Team Survivors: Preliminary Analysis of an Innovative Intervention to Promote Physical Activity in Survivors of Childhood Cancer and Hematopoietic Stem Cell Transplant
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Procedures, and Data Collection
2.2. Participants
2.3. Materials
2.3.1. Exercise Self-Efficacy
2.3.2. Health-Related Quality of Life
2.3.3. Feedback on Participation and Program Satisfaction
2.4. Intervention
2.5. Data Analysis
3. Results
3.1. Demographics
3.2. Pre- and Post-Intervention Outcomes
3.3. Feedback on Participation and Program Satisfaction
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Hudson, M.M.; Ness, K.K.; Gurney, J.G.; Mulrooney, D.A.; Chemaitilly, W.; Krull, K.R.; Green, D.M.; Armstrong, G.T.; Nottage, K.A.; Jones, K.E.; et al. Clinical ascertainment of health outcomes among adults treated for childhood cancer. JAMA 2013, 309, 2371–2381. [Google Scholar] [CrossRef] [PubMed]
- Bhakta, N.; Liu, Q.; Ness, K.K.; Baassiri, M.; Eissa, H.; Yeo, F.; Chemaitilly, W.; Ehrhardt, M.J.; Bass, J.; Bishop, M.W.; et al. The cumulative burden of surviving childhood cancer: An initial report from the St Jude Lifetime Cohort Study (SJLIFE). Lancet 2017, 390, 2569–2582. [Google Scholar] [CrossRef] [PubMed]
- Larsen, P.A.; Amidi, A.; Ghith, N.; Winther, J.F.; Pedersen, C. Quality of life of adolescent and adult survivors of childhood cancer in Europe: A systematic review. Int. J. Cancer 2023, 153, 1356–1375. [Google Scholar] [CrossRef]
- Conway Keller, M.; King, C.; Hart, L.; Engelke, K.; Needham, A.; Holden, E.; Foy, K.; Lucas, R. The end of cancer treatment experience for children, adolescents, and their parents: A systematic review of the literature. J. Psychosoc. Oncol. 2020, 38, 573–591. [Google Scholar] [CrossRef]
- Prasad, P.K.; Hardy, K.K.; Zhang, N.; Edelstein, K.; Srivastava, D.; Zeltzer, L.; Stovall, M.; Seibel, N.L.; Leisenring, W.; Armstrong, G.T.; et al. Psychosocial and neurocognitive outcomes in adult survivors of adolescent and early young adult cancer: A report from the childhood cancer survivor study. J. Clin. Oncol. 2015, 33, 2545–2552. [Google Scholar] [CrossRef]
- Badr, H.; Chandra, J.; Paxton, R.J.; Ater, J.L.; Urbauer, D.; Cruz, C.S.; Demark-Wahnefried, W. Health-related quality of life, lifestyle behaviors, and intervention preferences of survivors of childhood cancer. J. Cancer Surviv. 2013, 7, 523–534. [Google Scholar] [CrossRef]
- Murane, A.; Gough, K.; Thompson, K.; Holland, L.; Conyers, R. Adolescents and young adult cancer survivors: Exercise habits, quality of life and physical activity preferences. Support. Care Cancer 2015, 23, 501–510. [Google Scholar] [CrossRef] [PubMed]
- Stolley, M.R.; Restrepo, J.; Sharp, L.K. Diet and physical activity in childhood cancer survivors: A review of the literature. Ann. Behav. Med. 2010, 39, 232–249. [Google Scholar] [CrossRef]
- World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- Liska, T.M.; Kolen, A.M. The role of physical activity in cancer survivors’ quality of life. Health Qual. Life Outcomes 2020, 18, 197. [Google Scholar] [CrossRef]
- Wogksch, M.D.; Goodenough, C.G.; Finch, E.R.; Partin, R.E.; Ness, K.K. Physical activity and fitness in childhood cancer survivors: A scoping review. Aging Cancer 2021, 2, 112–128. [Google Scholar] [CrossRef]
