiovascular disease and metabolic syndrome, significantly affect the quality of life of survivors. Physical activity (PA) is considered a key strategy to mitigate these risks. Current studies predominantly rely on subjective assessments of movement behavior, which may lack accuracy. This cross-sectional study aims to use device-based monitoring to characterize levels of sedentary behavior and physical activity in survivors of childhood-diagnosed HL. Specific objectives were to evaluate these behaviors across age and gender groups and to assess compliance with physical activity guidelines for the adult population. The study involved 51 participants (59% female), with a median age of 25 years, a median age at diagnosis of 16 years, and a median time since diagnosis of 11 years. PA and sedentary behavior (SB) were measured over seven days using the Axivity AX3 accelerometer with a 24-hour wear protocol. Movement behavior was categorized into SB, light PA (LPA), moderate PA (MPA), and vigorous PA (VPA). Group differences in movement behaviors were examined using non-parametric tests, and results are presented as medians with interquartile ranges. Participants had a median daily time of 704.8 min in SB (IQR 127.9), 181.2 min in LPA (IQR 81.3), 110.2 min in MPA (IQR 68.8), and 2.8 min in VPA (IQR 2.8). Combined moderate-to-vigorous physical activity (MVPA) accounted for a median of 115 min per day (IQR 69.8). Significant differences in LPA were observed: men spent less time in LPA compared to women (p = 0.032), and younger participants spent less time in LPA compared to older participants (p = 0.006). While 100% of participants met the WHO-recommended threshold of > 150 min of MPA per week, only 14% met the guideline of > 75 min of VPA per week. Our study indicates that survivors diagnosed with childhood HL can achieve the levels of MVPA recommended by current adult PA guidelines, despite undergoing chemotherapy and radiotherapy. Additionally, significant differences in low-intensity PA were identified: men and younger participants spent less time in LPA compared to women and older participants, respectively. These findings highlight the importance of monitoring movement behaviors in long-term follow-up care to identify survivors with insufficient physical activity and excessive sedentary behavior and to implement targeted interventions to reduce long-term cardiovascular and metabolic risk. Given the cross-sectional design, causal relationships and changes in physical activity behavior over time cannot be inferred.