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Physical activity may help decrease symptom distress and is vital for ongoing development. The role of biomarkers in symptom science is emerging. The purpose of the study was to explore relationships between self-report of symptoms and physical activity, actigraphy measures, and cerebrospinal fluid (CSF) biomarkers. Methods: Participants were children who were ages 3 to 18 years at the time of ALL diagnosis and were now in the last 12-week cycle of ALL maintenance. Self-reports of fatigue, sleep disturbance, depressive symptoms, and physical activity were completed by participants and parents of younger children. Participants wore a wrist actigraph continuously for the 7 days before other measurements. F2-isoprostanes and interleukin-8 were evaluated in CSF samples. Results: Among the 15 participants, self-report of symptoms and physical activity indicated levels similar to healthy peers. F2-isoprostane had a strong positive correlation with fatigue levels and with depressive symptoms. Fatigue, sleep disturbance, and depressive symptoms positively correlated with each other. Actigraph measures showed children met the CDC guidelines for 60\u2005min of daily moderate to vigorous activity; sleep time was slightly less than healthy norms. Discussion: During maintenance therapy, most children return to healthy norms in symptom burden and physical activity. F2-isoprostane in the CSF is a biomarker for fatigue and depressive symptoms. Children who had persistent symptoms experienced them as a cluster, which confirms previous symptom cluster research.<\/jats:p>","DOI":"10.1177\/27527530221148479","type":"journal-article","created":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T01:26:11Z","timestamp":1681349171000},"page":"386-399","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Symptoms, Physical Activity, and Biomarkers in Children at the End of Leukemia Maintenance Therapy"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6137-9224","authenticated-orcid":false,"given":"Mary C.","family":"Hooke","sequence":"first","affiliation":[{"name":"School of Nursing, University of Minnesota, Minneapolis, MN, USA"},{"name":"Cancer and Blood Disorders Program, Children\u2019s Minnesota, Minneapolis, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek L.","family":"Salisbury","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Minnesota, Minneapolis, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9520-9565","authenticated-orcid":false,"given":"Michelle A.","family":"Mathiason","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Minnesota, Minneapolis, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia S.","family":"Kunin-Batson","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Minnesota, Minneapolis, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audrey","family":"Blommer","sequence":"additional","affiliation":[{"name":"Cancer and Blood Disorders Program, Children\u2019s Minnesota, Minneapolis, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Hutter","sequence":"additional","affiliation":[{"name":"Cancer and Blood Disorders Program, Children\u2019s Minnesota, Minneapolis, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pauline","family":"Mitby","sequence":"additional","affiliation":[{"name":"Cancer and Blood Disorders Program, Children\u2019s Minnesota, Minneapolis, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ida","family":"Moore","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Arizona, Tucson, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Whitman","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Arizona, Tucson, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Taylor","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael E.","family":"Scheurer","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marilyn J.","family":"Hockenberry","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,4,12]]},"reference":[{"key":"bibr1-27527530221148479","unstructured":"Actigraph. 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