- Ness, K.K.; Plana, J.C.; Joshi, V.M.; Luepker, R.V.; Durand, J.B.; Green, D.M.; Partin, R.E.; Santucci, A.K.; Howell, R.M.; Srivastava, D.K.; et al. Exercise intolerance, mortality, and organ system impairment in adult survivors of childhood cancer. J. Clin. Oncol. 2020, 38, 29–42. [Google Scholar] [CrossRef] [PubMed]
- Bratteteig, M.; Rueegg, C.S.; Raastad, T.; Grydeland, M.; Torsvik, I.K.; Schindera, C.; Ruud, E.; Anderssen, S.A. Physical activity, fitness, and cardiovascular disease risk in adolescent childhood cancer survivors compared to controls: The physical activity in childhood cancer survivors Study. J. Adolesc. Young Adult Oncol. 2024, 13, 338–346. [Google Scholar] [CrossRef] [PubMed]
- Braam, K.I.; van der Torre, P.; Takken, T.; Veening, M.A.; van Dulmen-den Broeder, E.; Kaspers, G.J. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst. Rev. 2016, 3, CD008796. [Google Scholar] [CrossRef]
- Cheung, A.T.; Li, W.H.C.; Ho, L.L.K.; Ho, K.Y.; Chan, G.C.F.; Chung, J.O.K. Physical activity for pediatric cancer survivors: A systematic review of randomized controlled trials. J. Cancer Surviv. 2021, 15, 876–889. [Google Scholar] [CrossRef]
- Huang, T.T.; Ness, K.K. Exercise interventions in children with cancer: A review. Int. J. Pediatr. 2011, 2011, 461512. [Google Scholar] [CrossRef] [PubMed]
- Adamovich, T.; Watson, R.; Murdoch, S.; Giovino, L.; Kulkarni, S.; Luchak, M.; Smith-Turchyn, J. Barriers and facilitators to physical activity participation for child, adolescent, and young adult cancer survivors: A systematic review. J. Cancer Surviv. 2024, 18, 245–262. [Google Scholar] [CrossRef]
- Götte, M.; Kesting, S.; Winter, C.; Rosenbaum, D.; Boos, J. Experience of barriers and motivations for physical activities and exercise during treatment of pediatric patients with cancer. Pediatr. Blood Cancer 2014, 61, 1632–1637. [Google Scholar] [CrossRef] [PubMed]
- Ross, W.L.; Le, A.; Zheng, D.J.; Mitchell, H.R.; Rotatori, J.; Li, F.; Fahey, J.T.; Ness, K.K.; Kadan-Lottick, N.S. Physical activity barriers, preferences, and beliefs in childhood cancer patients. Support. Care Cancer 2018, 26, 2177–2184. [Google Scholar] [CrossRef] [PubMed]
- Gilliam, M.B.; Schwebel, D.C. Physical activity in child and adolescent cancer survivors: A review. Health Psychol. Rev. 2013, 7, 92–110. [Google Scholar] [CrossRef]
- Dunton, G.F.; Liao, Y.; Intille, S.; Wolch, J.; Pentz, M.A. Physical and social contextual influences on children’s leisure-time physical activity: An ecological momentary assessment study. J. Phys. Act. Health 2011, 8 (Suppl. S1), S103–S108. [Google Scholar] [CrossRef]
- Mota, J.; Silva, P.; Santos, M.P.; Ribeiro, J.C.; Oliveira, J.; Duarte, J.A. Physical activity and school recess time: Differences between the sexes and the relationship between children’s playground physical activity and habitual physical activity. J. Sports Sci. 2005, 23, 269–275. [Google Scholar] [CrossRef] [PubMed]
- Wickel, E.E.; Eisenmann, J.C. Contribution of youth sport to total daily physical activity among 6- to 12-yr-old boys. Med. Sci. Sports Exerc. 2007, 39, 1493–1500. [Google Scholar] [CrossRef]
- Kelso, A.; Reimers, A.K.; Abu-Omar, K.; Wunsch, K.; Niessner, C.; Wäsche, H.; Demetriou, Y. Locations of physical activity: Where are children, adolescents, and adults physically active? A systematic review. Int. J. Environ. Res. Public Health 2021, 18, 1240. [Google Scholar] [CrossRef]
- Gilliam, M.B.; Madan-Swain, A.; Whelan, K.; Tucker, D.C.; Demark-Wahnefried, W.; Schwebel, D.C. Social, demographic, and medical influences on physical activity in child and adolescent cancer survivors. J. Pediatr. Psychol. 2012, 37, 198–208. [Google Scholar] [CrossRef] [PubMed]
