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Methodological non-experimental study.
Participants
Adult childhood cancer survivors were recruited from the Long-Term Follow-Up Clinic (LTFU) at the Department of Oncology, Sahlgrenska University Hospital in Gothenburg, Sweden, between November 2021 and September 2022. Inclusion criteria were age ≥ 18 years, diagnosed with cancer at < 18 years of age. Exclusion criteria were recurrence or secondary malignancy at study inclusion, individuals with physical or cognitive impairments or insufficient knowledge of the Swedish language.
Procedure
A physician screened eligible patients for participation during a physical or digital visit at the LTFU and provided written study material and information that the study coordinator would call within a week. Participants who signed informed consent received the study questionnaire, wear-time diary and accelerometer by post. The questionnaire covered background data (e.g. age, gender, level of education, employment status, cancer diagnosis), and contained the BHW-Q and the SED-GIH-Q. The questionnaire also included a question about whether participants had received any information about physical activity recommendations during or after treatment. The participants were asked to fill in the questionnaire and to wear the accelerometer on their right hip during waking hours for seven days. They were instructed to take off the accelerometer during water-based activities (e.g. showering). Participants were asked to report the accelerometer wear time in a diary. After seven days, the participants were asked to fill in the BHW-Q and the SED-GIH-Q again. After completion, the accelerometer and questionnaires were sent back to the LTFU at the Department of Oncology, Sahlgrenska in stamped addressed envelopes.
Measurements
Physical activity and sedentary time questionnaire
The physical activity questionnaire (BHW-Q) contains two questions [17].
BHW-Q VPA: During a regular week, how much time do you spend exercising at a level that makes you short of breath, for example running, fitness class, or ball games?
The questions are answered by pre-defined categories 1–6:
1 = 0 min, 2 = less than 30 min, 3 = 31–60 min, 4 = 61–90 min, 5 = 91–120 min, 6 = more than 120 min.
BHW-Q MPA: During a regular week, how much time are you physically active in ways that are not exercise, for example walks, bicycling, or gardening? Add together all activities lasting at least 10 min.
The questions are answered by pre-defined categories 1–7:
1 = 0 min, 2 = less than 30 min, 3 = 31–60 min, 4 = 61–90 min, 5 = 91–150 min, 6 = 151–300 min, 7 = more than 300 min.
We decided to add a modified question of the BHW-Q MPA including all physical activity BHW-MPAtot, due to the removal of the recommended 10-minute bouts in the updated guidelines in 2020 [13].
BHW-Q MPAtot: During a regular week, how much time are you physically active in ways that are not exercise, for example walks, bicycling, or gardening?
The questions are answered by the same pre-defined categories as BHW-Q MPA 1–7.
GIH’s question for assessing sedentary time (SED-GIH-Q) [18].
How much time do you spend sitting during a normal day not counting sleep?
The question is answered by pre-defined categories 1–7:
1 = Basically all day,2 = 13–15 h, 3 = 10–12 h, 4 = 7–9 h, 5 = 4–6 h, 6 = 1–3 h, 7 = never.
Accelerometer
Physical activity was measured objectively with the ActiGraph GT3X-BT accelerometer (ActiGraph, Pensacola, FL, USA) with normal filter settings. The accelerometer was used as a criterion-related validity instrument. The software ActiLife (version 6.13.4) was used to initialise, extract, and analyse the raw data from the accelerometer. The GT3X-BT measures electrical impulses from accelerations with a triaxial capacitive microelectromechanical system (MEMS) sensor. Data were collected with a sampling rate of 30 Hz and the raw data were converted to 60 s epochs in the unit counts per minute (cpm) for the vector magnitude that combined cpm from three axes into one outcome.
The Choi algorithm was used for calculating non-wear time [21], defined as consecutive zero counts for at least 90 min, while allowing a short time interval with nonzero counts lasting up to 2 min. Furthermore, non-wear time was compared with the time recorded in the diaries. A minimum of 600 min and at least four valid days, was required for being included in the analysis [22]. The Sasaki accelerometer cut-points for vector magnitude were used to differentiate between intensities of physical activity [23]. A cutoff of < 149 cpm was used to define sedentary time; light-intensity physical activity (LPA) 150–2689 cpm, MPA 2690–6166 cpm, VPA ≥ 6167 cpm. The weekly median time in wear time, LPA, MPA, VPA and sedentary time was calculated by dividing the sum of each variable by valid days and multiplying it by 7. For the purpose of comparing questionnaire data with accelerometer data, the pre-defined categorical answers from the questionnaire (BHW-Q VPA 1–6; BHW-Q MPA 1–7) were transformed to categorical minute scores by taking the mean of the interval for each category, e.g. 45 min for the category 31–60 min. The continuous accelerometer data were categorised into the same categories as the BHW-Q and GIH-SED-Q answer options. The “Activity minutes” were calculated by multiplying accelerometer data VPA by two, plus MPA, to generate an outcome of the total physical activity volume.
Statistical analysis
Statistical analyses were performed using SPSS, version 25.0 (IBM Corp. Armonk, NY, USA). Descriptive statistics was used to calculate demographics of the population and physical activity levels and sedentary time assessed with the questionnaires and accelerometer. After testing all variables for normal distribution with the Shapiro-Wilk test, the data were treated as non-parametric. Ordinal data were described with median and Q1-Q3, nominal data in numbers and percentages while interval data were described in median and min-max. To analyse test-retest reliability and criterion-related validity between the accelerometer and questionnaire Spearman’s rho (r) and linearly weighted Kappa coefficient (k) was used. To interpret weighted Kappa and Spearman’s rho the following criteria were used: A Kappa coefficient of 1 means perfect reliability, > 0.81 is considered almost perfect reliability, 0.61–0.8 as substantial, 0.41–0.6 as moderate, 0.21–0.4 as fair and < 0.2 as weak reliability [24]. Spearman’s rho correlation coefficient can assume values between − 1 and 1, where 1 indicates a perfect correlation and − 1 indicates a perfect negative correlation. The closer to 0, the weaker the correlation. At least 0.8 indicates very strong correlation, 0.6–0.8 as moderately strong, 0.3–0.5 as fair and < 0.3 indicates a poor correlation [25].
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