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BSG Live’26Introduction Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, yet objective data describing habitual physical activity (PA) in this population are limited. Accurate characterisation of real-world activity patterns is needed, given the health and potential survival benefits of PA in people with cancer.Methods This single-centre prospective cohort study recruited adults with primary liver cancer prior to treatment. Participants wore Axivity AX6 accelerometers to capture habitual physical activity. Self-reported physical activity was assessed using the International Physical Activity Questionnaire–Short Form (IPAQ-SF). Descriptive analyses compared accelerometer-derived and self-reported physical activity.Results A total of 101 patients with primary liver cancer were recruited (median age 72 years, range 49–86; 90% male). The cohort had a high cardiometabolic burden, with a mean body mass index of 30.9 kg/m 2; 52.4% had type 2 diabetes and 58.3% had hypertension. Cirrhosis was present in 55.6% of participants. Most patients had early-stage primary liver cancer at diagnosis.Accelerometer data indicated that a large proportion of the day was spent sedentary, with relatively little time accumulated in higher-intensity activity. Participants spent a mean of 588.6±125.5 min/day sedentary, 249.9±101.5 min/day in light-intensity activity, and 88.2±49.0 min/day in moderate-intensity activity, with vigorous activity negligible.Self-reported physical activity assessed using the questionnaire yielded lower values for sedentary time and light-intensity activity compared with accelerometry. Mean self-reported sedentary time was 456.0±162.0 min/day, approximately 133 min/day lower than accelerometer-derived estimates, while light-intensity activity was 52.7±61.0 min/day, approximately 197 min/day lower. Self-reported moderate-intensity activity (35.1±71.4 min/day) was also lower than accelerometer-derived estimates, whereas vigorous activity was reported (10.9±36.3 min/day) despite being negligible on accelerometry. Overall agreement between self-reported and accelerometer-derived physical activity was poor.Conclusions Patients with primary liver cancer spent a large proportion of the day sedentary and accumulated relatively little time in higher-intensity physical activity, as indicated by accelerometer-derived measures of daily movement behaviour. Self-reported physical activity yielded lower estimates of sedentary time and light- and moderate-intensity activity, and higher estimates of vigorous activity, compared with accelerometry, highlighting substantial differences between measurement approaches. Objective monitoring may therefore complement questionnaire-based assessment by providing an alternative characterisation of habitual activity patterns, with potential relevance for future studies examining physical activity in relation to clinical outcomes.