- Keats, M.R.; Culos-Reed, S.N.; Courneya, K.S.; McBride, M. Understanding physical activity in adolescent cancer survivors: An application of the theory of planned behavior. Psycho-Oncol. 2007, 16, 448–457. [Google Scholar] [CrossRef]
- Pitt, E.; Cashion, C.; Rumble, S.; Bradford, N. Associations between health behaviors, health self-efficacy, and long-term outcomes in survivors of childhood cancer: A cross-sectional study. Semin. Oncol. Nurs. 2023, 39, 151434. [Google Scholar] [CrossRef] [PubMed]
- Cao, X.; Zhang, Q.; Liu, X. Cross-lagged relationship between physical activity time, openness and depression symptoms among adolescents: Evidence from China. Int. J. Ment. Health Promot. 2023, 25, 1009–1018. [Google Scholar] [CrossRef]
- Hernandez, R.; Bassett, S.M.; Boughton, S.W.; Schuette, S.A.; Shiu, E.W.; Moskowitz, J.T. Psychological well-being and physical health: Associations, mechanisms, and future directions. Emot. Rev. 2018, 10, 18–29. [Google Scholar] [CrossRef]
- Ohrnberger, J.; Fichera, E.; Sutton, M. The relationship between physical and mental health: A mediation analysis. Soc. Sci. Med. 2017, 195, 42–49. [Google Scholar] [CrossRef]
- Brand, S.; Kalak, N.; Gerber, M.; Clough, P.J.; Lemola, S.; Sadeghi Bahmani, D.; Pühse, U.; Holsboer-Trachsler, E. During early to mid adolescence, moderate to vigorous physical activity is associated with restoring sleep, psychological functioning, mental toughness and male gender. J. Sports Sci. 2016, 35, 426–434. [Google Scholar] [CrossRef]
- Brand, S.; Gerber, M.; Beck, J.; Hatzinger, M.; Pühse, U.; Holsboer-Trachsler, E. High exercise levels are related to favorable sleep patterns and psychological functioning in adolescents: A comparison of athletes and controls. J. Adolesc. Health 2010, 46, 133–141. [Google Scholar] [CrossRef] [PubMed]
- Felfe, C.; Lechner, M.; Steinmayr, A. Sports and child development. PLoS ONE 2016, 11, e0151729. [Google Scholar] [CrossRef] [PubMed]
- Opstoel, K.; Chapelle, L.; Prins, F.J.; De Meester, A.; Haerens, L.; van Tartwijk, J.; De Martelaer, K. Personal and social development in physical education and sports: A review study. Eur. Phys. Educ. Rev. 2019, 26, 797–813. [Google Scholar] [CrossRef]
- Ullrich-French, S.; McDonough, M.H.; Smith, A.L. Social connection and psychological outcomes in a physical activity-based youth development setting. Res. Q. Exerc. Sport 2012, 83, 431–441. [Google Scholar] [CrossRef]
- Spruit, A.; Assink, M.; van Vugt, E.; van der Put, C.; Stams, G.J. The effects of physical activity interventions on psychosocial outcomes in adolescents: A meta-analytic review. Clin. Psychol. Rev. 2016, 45, 56–71. [Google Scholar] [CrossRef]
- Kirby, J.B.; Babkes Stellino, M.; Lewis, C.; Humphrey, K.; Gordon, K.; Lindsay, K.G. You’ve got a friend in me: Fostering social connection among college students through peer-led physical Activity. Health Promot. Pract. 2022, 23, 907–911. [Google Scholar] [CrossRef]
- Patterson, M.S.; Gagnon, L.R.; Vukelich, A.; Brown, S.E.; Nelon, J.L.; Prochnow, T. Social networks, group exercise, and anxiety among college students. J. Am. Coll. Health 2021, 69, 361–369. [Google Scholar] [CrossRef]
- Weiss, M.R.; Kipp, L.E.; Phillips Reichter, A.; Espinoza, S.M.; Bolter, N.D. Girls on the Run: Impact of a physical activity youth development program on psychosocial and behavioral outcomes. Pediatr. Exerc. Sci. 2019, 31, 330–340. [Google Scholar] [CrossRef]
