Family and school support and physical activity behaviour in childhood cancer survivors: A meta-analytic review from a social ecological perspective

Article ID: 5527

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Keywords: childhood cancer survivors; physical activity; parental support; peer support; social ecological model

Abstract

Physical activity is increasingly recognised as an important component of survivorship care for childhood cancer survivors, yet participation levels often remain low following treatment. Social ecological frameworks suggest that family, peer, and school environments may influence physical activity behaviour; however, quantitative synthesis of this evidence remains limited. This study aimed to systematically review and meta-analytically synthesise available quantitative evidence on the association between family, parental, peer, and school-related support and physical activity behaviour among childhood cancer survivors. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Observational and interventional studies examining social support contexts in relation to physical activity outcomes among survivors aged ≤21 years were eligible for inclusion. Quantitative synthesis was restricted to methodologically comparable association-based studies. Pearson correlation coefficients and odds ratios were extracted or derived and synthesised using random-effects models. Methodological quality was assessed using the Newcastle–Ottawa Scale. Three observational studies met the criteria for quantitative synthesis. Two studies examining family or parental support reported positive associations with moderate-to-vigorous physical activity (MVPA), yielding a pooled correlation coefficient of r = 0.42 (95% CI 0.11–0.65). One large cross-sectional study further demonstrated that higher parental support was associated with a greater likelihood of MVPA participation (OR = 0.92, 95% CI 0.88–0.96). Overall methodological quality was rated as moderate, with limitations primarily related to cross-sectional study designs and residual confounding. These findings indicate that family and parental support are positively associated with physical activity behaviour among childhood cancer survivors; however, the limited number of studies and observational nature of the evidence preclude causal inference. Future longitudinal and intervention studies that explicitly integrate family- and peer-based support mechanisms are needed to inform socially grounded physical activity promotion strategies in survivorship care.