# Structured and Unstructured Physical Activity, Screen Time and Quality of Life in Childhood Cancer Survivors

## TL;DR

Childhood cancer survivors often lack awareness of healthy activity guidelines and report poor physical activity and high screen time, which may affect their quality of life.

## Contribution

This study is the first to assess knowledge and patterns of structured/unstructured activity and screen time in childhood cancer survivors and their relation to quality of life.

## Key findings

- Most survivors were unaware of recommended physical activity and screen time limits.
- Excessive screen time and low physical activity were linked to poorer quality of life.
- Activity levels varied seasonally, with less unstructured activity in winter.

## Abstract

Many children who survive cancer face long-term health challenges, and daily habits like being active or spending time on screens can play an important role in their wellbeing. In this study, we explored how much physical activity and recreational screen time 8–13-year-old survivors report engaging in, and how aware they are of the recommended guidelines. We found that 85% and 58% of survivors were not aware of recommended limits for screen time and physical activity, 65% and 73% spent too much time on screens on weekdays and weekends, and 81% did not meet physical activity recommendations. Survivors who exceeded recommended screen time, or were less active, also reported poorer quality of life. These findings suggest that survivors need clearer guidance and support to build healthy lifestyles after cancer. By understanding these behaviours, researchers and clinicians can design better programmes that help survivors stay active, limit screen use, and improve their long-term health after cancer.

Background/Objectives: Childhood cancer survivors face long-term cancer-related health risks, and daily behaviours, such as physical activity and recreational screen use, may influence their long-term overall wellbeing. Yet, little is known about survivors’ knowledge and understanding of recommended guidelines or their patterns of structured and unstructured activity. This study aimed to (i) assess survivors’ knowledge of physical activity and screen time guidelines, (ii) describe their self-reported (un)structured activity and screen use across weekdays and weekends, and (iii) examine associations with health-related quality of life. Methods: This secondary analysis used data from a feasibility pilot study of an intervention for survivors aged 8–13 years who had completed cancer treatment at least 12 months earlier. Participants self-reported physical activity, recreational screen use, knowledge of guidelines, and health-related quality of life (HRQoL). We used descriptive statistics and non-parametric tests to analyse behavioural patterns and associations. Results: Over one-third of survivors underestimated or overestimated the recommended physical activity and screen time (35%), whilst 23–50% reported ‘don’t know’. Participation in ‘Physical Education’ classes at school did not differ between summer and winter school terms, yet there was greater participation in structured physical activities in winter compared to summer school terms (median 270 vs. 170 min/week). For unstructured physical activities, 69% reported engaging in a median of 60 min/week at school on most days of the week in summer, whilst most survivors (96%) did not report any unstructured activity in winter. Only 19% met the recommended daily minimum of 60 min of physical activity year-round. Excessive screen use increased from school days (19%) to weekends (46%), notably handheld device screen time. We did not find any significant associations between meeting physical activity and screen time recommendations and HRQoL. Conclusions: Survivors frequently engage in irregular structured and unstructured physical activity levels and increased screen time. These findings emphasise the need for targeted, year-round interventions to improve physical activity, reduce recreational screen use, and support long-term survivorship health.