- Livsey, L.; Lewis, K. Breast cancer survivors’ perceptions of participating in a supervised exercise intervention: An exploratory review of the literature. Women Health 2018, 58, 1017–1036. [Google Scholar] [CrossRef]
- McDonough, M.H.; Sabiston, C.M.; Crocker, P.R.E. An interpretative phenomenological examination of psychosocial changes among breast cancer survivors in their first season of dragon boating. J. Appl. Sport Psychol. 2008, 20, 425–440. [Google Scholar] [CrossRef]
- Kroll, T.; Kehn, M.; Ho, P.S.; Groah, S. The SCI exercise self-efficacy scale (ESES): Development and psychometric properties. Int. J. Behav. Nutr. Phys. Act. 2007, 4, 34. [Google Scholar] [CrossRef] [PubMed]
- Nooijen, C.F.; Post, M.W.; Spijkerman, D.C.; Bergen, M.P.; Stam, H.J.; van den Berg-Emons, R.J. Exercise self-efficacy in persons with spinal cord injury: Psychometric properties of the Dutch translation of the exercise self-efficacy scale. J. Rehabil. Med. 2013, 45, 347–350. [Google Scholar] [CrossRef] [PubMed]
- Te Velde, S.J.; Lankhorst, K.; Zwinkels, M.; Verschuren, O.; Takken, T.; de Groot, J.; HAYS study group. Associations of sport participation with self-perception, exercise self-efficacy and quality of life among children and adolescents with a physical disability or chronic disease-a cross-sectional study. Sports Med. 2018, 4, 38. [Google Scholar] [CrossRef]
- Tsianakas, V.; Harris, J.; Ream, E.; Van Hemelrijck, M.; Purushotham, A.; Mucci, L.; Green, J.S.; Fewster, J.; Armes, J. CanWalk: A feasibility study with embedded randomised controlled trial pilot of a walking intervention for people with recurrent or metastatic cancer. BMJ Open 2017, 7, e013719. [Google Scholar] [CrossRef] [PubMed]
- Zelber-Sagi, S.; Bord, S.; Dror-Lavi, G.; Smith, M.L.; Towne, S.D., Jr.; Buch, A.; Webb, M.; Yeshua, H.; Nimer, A.; Shibolet, O. Role of illness perception and self-efficacy in lifestyle modification among non-alcoholic fatty liver disease patients. World J. Gastroenterol. 2017, 23, 1881–1890. [Google Scholar] [CrossRef]
- Varni, J.W.; Seid, M.; Kurtin, P.S. PedsQLTM 4.0: Reliability and validity of the Pediatric Quality of Life Inventory Version 4.0 generic core scales in healthy and patient populations. Med. Care 2001, 39, 800–812. [Google Scholar] [CrossRef]
- Varni, J.W.; Burwinkle, T.M.; Katz, E.R.; Meeske, K.; Dickinson, P. The PedsQL in pediatric cancer: Reliability and validity of the pediatric quality of life inventory generic core scales, multidimensional fatigue scale, and cancer module. Cancer 2002, 94, 2090–2106. [Google Scholar] [CrossRef]
- Varni, J.W.; Burwinkle, T.M.; Seid, M.; Skarr, D. The PedsQL 4.0 as a pediatric population health measure: Feasibility, reliability, and validity. Ambul. Pediatr. 2003, 3, 329–341. [Google Scholar] [CrossRef]
- Robinson, K.M.; Piacentine, L.B.; Waltke, L.J.; Ng, A.V.; Tjoe, J.A. Survivors speak: A qualitative analysis of motivational factors influencing breast cancer survivors’ participation in a sprint distance triathlon. J. Clin. Nurs. 2016, 25, 247–256. [Google Scholar] [CrossRef]
- Ward, E.; DeSantis, C.; Robbins, A.; Kohler, B.; Jemal, A. Childhood and adolescent cancer statistics, 2014. CA Cancer J. Clin. 2014, 64, 83–103. [Google Scholar] [CrossRef]
