Fatores sociodemográficos, ambientais, barreiras e facilitadores à prática de atividade física no lazer de pacientes pediátricos oncológicos
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2019-12-20
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Universidade Estadual Paulista (Unesp)
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A prática de atividade física (AF) de lazer de pacientes pediátricos oncológicos é baixa, porém recentes evidências confirmam que a AF pode gerar benefícios biopsicossociais durante e após o tratamento de câncer. Porém, diversos fatores podem influenciar nessa prática, como os sociodemográficos e ambientais, além das barreiras e facilitadores, sendo que estes ainda não estão bem estabelecidos na literatura, principalmente em países de média e baixa renda. Por isso, este estudo buscou identificar se os fatores sociodemográficos e ambientais, as barreiras e facilitadores têm associação à prática de AF de lazer de adolescentes durante o tratamento de câncer. Foram incluídos adolescentes entre 10 a 19 anos e um dos pais/responsáveis, residentes no estado de São Paulo, em período de tratamento no Centro Infantil Boldrini entre Janeiro de 2008 e Julho de 2018 e, em com qualquer tipo de câncer. Os participantes responderam um questionário com questões sociodemográficas, ambientais (NEWS-Y), barreiras e facilitadores à prática de AF. Um dos pais/responsáveis também respondeu questões socioeconômicas (ABEP). Foi realizada análise estatística descritiva, distribuição de frequência relativa e absoluta, o teste de Shapiro-Wilk e o T de Student. Ademais, utilizou o teste qui-quadrado para grupo único e de Pearson, teste exato de Fisher, regressão logística binária e regressão de Poisson com variância robusta, considerando p<0,05 e intervalo de confiança 95%. Participaram 50 adolescentes, porém foram identificados 10 outliers, sendo analisados 40 adolescentes (62,5% sexo masculino), com idade média de 14,68±2,68 anos, IMC de 22,80±6,99 Kg/m², diagnosticados com Leucemias (40,0%) e tempo médio de AF de lazer 286,75±238,59 min/sem. Assim, não houve associação entre a AF de lazer dos adolescentes e dos pais/responsáveis, nem com os fatores sociodemográficos (p>0,05). Porém, houve associação aos fatores ambientais segurança na vizinhança (RP ajustado=1,66; IC95%=1,05 - 2,61; p= 0,02) e instalações recreativas (RP ajustado=0,53; IC95%=0,28 - 0,99; p= 0,04). Nessa fase, as barreiras à AF de lazer são falta de companhia e energia, a fadiga e sentir-se desmotivados. Porém, tanto adolescentes, quanto familiares acreditam que a prática seja factível, benéfica, podendo ser em grupo e com o auxílio de um personal trainer. Sendo assim, os adolescentes durante o tratamento oncológico reportaram insuficiente prática de AF de lazer, com algumas influências ambientais, principalmente quanto à segurança na vizinhança. Também, relataram barreiras a nível fisiológico, social e psicológico, contudo acreditam que essa prática os beneficie durante o tratamento. Futuros estudos devem estruturar metodologias mais robustas, com designs longitudinais e com instrumentos diretos para as coletas. Além disso, devem fortalecer parcerias nacionais e internacionais, a fim de continuar na busca por evidências e ações que propiciem a prática segura e efetiva da AF de lazer de pacientes pediátricos oncológicos.
