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

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

doi:10.1186/s12885-017-3066-2

Abstract

BackgroundThe 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.MethodsWe 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.ResultsAt 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).ConclusionsAt 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.

Highlights

The influence of physical activity on patient-reported recovery of physical functioning after colorectal cancer (CRC) surgery is unknown
71 patients were excluded from analyses since they did not provide any information on physical activity and/or physical functioning before surgery (n = 31) or 6 months post-diagnosis (n = 40)
At 6 months post-diagnosis (164 ± 25 days after tumor resection) 54% (n = 178) of CRC patients had not recovered to pre-operative physical functioning

Summary

Introduction

The influence of physical activity on patient-reported recovery of physical functioning after colorectal cancer (CRC) surgery is unknown. Surgery for colorectal cancer (CRC) is followed by a period of recovery which begins in hospital and continues after discharge [1, 2]. Following a rapid decline after CRC surgery [1, 9, 10], patient physical function scores return to pre-operative values [9, 10]. Not all individual CRC patients recover to their pre-operative level of physical functioning. In a study among patients over 60 years of age undergoing major abdominal surgery for mixed reasons, less than 50% of patients recovered to baseline levels of functional status at 6 months after surgery [11]. Recovery depends on clinical factors such as location of the tumor, presence of an ostomy, and patient characteristics (age and physical functioning before surgery) [12, 13]

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