- Wurz, A.; McLaughlin, E.; Lategan, C.; Ellis, K.; Culos-Reed, S.N. Synthesizing the literature on physical activity among children and adolescents affected by cancer: Evidence for the international Pediatric Oncology Exercise Guidelines (iPOEG). Transl. Behav. Med. 2021, 11, 699–708. [Google Scholar] [CrossRef]
- Brown, N.I.; Sauls, R.; Almendares, M.; Gray, H.L.; Stern, M. Factors impacting physical activity among post-treatment pediatric cancer survivors with overweight and obesity. Eur. J. Pediatr. 2024, 183, 3129–3136. [Google Scholar] [CrossRef] [PubMed]
- Cox, C.L.; Montgomery, M.; Oeffinger, K.C.; Leisenring, W.; Zeltzer, L.; Whitton, J.A.; Mertens, A.C.; Hudson, M.M.; Robison, L.L. Promoting physical activity in childhood cancer survivors: Results from the Childhood Cancer Survivor Study. Cancer 2009, 115, 642–654. [Google Scholar] [CrossRef]
- Huang, I.C.; Thompson, L.A.; Chi, Y.Y.; Knapp, C.A.; Revicki, D.A.; Seid, M.; Shenkman, E.A. The linkage between pediatric quality of life and health conditions: Establishing clinically meaningful cutoff scores for the PedsQL. Value Health 2009, 12, 773–781. [Google Scholar] [CrossRef] [PubMed]
- Kuntz, N.; Anazodo, A.; Bowden, V.; Sender, L.; Morgan, H. Pediatric cancer patients’ treatment journey: Child, adolescent, and young adult cancer narratives. J. Pediatr. Nurs. 2019, 48, 42–48. [Google Scholar] [CrossRef] [PubMed]
- Howard, A.F.; Tan de Bibiana, J.; Smillie, K.; Goddard, K.; Pritchard, S.; Olson, R.; Kazanjian, A. Trajectories of social isolation in adult survivors of childhood cancer. J. Cancer Surviv. 2014, 8, 80–93. [Google Scholar] [CrossRef]
- Graupensperger, S.; Gottschall, J.S.; Benson, A.J.; Eys, M.; Hastings, B.; Evans, M.B. Perceptions of groupness during fitness classes positively predict recalled perceptions of exertion, enjoyment, and affective valence: An intensive longitudinal investigation. Sport Exerc. Perform. Psychol. 2019, 8, 290–304. [Google Scholar] [CrossRef]
- Heinrich, K.M.; Kurtz, B.K.; Patterson, M.; Crawford, D.A.; Barry, A. Incorporating a sense of community in a group exercise intervention facilitates adherence. Health Behav. Res. 2022, 5, 1. [Google Scholar] [CrossRef]
- Davis, A.; Taylor, J.; Cohen, E. Social bond and exercise: Evidence for a reciprocal relationship. PLoS ONE 2015, 10, e0136705. [Google Scholar] [CrossRef]
- Friedman, D.N.; Lavery, J.A.; Moskowitz, C.S.; Gordon, I.; Gilliland, J.; Scott, J.; Diotallevi, D.; Pottenger, E.; Wilson, N.; Antal, Z.; et al. Feasibility and acceptability of a parent-child intervention to improve step count in childhood cancer survivors exposed to cardiotoxic therapy: The STEP UP for FAMILIES Study. Pediatr. Blood Cancer 2024, 71, e31320. [Google Scholar] [CrossRef]
- Ware, M.E.; Kadan-Lottick, N.S.; Devidas, M.; Terrell, S.; Chow, E.J.; Ehrhardt, M.J.; Hardy, K.K.; Chemaitilly, W.; Hein, W.; Winick, N.; et al. Design and methods of a randomized web-based physical activity intervention among children with cancer: A report from the Children’s Oncology Group. Contemp. Clin. Trials 2022, 122, 106961. [Google Scholar] [CrossRef]
- Kang, K.A.; Han, S.J.; Chun, J.; Kim, H.Y.; Oh, Y.; Yoon, H. Healthy lifestyle interventions for childhood and adolescent cancer survivors: A systematic review and meta-analysis. Child Health Nurs. Res. 2023, 29, 111–127. [Google Scholar] [CrossRef] [PubMed]
- Shi, Q.; Zheng, J.; Liu, K. Supervised exercise interventions in childhood cancer survivors: A systematic review and meta-analysis of randomized controlled trials. Children 2022, 9, 824. [Google Scholar] [CrossRef] [PubMed]
