Post-diagnosis physical activity and sedentary behaviour and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies
PubMed 38692650 · doi:10.1002/ijc.34903
What was done
A systematic review and meta-analysis of observational studies indexed in PubMed and Embase through February 28, 2022. The authors evaluated post-diagnosis total physical activity, recreational physical activity (by frequency, duration, intensity, and volume), and sedentary behaviour in relation to all-cause mortality, cause-specific mortality, and recurrence among colorectal cancer survivors. Data were pooled using categorical, linear, and non-linear dose-response random-effects models, and the CUP Global Expert Panel evaluated the likelihood of causality. The review included 16 observational studies comprising 82,220 non-overlapping patients across six countries.
What was found
Physical activity was consistently inversely associated with colorectal cancer morbidity and mortality outcomes, with estimated risk reductions ranging from 13% to 60%. Sedentary behaviour was positively associated with all-cause mortality, though numerical estimates were not provided in the abstract. The CUP Global Expert Panel graded the evidence as limited-suggestive for recreational physical activity with all-cause mortality and cancer recurrence, but graded total physical activity, specific activity domains, and sedentary behaviour as limited-no conclusion for all outcomes.
Why it matters
This review synthesizes the worldwide observational evidence on lifestyle factors after colorectal cancer diagnosis, highlighting suggestive survival benefits for physical activity while underscoring that current evidence is insufficient for strong clinical recommendations.
Limits
Findings rely entirely on observational studies susceptible to residual confounding, selection bias, and reverse causation. Few studies evaluated each specific dimension of activity, and the underlying literature lacked objective activity tracking and repeated measures over time.
Cited by
- supports Epidemiological studies show that cancer patients who report more exercise have a lower risk of disease recurrence and a lower risk of dying from cancer.