Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness

Abstract

Background This meta-analysis evaluated the safety, feasibility and effect of exercise among individuals with colorectal cancer. Methods A database search (CINAHL, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing, Science Direct) for randomised, controlled, exercise trials involving individuals with colorectal cancer, published before January 1, 2020 was undertaken. Safety (adverse events), feasibility (withdrawal and adherence rates) and effect data (health outcomes including quality of life, QoL) were abstracted. Risk difference (RD) and standardised mean differences (SMD) were calculated to compare safety and effects between exercise and usual care (UC). Subgroup analyses were conducted to assess whether outcomes differed by exercise mode, duration, supervision and treatment. Risk of bias was assessed using the Physiotherapy Evidence Database tool. Results For the 19 trials included, there was no difference in adverse event risk between exercise and UC (RD = 0.00; 95% CI:–0.01, 0.01, p = 0.92). Median withdrawal rate was 12% (0–22%) and adherence was 86% (42–91%). Significant effects of exercise compared to UC were observed for QoL, fatigue, aerobic fitness, upper-body strength, depression, sleep and reduced body fat (SMD = 0.21–0.66, p < 0.05). Subgroup analyses suggested larger benefits (p < 0.05) for QoL and fatigue for supervised interventions; for QoL, aerobic fitness and reduced body fat for ≥12-week interventions; and for aerobic fitness when interventions were during chemotherapy. Conclusion Although reporting of safety and compliance data was lacking in most trials, findings support that exercise is safe and feasible in colorectal cancer. Further, participation in mixed-mode exercise, including unsupervised exercise, leads to improvements in various health-related outcomes.

A Systematic Review of the Safety, Feasibility and Benefits of Exercise for Patients with Advanced Cancer

“…Median recruitment rates of exercise studies in the oncology field are 38% for colorectal cancer patients [52] and 59% for lung cancer patients in mixed stages I-IV [53]. The median enrollment rate of included studies of our review was 65.7%.…”

Effects of supervised aerobic exercise on cardiorespiratory fitness and patient-reported health outcomes in colorectal cancer patients undergoing adjuvant chemotherapy—a pilot study

“…However, the majority of the evidence provided comes from studies involving breast, prostate, or hematological cancer patients. Prospective studies involving CRC patients remain scarce, especially those conducted during CRC treatment [15][16][17]. In fact, to our knowledge, only five controlled trials have explored the effects of aerobic and resistance exercise specifically in CRC patients undergoing adjuvant chemotherapy.…”

Is exercise really safe, feasible, and effective for all people diagnosed with cancer?

“…We therefore compared the results of two independent, published meta-analyses that were conducted to assess the safety, feasibility, and effects of exercise following colorectal cancer (CRC) 3 and lung cancer (LC) 4 , and recently presented the findings at the Clinical Oncology Society of Australia 47th Annual Scientific Meeting 5 . While these two cancers represent common cancers (both are in the top five most common cancers diagnosed in Australia each year), compared with the 5-year survival rate for all-cancers combined, CRC is associated with a similar rate (70%) while LC is associated with a lower survival rate (18%).…”