- Dong, Y.; Ban, Y.; Zhong, T.; Guo, Y.; Tang, D.; Yu, R.; Liu, K. Individualized physical activity prescriptions for children and adolescents with cancer: A systematic review and meta-analysis of randomized controlled trials. Cancer Nurs. 2024. [Google Scholar] [CrossRef]
- Devine, K.A.; Viola, A.; Levonyan-Radloff, K.; Mackowski, N.; Bozzini, B.; Chandler, A.; Xu, B.; Ohman-Strickland, P.; Mayans, S.; Farrar-Anton, A.; et al. Feasibility of FitSurvivor: A technology-enhanced group-based fitness intervention for adolescent and young adult survivors of childhood cancer. Pediatr. Blood Cancer 2020, 67, e28530. [Google Scholar] [CrossRef]
- Larsen, E.H.; Mellblom, A.V.; Larsen, M.H.; Ruud, E.; Thorsen, L.; Petersen, N.N.; Larsen, H.B.; Fridh, M.K.; Lie, H.C. Perceived barriers and facilitators to physical activity in childhood cancer survivors and their parents: A large-scale interview study from the International PACCS Study. Pediatr. Blood Cancer 2023, 70, e30056. [Google Scholar] [CrossRef]
Responder | 2023 Post-Intervention Response Rate ** | 2024 Pre-Intervention Response Rate | 2024 Post-Intervention Response Rate |
---|---|---|---|
Survivors | 2 | 7 | 2 |
Caregivers | 10 * | 14 * | 11 * |
Total | 12 | 21 | 13 |
2023 Cohort Caregivers ** | 2024 Cohort Caregivers | ||
---|---|---|---|
Post-Intervention (n = 10) M (SD) | Pre-Intervention (n = 14) M (SD) | Post-Intervention (n = 11) M (SD) | |
ESES 1 | 33.5 (6.4) | 33.7 (3.9) | 33.0 (3.8) |
PedsQL Total Score 2 | 81.6 (10.6) | 72.0 (15.9) | 76.1 (10.7) |
PedsQL Psychosocial 3 | 81.0 (12.3) | 71.6 (16.7) | 75.8 (10.8) |
PedsQL EF 4 | 78.4 (15.6) | 68.6 (19.5) | 74.1 (14.6) |
PedsQL SF 5 | 83.0 (13.4) | 76.8 (17.8) | 80.5 (16.8) |
PedsQL SchF 6 | 81.5 (14.7) | 69.3 (20.1) | 72.7 (16.3) |
PedsQL Physical 7 | 83.4 (7.7) | 73.4 (16.3) | 77.0 (12.8) |
Measures/Scales | t | p | d |
---|---|---|---|
ESES 1 | 0.4 | 0.7 | 3.9 |
PedsQL Total Score 2 | −0.7 | 0.5 | 12.9 |
PedsQL Psychosocial 3 | −0.7 | 0.5 | 14.4 |
PedsQL EF 4 | −0.8 | 0.4 | 17.5 |
PedsQL SF 5 | −0.5 | 0.6 | 17.5 |
PedsQL SchF 6 | −0.5 | 0.7 | 18.6 |
PedsQL Physical 7 | −0.6 | 0.6 | 14.9 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Flannery, M.K.; Morin, J.; O’Malley, K.; Schmidt, D.; Hoag, J.A. Team Survivors: Preliminary Analysis of an Innovative Intervention to Promote Physical Activity in Survivors of Childhood Cancer and Hematopoietic Stem Cell Transplant. Children 2025, 12, 399. https://doi.org/10.3390/children12040399
Flannery MK, Morin J, O’Malley K, Schmidt D, Hoag JA. Team Survivors: Preliminary Analysis of an Innovative Intervention to Promote Physical Activity in Survivors of Childhood Cancer and Hematopoietic Stem Cell Transplant. Children. 2025; 12(4):399. https://doi.org/10.3390/children12040399
Chicago/Turabian StyleFlannery, Meghan K., Jocelyn Morin, Katrina O’Malley, Debra Schmidt, and Jennifer A. Hoag. 2025. "Team Survivors: Preliminary Analysis of an Innovative Intervention to Promote Physical Activity in Survivors of Childhood Cancer and Hematopoietic Stem Cell Transplant" Children 12, no. 4: 399. https://doi.org/10.3390/children12040399
APA StyleFlannery, M. K., Morin, J., O’Malley, K., Schmidt, D., & Hoag, J. A. (2025). Team Survivors: Preliminary Analysis of an Innovative Intervention to Promote Physical Activity in Survivors of Childhood Cancer and Hematopoietic Stem Cell Transplant. Children, 12(4), 399. https://doi.org/10.3390/children12040399