Abstract
BackgroundLifestyle recommendations for cancer survivors are warranted to improve survival. In this study, we aimed to examine the association of total physical activity, different types of physical activity, hours of sleeping at day and night, and hours spent watching television (TV) with all-cause mortality in long-term colorectal cancer (CRC) survivors.MethodsWe assessed physical activity in 1376 CRC survivors (44% women; median age, 69 years) at median 6 years after CRC diagnosis using a validated questionnaire. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) for all-cause mortality according to categories of physical activities, sleep duration, and TV watching.ResultsDuring a median follow-up time of 7 years, 200 participants had died. Higher total physical activity was significantly associated with lower all-cause mortality (HR: 0.53; 95% CI: 0.36–0.80, 4th vs. 1st quartile). Specifically, sports, walking, and gardening showed a significant inverse association with all-cause mortality (HR: 0.34; 95% CI: 0.20–0.59, HR: 0.65; 95% CI: 0.43–1.00, and HR: 0.62; 95% CI: 0.42–0.91, respectively for highest versus lowest category). Individuals with ≥2 h of sleep during the day had a significantly increased risk of all-cause mortality compared to individuals with no sleep at day (HR: 2.22; 95% CI: 1.43–3.44). TV viewing of ≥4 h per day displayed a significant 45% (95% CI: 1.02–2.06) higher risk of dying compared to ≤2 h per day of watching TV.ConclusionsPhysical activity was inversely related to all-cause mortality; specific activity types might be primarily responsible for this association. More hours of sleep during the day and a higher amount of TV viewing were each associated with higher all-cause mortality. Based on available evidence, it is reasonable to recommend CRC survivors to engage in regular physical activity.
Highlights
Lifestyle recommendations for cancer survivors are warranted to improve survival
To account for reverse causality, we examined the association of postdiagnostic total physical activity with all-cause mortality after excluding colorectal cancer (CRC) survivors who died within 12 months after physical activity assessment
Our results strengthen the evidence on the association of higher postdiagnostic physical activity with reduced mortality risk in CRC survivors
Summary
Lifestyle recommendations for cancer survivors are warranted to improve survival. In this study, we aimed to examine the association of total physical activity, different types of physical activity, hours of sleeping at day and night, and hours spent watching television (TV) with all-cause mortality in long-term colorectal cancer (CRC) survivors. In 2012, there were nearly 1.4 million people diagnosed with colorectal cancer (CRC) and it is predicted that by 2035 the number of cases will increase to 1.36 million for men and 1.08 million for women worldwide [1]. Rising survival rates and increasing numbers of newly diagnosed cases lead to a growing group of CRC survivors [4]. Regular physical activity has a broad range of beneficial health effects, e.g., on obesity and other cardiovascular risk factors [7] and is associated with better overall survival in the general population and in many patient groups [8, 9]. A meta-analysis of 52 studies reported a risk reduction of colon cancer incidence of about 24% in physically active men and of about 21% in active women compared to inactive people [11]. Exercise has been shown to increase quality of life and to improve physical functioning among cancer survivors [14, 15]
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