An increase in physical activity after colorectal cancer surgery is associated with improved recovery of physical functioning: a prospective cohort study

Moniek van Zutphen, Renate M Winkels, Fränzel J B van Duijnhoven, Suzanne A van Harten-Gerritsen, Dieuwertje E G Kok, Peter van Duijvendijk, Henk K van Halteren, Bibi M E Hansson, Flip M Kruyt, Ernst J Spillenaar Bilgen, Johannes H W de Wilt, Jaap J Dronkers, Ellen Kampman, Moniek van Zutphen, Renate M Winkels, Fränzel J B van Duijnhoven, Suzanne A van Harten-Gerritsen, Dieuwertje E G Kok, Peter van Duijvendijk, Henk K van Halteren, Bibi M E Hansson, Flip M Kruyt, Ernst J Spillenaar Bilgen, Johannes H W de Wilt, Jaap J Dronkers, Ellen Kampman

Abstract

Background: The influence of physical activity on patient-reported recovery of physical functioning after colorectal cancer (CRC) surgery is unknown. Therefore, we studied recovery of physical functioning after hospital discharge by (a) a relative increase in physical activity level and (b) absolute activity levels before and after surgery.

Methods: We included 327 incident CRC patients (stages I-III) from a prospective observational study. Patients completed questionnaires that assessed physical functioning and moderate-to-vigorous physical activity shortly after diagnosis and 6 months later. Cox regression models were used to calculate prevalence ratios (PRs) of no recovery of physical functioning. All PRs were adjusted for age, sex, physical functioning before surgery, stage of disease, ostomy and body mass index.

Results: At 6 months post-diagnosis 54% of CRC patients had not recovered to pre-operative physical functioning. Patients who increased their activity by at least 60 min/week were 43% more likely to recover physical function (adjusted PR 0.57 95%CI 0.39-0.82), compared with those with stable activity levels. Higher post-surgery levels of physical activity were also positively associated with recovery (P for trend = 0.01). In contrast, activity level before surgery was not associated with recovery (P for trend = 0.24).

Conclusions: At 6 month post-diagnosis, about half of CRC patients had not recovered to preoperative functioning. An increase in moderate-to-vigorous physical activity after CRC surgery was associated with enhanced recovery of physical functioning. This benefit was seen regardless of physical activity level before surgery. These associations provide evidence to further explore connections between physical activity and recovery from CRC surgery after discharge from the hospital.

Keywords: Colorectal cancer; Colorectal surgery; Epidemiology; Physical activity; Recovery of function; Rehabilitation.

Figures

Fig. 1
Fig. 1
Prevalence ratio and 95% confidence intervals (CI) of the association between no recovery of physical functioning at 6 months post colorectal cancer diagnosis and achange in moderate-to-vigorous physical activity from pre-to-post surgery (n = 327), n = 87, 47, 70, 42, 41, 40 patients; or b absolute level of moderate-to-vigorous physical activity after surgery among the subset of patients that either increased their activity level or had a stable activity level from pre-to-post surgery (n = 123), n = 21, 41, 61 patients; or c absolute level of moderate-to-vigorous physical activity before surgery among the subset of patients that either increased their activity level or had a stable activity level from pre-to-post surgery (n = 123), n = 39, 47, 37 patients. Models adjusted for age, sex, physical functioning before surgery, stage of disease, ostomy, and body mass index

