KiKli Fit: Insights into the Development and Practice of a Physical Activity Program in Pediatric Cancer

Abstract

Introduction Pediatric cancer patients are particularly vulnerable to short- and long-term side and late-effects in physical and mental health caused by their disease and its treatment (Benzing et al., 2021, 2022; Robison & Hudson, 2013).Physical activity (PA) has been shown to benefit various physical and mental health domains. Emerging research in pediatric oncology increasingly demonstrates the positive impact of PA both during and after treatment. However, PA interventions in acute care settings within Swiss pediatric oncology remain rare. Therefore, the KiKli Fit project was initiated to design and implement a tailored PA program at the Department of Pediatric Oncology and Hematology at the University Hospital Bern.

Methods First, a needs analysis was conducted through 14 qualitative interviews with patients to gather insights into their preferences and requirements for a PA intervention. Second, ward staff participated in an online questionnaire to identify structural and systemic opportunities and barriers to implementing such an intervention. Third, a group discussion involving ten ward staff members (including psychologists, nurses, doctors, and physiotherapists) was held to develop a concept for the PA program collaboratively. Building on this, a PA program was designed and implemented over 1.5-years. During this time, various formal and informal assessments were conducted to ensure quality assurance.

Results Patients reported various negative side effects and low physical activity levels. Furthermore, they strongly desired greater variety during hospitalization and emphasized the need for a motivating and guided PA program. Similarly, hospital staff supported the implementation of such programs and advocated for the early integration of PA promotion into acute therapy. However, they identified several barriers to participation, including medical constraints, chemotherapy administration, fatigue, visits, or lack of motivation. Importantly, incorporating such programs into the routine of hospital care presents another significant challenge.

Discussion/Conclusion The development and practice of the KiKli Fit program highlight the importance of involving all stakeholders to ensure a tailored and feasible intervention. The participatory approach, including input from patients and interdisciplinary staff, was essential for aligning the program with patient needs and hospital operations. Continuous communication and collaboration helped address challenges, such as logistical barriers, facilitating integration into hospital routines. Future efforts should focus on sustaining interdisciplinary collaboration and evaluating the long-term effects of the program to facilitate an integration of PA programs into standard care in Swiss Children’s hospitals.

References

Benzing, V., Siegwart, V., Spitzhüttl, J., Schmid, J., Grotzer, M., Roebers, C. M., Steinlin, M., Leibundgut, K., Everts, R., & Schmidt, M. (2021). Motor ability, physical self‐concept and health‐related quality of life in pediatric cancer survivors. Cancer Medicine, cam4.3750. https://doi.org/10.1002/cam4.3750

Benzing, V., Siegwart, V., Anzeneder, S., Spitzhuettl, J., Grotzer, M., Roebers, C. M., Steinlin, M., Leibundgut, K., Everts, R., & Schmidt, M. (2022). The mediational role of executive functions for the relationship between motor ability and academic performance in pediatric cancer survivors. Psychology of Sport and Exercise, 60, 102160. https://doi.org/10.1016/j.psychsport.2022.102160

Robison, L. L., & Hudson, M. M. (2013). Survivors of childhood and adolescent cancer: life-long risks and responsibilities. Nature Reviews Cancer, 14(1), 61–70. https://doi.org/10.1038/nrc3634