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The aim was to investigate exercise capacity and physical activity levels of adult survivors of childhood ALL and their associations with neurocognitive outcomes, including processing speed and functional frontal cortical brain connectivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional study included 47 adult survivors of childhood ALL; 29 (61.7%) were male, with a median age of 29 years (min\u2013max 21\u201347). Participants completed questionnaires, a graded exercise test on a cycle ergometer, neurocognitive tests, and frontal cortical brain imaging with functional near\u2010infrared spectroscopy. Associations between predicted peak exercise capacity and fatigue (Fatigue Severity Scale [FSS]), processing speed (Processing Speed Composite), and functional frontal cortical network connectivity (global efficiency and modularity) were analyzed using linear regression. Parallel analyses were performed with physical activity level as the independent variable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants achieved a mean peak exercise capacity corresponding to 83.8% (standard deviation [SD]\u00a0=\u00a013.1) of the age\u2010 and sex\u2010predicted value (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), and 42.2% did not meet WHO\u2010recommended levels of physical activity. Statistically significant associations were identified between higher predicted peak exercise capacity and lower fatigue (FSS total score\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22120.33, 95% CI [confidence interval] \u22120.66 to \u22120.05,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02) and between higher physical activity levels and lower fatigue (FSS total score\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22120.4, 95% CI \u22121.8 to \u22120.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.015). No other significant associations were found.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adult survivors of childhood ALL had reduced exercise capacity, and a substantial proportion did not meet recommended physical activity levels. Exercise capacity and physical activity levels were associated with fatigue. No significant associations were observed with functional frontal cortical network connectivity or cognitive measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70736","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T10:50:27Z","timestamp":1791370227000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exercise Capacity, Physical Activity, Fatigue, and Neurocognitive Function in Adult Survivors of Childhood Acute Lymphoblastic Leukemia"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7324-9630","authenticated-orcid":false,"given":"Laura","family":"Jess","sequence":"first","affiliation":[{"name":"Department of Oncology Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"N\u00e4rh\u00e4lsan Bollebygd Rehabilitation Clinic  Bollebygd Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8919-8601","authenticated-orcid":false,"given":"Gustaf","family":"Glav\u00e5","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2669-5440","authenticated-orcid":false,"given":"Simon","family":"Skau","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Mathematics and Computer Science Karlstad University  Karlstad Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4247-5613","authenticated-orcid":false,"given":"Hans\u2010Georg","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6031-7478","authenticated-orcid":false,"given":"Maria","family":"B\u00e4ck","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy and Physiotherapy Sahlgrenska University Hospital  Gothenburg Sweden"},{"name":"Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9482-5366","authenticated-orcid":false,"given":"Marianne","family":"Jarfelt","sequence":"additional","affiliation":[{"name":"Department of Oncology Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"The Long\u2010Term Follow\u2010Up Clinic for Adult Childhood 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