Improving Physical Activity Behaviors Among Childhood Cancer Survivors Through an Educational Intervention: A Mixed‐Methods Pre–Post Study

BACKGROUND: Childhood cancer survivors (CCS) are at increased risk of long-term cardiopulmonary and functional complications, but physical activity participation remains low. Scalable, evidence-based interventions integrated into routine survivorship care are limited, especially in low- and middle-income settings. This study evaluated the effectiveness of a brief, family-centered educational intervention in improving physical activity behaviors and exercise-related cognition among CCS in China. PROCEDURE: We conducted a mixed-methods, single-arm educational intervention involving CCS and their caregivers. Baseline assessments (T0) and follow-up assessments conducted 1-3 months after the intervention (T1) evaluated three major outcome domains: (i) physical activity behaviors, assessed using the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and selected Physical Activity Questionnaire for Children/Adolescents (PAQ-C/A) items, including moderate-to-vigorous physical activity (MVPA) and total physical activity; (ii) exercise-related cognitive constructs, assessed using Health Belief Model (HBM)-based measures and selected Exercise Benefits/Barriers Scale (EBBS) items; and (iii) family support and parental awareness regarding exercise and treatment-related health risks. Semi-structured interviews were conducted to further explore perceptions and experiences related to physical activity participation. RESULTS: A total of 106 CCS completed T0 and 78 (73.6%) completed T1; 18 participated in interviews. At baseline, most survivors reported low physical activity levels and exercise-related fatigue during vigorous activity. Following the intervention, physical activity behaviors improved significantly, with increases in weekly MVPA (from 98.5 to 172.3 min/week; p = 0.004), total physical activity (from 166.6 to 318.0 min/week; p < 0.001), and GLTEQ scores (from 40.4 to 56.0; p = 0.005). Exercise-related cognition also improved, including greater perceived severity of insufficient physical activity, and increased perceived energy and vitality benefits of exercise. Parental awareness of cardiopulmonary risk increased from 50.0% to 71.8% (p = 0.003). Family support behaviors improved, including parental encouragement (p = 0.016), family co-exercise (p = 0.006), and caregivers' own exercise habits (p = 0.008). Qualitative interviews highlighted the importance of medical guidance, family involvement, individualized exercise recommendations, and concerns regarding fatigue and safety. CONCLUSIONS: A brief, family-centered educational intervention was associated with improved physical activity behaviors, enhanced exercise-related cognition, increased parental awareness, and stronger family support among childhood cancer survivors. These findings support the feasibility and potential value of integrating scalable exercise education into routine survivorship care.