Determinants of Physical Activity among Patients with Colorectal Cancer: From Diagnosis to 5 Years after Diagnosis

Abstract

Introduction: Physical activity (PA) is associated with higher quality of life and probably better prognosis among colorectal cancer (CRC) patients. This study focuses on determinants of PA among CRC patients from diagnosis until 5 yr postdiagnosis.

Methods: Sociodemographic and disease-related factors of participants of two large CRC cohort studies were combined. Moderate-to-vigorous PA during sport and leisure time (MVPA-SL) was measured at diagnosis (T0) and 6, 12, 24, and 60 months (T6 to T60) postdiagnosis, using the SQUASH questionnaire. Mixed-effects models were performed to identify sociodemographic and disease-related determinants of MVPA-SL, separately for stage I-III colon (CC), stage I-III rectal cancer (RC), and stage IV CRC (T0 and T6 only). Associations were defined as consistently present when significant at ≥4 timepoints for the stage I-III subsets. MVPA-SL levels were compared with an age- and sex-matched sample of the general Dutch population.

Results: In total, 2905 CC, 1459 RC and 436 stage IV CRC patients were included. Patients with higher fatigue scores, and women compared with men had consistently lower MVPA-SL levels over time, regardless of tumor type and stage. At T6, having a stoma was significantly associated with lower MVPA-SL among stage I-III RC patients. Systemic therapy and radiotherapy were not significantly associated with MVPA-SL changes at T6. Compared with the general population, MVPA-SL levels of CRC patients were lower at all timepoints, most notably at T6.

Conclusions: Female sex and higher fatigue scores were consistent determinants of lower MVPA-SL levels among all CRC patients, and MVPA-SL levels were lowest at 6 months postdiagnosis. Our results can inform the design of intervention studies aimed at improving PA, and guide healthcare professionals in optimizing individualized support.

Trial registration: ClinicalTrials.gov NCT02070146 NCT03191110.

FIGURE 1

Determinants of hours per week Sport and Leisure time Moderate and Vigorous PA (MVPA-SL) for subgroups of CRC patients. *p = 0.01 to <0.05, **p = 0.001 to <0.01, and ***p < 0.001. T0, at diagnosis; T6, 6 months after diagnosis; T12, 12 months after diagnosis; T24, 24 months after diagnosis; T60, 60 months after diagnosis. St. I-III CC, stage I-III colon cancer; St. I-III RC, stage I-III rectal cancer; st. IV CRC, stage IV colorectal cancer.

FIGURE 2

Determinants of ACSM PA guideline adherence (yes) for subgroups of CRC patients. *p = 0.01 to <0.05, **p = 0.001 to <0.01, and ***p < 0.001.

FIGURE 3

Physical activity levels of CRC patients and the general Dutch population, matched on age and sex.

FIGURE 4

Determinants of hours per week MVPA-SL for subgroups of CRC patients at diagnosis, and for the general Dutch population, matched on age and sex. *p = 0.01 to <0.05, **p = 0.001 to <0.01, and ***p < 0.001.

FIGURE 5

Determinants of ACSM PA guideline adherence (yes) for subgroups of CRC patients at diagnosis, and for the general Dutch population, matched on age and sex. *p = 0.01 to <0.05, **p = 0.001 to <0.01, and ***p < 0.001.