Physical Activity and Neurocognitive Function in Adult Survivors of Childhood Cancers

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In a Childhood Cancer Survivor Study analysis reported in the Journal of Clinical Oncology, Barlow-Krelina et al found that consistent physical activity vs consistent inactivity was associated with reduced neurocognitive problems and greater improvement in neurocognitive domains during long-term follow-up of adult survivors of childhood cancers.

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Study Details

The study included physical activity and neurocognitive data from 12,123 5-year survivors of childhood cancer diagnosed between 1970 and 1999, and 720 of their siblings. Among survivors, 2,105 were survivors of central nervous system (CNS) cancers and 10,018 were survivors of non-CNS cancers. Their median age at diagnosis was 7 years and median time since diagnosis at study baseline was 16 years. Data on physical activity were obtained at baseline, and data on physical activity and neurocognitive function were obtained at medians of 7 and 12 years post-baseline.

Consistent physical activity was defined as ≥ 75 minutes of vigorous or ≥ 150 minutes of moderate activity per week. Neurocognitive function was assessed by the CCSS-Neurocognitive Questionnaire, a self-reported measure of problems in task efficiency, emotional regulation, organization, and memory, and the Brief Symptom Inventory-18 (used to adjust for emotional distress in analyzing associations between physical activity and neurocognitive problems). Neurocognitive data were converted to T-scores using sibling data, where 50 is the mean and higher scores indicate greater problems.      

Key Findings

Survivors were less likely vs siblings to report consistent physical activity (28.1% vs 33.6%) and more likely to report problems at first follow-up in task efficiency (mean T-scores = 50.0 for siblings vs 61.4 for CNS cancer survivors and 53.3 for non-CNS cancer survivors), emotional regulation (51.4 vs 54.5 and 53.4), and memory (50.8 vs 58.9 and 53.5), with CNS cancer survivors also having poorer reported organization (49.9 vs 52.8). The P values were < .001 for all comparisons.  

After adjustment for age at diagnosis and questionnaire, emotional distress, and cancer treatment exposures, consistent physical activity vs consistent inactivity among both non-CNS cancer and CNS cancer survivors was associated with reduced neurocognitive problems at first follow-up, with T-scores reduced by 7.9 to 2.2 points across all neurocognitive domains (P ≤ .01 for all comparisons).

Among both non-CNS cancer and CNS cancer survivors, consistent physical activity vs consistent inactivity was associated with greater improvement in neurocognitive function between first and second follow-up, with T-scores reduced by 6.0 to 2.5 across all domains (P ≤ .01 for all comparisons). 

Consistent physical activity was associated with lower body mass index (BMI) and lower risk for a chronic health condition. Adjustment for BMI and chronic health conditions attenuated the associations between domain scores and physical activity, but the effects were small (T-score differences of 0.1–0.4).

The investigators concluded: “Adult survivors of childhood cancer who report more consistent physical activity have fewer neurocognitive problems and larger improvements in these concerns many years after treatment.”

Kim Edelstein, PhD, of Princess Margaret Cancer Centre, Toronto, is the corresponding author for the Journal of Clinical Oncology article.  

Disclosure: The study was supported by the National Institutes of Health, American Lebanese Syrian Associated Charities, Princess Margaret Cancer Foundation, and Ontario Ministry of Health and Long-Term Care. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.