The leisure-time physical activity (PA) practice in pediatric cancer patients is low; however, recent evidence confirms that PA can generate biopsychosocial benefits during and after cancer treatment. Despite not well established in the literature, several sociodemographic and environmental factors, as well as barriers and facilitators can influence this practice, especially in low- and middle-income countries. Therefore, this study sought to identify whether sociodemographic and environmental factors, barriers and facilitators are associated with leisure-time PA practice among adolescents during cancer treatment. Adolescents between 10 and 19 years old and one of the parents/guardians, living in the state of São Paulo, undergoing treatment at the Boldrini Children's Center between January 2008 and July 2018, and with any type of cancer were included. Participants answered a questionnaire with sociodemographic, environmental (NEWS-Y) questions, barriers and facilitators to the PA practice. One parent/guardian also answered socioeconomic questions (ABEP). Descriptive statistical analysis, relative and absolute frequency distribution, the Shapiro-Wilk test and Student's T were performed. In addition, the chi-square test was used for the single group and Pearson's test, Fisher's exact test, binary logistic regression and Poisson regression with robust variance, considering p<0.05 and 95% confidence interval. Fifty adolescents participated; however, ten outliers were identified, forty adolescents (62.5% male) were analyzed with an average age of 14.68±2.68 years, BMI of 22.80±6.99 Kg/m², diagnosed with Leukemia (40.0%) and mean leisure-time PA 286.75±238.59 min/wk. Thus, there was no association between leisure-time PA among adolescents and parents/guardians, nor with sociodemographic factors (p>0.05). Nevertheless, there was an association with environmental factor safety in the neighborhood (adjusted PR= 1.66; 95%CI= 1.05 - 2.61; p= 0.02) and recreational facilities (adjusted PR= 0.53; 95%CI= 0.28 - 0.99; p= 0.04). In this phase, the barriers to leisure-time PA are lack of company and energy, fatigue and feeling unmotivated. Both adolescents and family members believe that the practice is feasible, beneficial, and can be done in groups and with the help of a personal trainer. Thus, adolescents during cancer treatment reported insufficient leisure-time PA practice, with some environmental influences, especially regarding safety in the neighborhood. In adition, they reported barriers at the physiological, social and psychological levels, despite believing that this practice would benefit them during treatment. Future studies should structure more robust methodologies with longitudinal designs and direct instruments for collections. More, they must strengthen national and international partnerships, to ensure an ongoing search for evidence and actions that provide safe and effective practice of leisure-time PA in oncologic pediatric patients.
The leisure-time physical activity (PA) practice in pediatric cancer patients is low; however, recent evidence confirms that PA can generate biopsychosocial benefits during and after cancer treatment. Despite not well established in the literature, several sociodemographic and environmental factors, as well as barriers and facilitators can influence this practice, especially in low- and middle-income countries. Therefore, this study sought to identify whether sociodemographic and environmental factors, barriers and facilitators are associated with leisure-time PA practice among adolescents during cancer treatment. Adolescents between 10 and 19 years old and one of the parents/guardians, living in the state of São Paulo, undergoing treatment at the Boldrini Children's Center between January 2008 and July 2018, and with any type of cancer were included. Participants answered a questionnaire with sociodemographic, environmental (NEWS-Y) questions, barriers and facilitators to the PA practice. One parent/guardian also answered socioeconomic questions (ABEP). Descriptive statistical analysis, relative and absolute frequency distribution, the Shapiro-Wilk test and Student's T were performed. In addition, the chi-square test was used for the single group and Pearson's test, Fisher's exact test, binary logistic regression and Poisson regression with robust variance, considering p<0.05 and 95% confidence interval. Fifty adolescents participated; however, ten outliers were identified, forty adolescents (62.5% male) were analyzed with an average age of 14.68±2.68 years, BMI of 22.80±6.99 Kg/m², diagnosed with Leukemia (40.0%) and mean leisure-time PA 286.75±238.59 min/wk. Thus, there was no association between leisure-time PA among adolescents and parents/guardians, nor with sociodemographic factors (p>0.05). Nevertheless, there was an association with environmental factor safety in the neighborhood (adjusted PR= 1.66; 95%CI= 1.05 - 2.61; p= 0.02) and recreational facilities (adjusted PR= 0.53; 95%CI= 0.28 - 0.99; p= 0.04). In this phase, the barriers to leisure-time PA are lack of company and energy, fatigue and feeling unmotivated. Both adolescents and family members believe that the practice is feasible, beneficial, and can be done in groups and with the help of a personal trainer. Thus, adolescents during cancer treatment reported insufficient leisure-time PA practice, with some environmental influences, especially regarding safety in the neighborhood. In adition, they reported barriers at the physiological, social and psychological levels, despite believing that this practice would benefit them during treatment. Future studies should structure more robust methodologies with longitudinal designs and direct instruments for collections. More, they must strengthen national and international partnerships, to ensure an ongoing search for evidence and actions that provide safe and effective practice of leisure-time PA in oncologic pediatric patients.
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Câncer, Adolescentes, Atividade física, Cancer, Adolescents, Physical activity