Pediatr Blood Cancer 2014;61:1023–1028 Comparison of Self-Reported Physical Activity in Children and Adolescents Before and During Cancer Treatment Miriam Go ¨ tte, Dipl, 1 * Sabine Kesting, MA, 1 Corinna Winter, PhD, 2 Dieter Rosenbaum, PhD, 2 and Joachim Boos, MD 1 INTRODUCTION Physical activity and physical fitness are essential for a healthy development of children and adolescents [1,2] and physical education is a compulsory subject at school. Furthermore, there is strong evidence for the relationship between physical activity and motor proficiency in children and adolescents [3,4] Pediatric cancer patients in Germany are isolated from school and their social environments for up to one year. This implicates a reduction of activities of daily living like walking to school and playing with friends and leads to decreased activity levels [5,6]. However, no physical activity promotion routine is implemented for pediatric cancer patients as a supportive care during cancer treatment. Several studies already analyzed the consequences of cancer disease, medical treatment and physical inactivity on physical fitness. Preliminary results indicate a reduction of muscle strength [7], impairments in fine and gross motor skills [8] and a low functional capacity [9]. Although functional impairments seem to be present, not even physiotherapy as a basic physical activity support is offered to all patients. Even patients with identified musculoskeletal complications often are not referred to physiotherapy treatment [10]. The importance of physical activities during childhood is accepted generally and increasing evidence suggests that physical activity promotion during cancer treatment may have beneficial effects on physical and psychosocial well being as well [11,12]. The purpose of this survey was to evaluate the current need for exercise interventions in children and adolescents during acute cancer treatment. Therefore we compared physical activity levels before and during cancer diagnosis by self-reports. Furthermore we referred the patients’ activity levels to corresponding reference values and analyzed different entities and treatment phases. This paper describes intra-individual changes of physical activity levels in different types of pediatric cancer and provides information about specific risk factors for inactivity. METHODS Recruitment and Study Design This cross-sectional study included patients who were treated at the Department for Pediatric Hematology and Oncology at University Hospital Muenster between February 2011 and July 2013. Inclusion criteria were regular in-patient stays at the pediatric cancer ward during this defined time period, age between 4 and 23 years and no survey during initial therapy for patients who have a relapse. The survey was administered at a standardized date 3 months post diagnosis in order to assess leukemia patients during consolidation and bone tumor patients during neo-adjuvant therapy. An exclusion criterion was the inability to fill in the questionnaire due to lack of understanding the German language or cognitive impairments. All patients and their legal guardians were informed orally and in writing about the study design that ensured pseudonymization of patients and data and they were asked to provide written consent for participating. The local ethics committee had approved this study. For several years, the pediatric cancer ward in Muenster has been offering a supervised exercise program and all patients of the present study had the possibility to take part voluntarily in this sport pedagogical program during their in-patient treatment phases. However, the underlying research question did not focus on assessing effects of this program. Physical Activity Questionnaire Data about physical activity before and during treatment was collected with a modified version of the physical activity questionnaire from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) of the Robert Koch Institute [13,14]. Therefore, results of activity levels before Background. Physical activities are important for the develop- ment of children and increasing evidence suggests beneficial effects of physical activity promotion during cancer treatment as well. The present study aimed at evaluating the current need of exercise interventions in pediatric cancer patients undergoing acute treatment and identifying risk factors for inactivity. Procedure. Data about self- reported physical activity before and during treatment was collected in a cross-sectional design with the physical activity questionnaire from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) in a modified cancer specific version. Results. One hundred thirty pediatric cancer patients with various entities were questioned 3.0  1.6 months since diagnosis. Patients’ activity levels before diagnosis mainly matched reference values for healthy children in Germany. Reductions during treatment affected all dimensions of daily physical activities and minutes of exercise per week decreased significantly (P < 0.001). Largest reductions of physical activities during treatment were identified for bone tumor patients and in-patient stays. Conclusions. Due to the well known importance of physical activity during childhood and the identified risk of inactivity during cancer treatment, supervised exercise interventions should be implemented into acute treatment phase to enhance activity levels and ensure a continuously support by qualified exercise professionals. Pediatr Blood Cancer 2014;61:1023–1028. # 2013 Wiley Periodicals, Inc. Key words: acute treatment; bone tumor; exercise; leukemia; pediatric cancer patients; physical activity 1 Department of Pediatric Hematology and Oncology, University Hospital of Muenster, Muenster, Germany; 2 Movement Analysis Laboratory, Institute for Experimental Musculoskeletal Medicine, University Hospital of Muenster, Muenster, Germany Grant sponsor: Cora Lobscheid-Stiftung Conflict of interest: Nothing to declare.  Correspondence to: Miriam Go ¨tte, Department for Pediatric Hema- tology and Oncology, University Hospital of Muenster, Albert- Schweitzer-Campus 1, A1, Muenster 48149, Germany. E-mail: miriam.goette@ukmuenster.de Received 23 September 2013; Accepted 19 November 2013  C 2013 Wiley Periodicals, Inc. DOI 10.1002/pbc.24898 Published online 19 December 2013 in Wiley Online Library (wileyonlinelibrary.com).