Recreational physical activity, body mass index, and survival in women with colorectal cancer

Abstract

Background and purpose Previous studies have shown that physical inactivity and obesity are risk factors for the development of colorectal cancer. However, controversy exists regarding the influence of these factors on survival in colorectal cancer patients. We evaluated the impact of recreational physical activity and body mass index (BMI) before and after colorectal cancer diagnosis on disease-specific mortality and all-cause mortality. Patients and Methods This prospective cohort study included 1339 women enrolled in the Women’s Health Initiative study who were diagnosed with colorectal cancer subsequent to study enrolment. BMI and recreational physical activity were measured before cancer diagnosis at study entry (pre-diagnostic) and after diagnosis at study follow-up interviews (post-diagnostic). We used Cox regression to estimate the association between pre- and post-diagnostic exposures and survival after colorectal cancer diagnosis. Results Among women diagnosed with colorectal cancer, 265 (13%) deaths occurred during a median study follow-up of 11.9 years, of which 171 (65%) were attributed to colorectal cancer. Compared with women reporting no pre-diagnostic recreational physical activity, those reporting activity levels of ≥18 MET-hours/week had significantly lower colorectal cancer-specific mortality (hazard ratio (HR)=0.68; 95% confidence interval (CI): 0.41–1.13) and all-cause mortality (HR=0.63; 95% CI: 0.42–0.96). Similar inverse associations were seen for post-diagnostic recreational physical activity. Neither pre- nor post-diagnostic BMI were associated with mortality after colorectal cancer diagnosis. Conclusion Recreational physical activity before and after CR colorectal cancer C diagnosis, but not BMI, is associated with more favourable survival.

The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer: a pilot randomised controlled trial with embedded feasibility study

“…The meta-analysis also found that higher post-diagnosis physical activity level was associated with a significantly increased overall survival (HR overall survival = 0.62, 95% CI 0.54 to 0.71; fixed-effects model; p < 0.001). Five [31][32][33][34][35] out of the six individual studies assessing the relationship between physical activity level and overall survival found a statistically significant increase in overall survival among patients with higher post-diagnosis physical activity levels. Pooled relative risks from another meta-analysis 23 among CRC survivors showed inverse associations between post-diagnosis leisure-time physical activity and mortality based on six prospective cohorts.…”

“…Three separate meta-analyses 23,28,29 including the same six observational studies [30][31][32][33][34][35] were published in 2013-14. Owing to different cut-off values for level of physical activity and different statistical analyses used, there is slight variation in the results; what is evident, however, is that all three studies show that a higher level of physical activity is associated with an increase in cancer-specific and overall survival.…”

“…A meta-analysis 28 reported that three 32,34,35 out of the six prospective cohorts assessing post-diagnosis physical activity found a statistically significant increase in cancer-specific survival among patients with a high level of physical activity, compared with patients with a low level. Overall, higher post-diagnosis physical activity was significantly associated with an improved cancer-specific survival [hazard ratio (HR) cancer-specific survival = 0.61, 95% confidence interval (CI) 0.44 to 0.86; random-effects model; p < 0.001].…”

“…Pooled relative risks from another meta-analysis 23 among CRC survivors showed inverse associations between post-diagnosis leisure-time physical activity and mortality based on six prospective cohorts. [30][31][32][33][34][35] The authors conducted a meta-analysis for exerciser versus not exerciser, moderate level of physical activity versus low physical activity, and high level of physical activity versus low physical activity. Low physical activity (reference group) was defined as 0, < 3 and < 3.5 MET hours per week or sedentary and the highest category was defined as ≥ 18 and ≥ 8.75 MET hours per week or sufficiently active.…”

Surveillance and Survivorship after Treatment for Colon Cancer

“…A diet rich in fruits, vegetables, poultry, fish, whole grain, and poor in red meat and concentrated sweets was associated with better outcomes with regard to cancer recurrence or death. [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] Another important aspect of survivorship care is health promotion. Evidence suggests that noncancer comorbidities have a negative impact on overall quality of life and long-term survival when compared with the cancer diagnosis itself.…”