Physical activity and exercise in pediatric oncology: conceptual distinctions and clinical implications

Progress in chemotherapy, radiotherapy, surgical methods, and supportive care has significantly increased survival rates among children with cancer, resulting in a rising number of long-term survivors.[1] Today, longterm survival has become a realistic expectation for many patients, with five-year survival rates exceeding 80% in several parts of the world.[1] However, the success of modern oncology brings new challenges.Many children continue to experience treatmentrelated effects, sometimes persisting well beyond the completion of therapy, such as fatigue, muscle weakness, reduced endurance, peripheral neuropathy, decreased bone mineral density, and increased cardiometabolic risk.[2][3][4] These lingering effects may restrict involvement in everyday tasks, impede emotional and social wellbeing, and reduce overall quality of life (QoL) throughout both the active treatment phase and survivorship.[1,2] In response to these challenges, interest has grown in rehabilitation strategies that complement medical treatment through non-pharmacological means.Movement-based approaches, ranging from everyday physical activity to structured exercise programs, are increasingly recognized as important components of pediatric oncology care.[3,5] However, the terms "physical activity" and "exercise" are often used interchangeably in the literature despite referring to conceptually distinct constructs.Physical activity encompasses any bodily movement produced by skeletal muscles that results in energy expenditure, including play, walking, climbing stairs, or household tasks.[6] Exercise is a subset of physical activity that is planned, structured, and repetitive, carried out with the intention of improving or maintaining physical fitness.[7] In pediatric oncology, exercise programs typically combine aerobic, resistance, flexibility, and balance training, with parameters adapted to each child's medical status, energy level, and developmental needs.[8] ABSTRACT Survival in childhood cancers has markedly improved, yet many children experience treatment-related difficulties such as persistent fatigue, muscle weakness, reduced endurance, and impaired quality of life.As interest in non-pharmacological approaches grows, movement-based strategies, ranging from general physical activity to structured exercise, have become increasingly prominent in pediatric oncology care.This review aims to clarify the conceptual and practical differences between physical activity and structured exercise, and to summarize current evidence on movement-based interventions used during active treatment and survivorship in children and adolescents with cancer.Drawing on quantitative and qualitative studies published between 2000 and 2025, it shows that priorities shift across treatment phases: safety and feasibility are emphasized during active therapy, whereas long-term health and functional recovery gain importance in survivorship.The findings highlight the need for clearer terminology, coordinated multidisciplinary practice, meaningful family involvement, and consistent outcome measures with longer-term follow-up in future research.