References

    1. Lee L, Tran T, Mayo NE, Carli F, Feldman LS. What does it really mean to “recover” from an operation? Surgery. 2014;155(2):211–216. doi: 10.1016/j.surg.2013.10.002.
    1. Miller TE, Mythen M. Successful recovery after major surgery: Moving beyond length of stay. Perioper Med (Lond) 2014;3:4. doi: 10.1186/2047-0525-3-4.
    1. Neville A, Lee L, Antonescu I, et al. Systematic review of outcomes used to evaluate enhanced recovery after surgery. Br J Surg. 2014;101(3):159–170. doi: 10.1002/bjs.9324.
    1. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “She was probably able to ambulate, but i’m not sure”. JAMA. 2011;306(16):1782–1793. doi: 10.1001/jama.2011.1556.
    1. Given B, Given C, Azzouz F, Stommel M. Physical functioning of elderly cancer patients prior to diagnosis and following initial treatment. Nurs Res. 2001;50(4):222–232. doi: 10.1097/00006199-200107000-00006.
    1. Johnson BL, Trentham-Dietz A, Koltyn KF, Colbert LH. Physical activity and function in older, long-term colorectal cancer survivors. Cancer Causes Control. 2009;20(5):775–784. doi: 10.1007/s10552-008-9292-9.
    1. Oliphant SS, Lowder JL, Lee M, Ghetti C. Most older women recover baseline functional status following pelvic organ prolapse surgery. Int Urogynecol J. 2014;25(10):1425–1432. doi: 10.1007/s00192-014-2394-x.
    1. WHO . International classification of functioning, disability and health. Geneva: World Health Organization; 2001.
    1. Andersson J, Angenete E, Gellerstedt M, et al. Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial. Br J Surg. 2013;100(7):941–949. doi: 10.1002/bjs.9144.
    1. Janson M, Lindholm E, Anderberg B, Haglind E. Randomized trial of health-related quality of life after open and laparoscopic surgery for colon cancer. Surg Endosc. 2007;21(5):747–753. doi: 10.1007/s00464-007-9217-9.
    1. Lawrence VA, Hazuda HP, Cornell JE, et al. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg. 2004;199(5):762–772. doi: 10.1016/j.jamcollsurg.2004.05.280.
    1. Dronkers JJ, Chorus AM, van Meeteren NL, Hopman-Rock M. The association of pre-operative physical fitness and physical activity with outcome after scheduled major abdominal surgery. Anaesthesia. 2013;68(1):67–73. doi: 10.1111/anae.12066.
    1. Wilson TR, Alexander DJ. Clinical and non-clinical factors influencing postoperative health-related quality of life in patients with colorectal cancer. Br J Surg. 2008;95(11):1408–1415. doi: 10.1002/bjs.6376.
    1. Tak E, Kuiper R, Chorus A, Hopman-Rock M. Prevention of onset and progression of basic adl disability by physical activity in community dwelling older adults: A meta-analysis. Ageing Res Rev. 2013;12(1):329–338. doi: 10.1016/j.arr.2012.10.001.
    1. Paterson DH, Warburton DE. Physical activity and functional limitations in older adults: A systematic review related to canada’s physical activity guidelines. Int J Behav Nutr Phys Act. 2010;7:38. doi: 10.1186/1479-5868-7-38.
    1. Peddle CJ, Au HJ, Courneya KS. Associations between exercise, quality of life, and fatigue in colorectal cancer survivors. Dis Colon Rectum. 2008;51(8):1242–1248. doi: 10.1007/s10350-008-9324-2.
    1. Grimmett C, Bridgewater J, Steptoe A, Wardle J. Lifestyle and quality of life in colorectal cancer survivors. Qual Life Res. 2011;20(8):1237–1245. doi: 10.1007/s11136-011-9855-1.
    1. Lynch BM, Cerin E, Owen N, Aitken JF. Associations of leisure-time physical activity with quality of life in a large, population-based sample of colorectal cancer survivors. Cancer Causes Control. 2007;18(7):735–742. doi: 10.1007/s10552-007-9016-6.
    1. Courneya KS, Friedenreich CM. Relationship between exercise pattern across the cancer experience and current quality of life in colorectal cancer survivors. J Altern Complement Med. 1997;3(3):215–226. doi: 10.1089/acm.1997.3.215.
    1. Vallance JK, Boyle T, Courneya KS, Lynch BM. Associations of objectively assessed physical activity and sedentary time with health-related quality of life among colon cancer survivors. Cancer. 2014;120(18):2919–2926. doi: 10.1002/cncr.28779.
    1. Buffart LM, Thong MS, Schep G, Chinapaw MJ, Brug J, van de Poll-Franse LV. Self-reported physical activity: Its correlates and relationship with health-related quality of life in a large cohort of colorectal cancer survivors. PLoS One. 2012;7(5):e36164. doi: 10.1371/journal.pone.0036164.
    1. Winkels RM, Heine-Broring RC, van Zutphen M, et al. The colon study: Colorectal cancer: Longitudinal, observational study on nutritional and lifestyle factors that may influence colorectal tumour recurrence, survival and quality of life. BMC Cancer. 2014;14(1):374. doi: 10.1186/1471-2407-14-374.
    1. Aaronson NK, Ahmedzai S, Bergman B, et al. The european organization for research and treatment of cancer qlq-c30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–376. doi: 10.1093/jnci/85.5.365.
    1. Fayers PM, Aaronson NK, Bjordal K, et al. The eortc qlq-c30 scoring manual. 3. Brussels: European Organisation for Research and Treatment of Cancer; 2001.
    1. Cocks K, King MT, Velikova G, et al. Evidence-based guidelines for interpreting change scores for the european organisation for the research and treatment of cancer quality of life questionnaire core 30. Eur J Cancer. 2012;48(11):1713–1721. doi: 10.1016/j.ejca.2012.02.059.
    1. Wendel-Vos GC, Schuit AJ, Saris WH, Kromhout D. Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol. 2003;56(12):1163–1169. doi: 10.1016/S0895-4356(03)00220-8.
    1. Wagenmakers R, van den Akker-Scheek I, Groothoff JW, et al. Reliability and validity of the short questionnaire to assess health-enhancing physical activity (squash) in patients after total hip arthroplasty. BMC Musculoskelet Disord. 2008;9:141. doi: 10.1186/1471-2474-9-141.
    1. de Hollander EL, Zwart L, de Vries SI, Wendel-Vos W. The squash was a more valid tool than the obin for categorizing adults according to the dutch physical activity and the combined guideline. J Clin Epidemiol. 2012;65(1):73–81. doi: 10.1016/j.jclinepi.2011.05.005.
    1. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 compendium of physical activities: A second update of codes and met values. Med Sci Sports Exerc. 2011;43(8):1575–1581. doi: 10.1249/MSS.0b013e31821ece12.
    1. Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21. doi: 10.1186/1471-2288-3-21.
    1. Bhalla A, Williams JP, Hurst NG, et al. One-third of patients fail to return to work 1 year after surgery for colorectal cancer. Tech Coloproctol. 2014;18(12):1153–1159. doi: 10.1007/s10151-014-1232-y.
    1. Ulander K, Jeppsson B, Grahn G. Quality of life and independence in activities of daily living preoperatively and at follow-up in patients with colorectal cancer. Support Care Cancer. 1997;5(5):402–409. doi: 10.1007/s005200050099.
    1. Kopp I, Bauhofer A, Koller M. Understanding quality of life in patients with colorectal cancer: Comparison of data from a randomised controlled trial, a population based cohort study and the norm reference population. Inflamm Res. 2004;53(Suppl 2):S130–S135.
    1. Phillips BE, Smith K, Liptrot S, et al. Effect of colon cancer and surgical resection on skeletal muscle mitochondrial enzyme activity in colon cancer patients: A pilot study. J Cachexia Sarcopenia Muscle. 2013;4(1):71–77. doi: 10.1007/s13539-012-0073-7.
    1. Onerup A, Bock D, Borjesson M, et al. Is preoperative physical activity related to post-surgery recovery?-a cohort study of colorectal cancer patients. Int J Colorectal Dis. 2016;31(6):1131–1140. doi: 10.1007/s00384-016-2551-4.
    1. Boereboom C, Doleman B, Lund JN, Williams JP. Systematic review of pre-operative exercise in colorectal cancer patients. Tech Coloproctol. 2016;20(2):81–89. doi: 10.1007/s10151-015-1407-1.
    1. Terwee CB, Bot SD, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42. doi: 10.1016/j.jclinepi.2006.03.012.
    1. Bours MJ, Beijer S, Winkels RM, et al. Dietary changes and dietary supplement use, and underlying motives for these habits reported by colorectal cancer survivors of the Patient Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship (PROFILES) registry. Br J Nutr. 2015;114(2):286–96. doi: 10.1017/S0007114515001798.

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