Abstract
ObjectivePhysical activity is associated with reduced risk of colorectal cancer. However, whether physical activity could impart cancer patients’ survival benefits remains uncertain. The aim of this study is to systematically evaluate the relationship between physical activity and colorectal cancer mortality.ResultsOur meta-analysis included 11 studies involving 17,295 patients with a follow-up period ranging from 3.8 to 11.9 years. Results indicated that physical activity was inversely associated with overall (RR = 0.81, 95% CI = 0.72–0.91) and colorectal cancer-specific mortality (RR = 0.79, 95% CI = 0.71–0.89) before the diagnosis of cancer, respectively. For physical activity after diagnosis, the pooled RRs of colorectal cancer-specific and total mortality were 0.77 (95% CI, 0.63–0.94) and 0.71 (95% CI, 0.63–0.81), respectively. Similar inverse associations between exercise and prognosis were found among colorectal cancer survivors who had high-level exercise compared with those who had low-level exercise or were inactive. There was no obvious evidence for publication bias among studies.Materials and MethodsWe performed a systematic data search in PubMed, Cochrane Library databases and Web of Science for relevant articles before Jan 2016. We adopted adjusted estimates to calculate pooled relative risks (RRs) with 95% confidence intervals (CI) by the random-effects model. The publication bias was assessed by Begg's test.ConclusionsOur meta-analysis provides comprehensive evidence that physical activity, whether before or after the diagnosis of colorectal cancer, is related to reduced overall and cancer-specific mortality. Our findings may have significant public health implications and more prospective randomized clinical trials should be warranted to certify this protective association.
Highlights
Colorectal cancer (CRC) still represents one of most common malignances and a leading cause of cancer-related deaths globally, which accounts for over 1.2 million new colorectal cancer patients and 608,700 deaths in 2008 [1]
Results indicated that physical activity was inversely associated with overall (RR = 0.81, 95% confidence intervals (CI) = 0.72–0.91) and colorectal cancer-specific mortality (RR = 0.79, 95% CI = 0.71–0.89) before the diagnosis of cancer, respectively
For physical activity after diagnosis, the pooled relative risks (RRs) of colorectal cancer-specific and total mortality were 0.77 and 0.71, respectively
Summary
Colorectal cancer (CRC) still represents one of most common malignances and a leading cause of cancer-related deaths globally, which accounts for over 1.2 million new colorectal cancer patients and 608,700 deaths in 2008 [1]. Accumulating evidence from epidemiologic studies has indicated that some modifiable lifestyle factors, such as physical activity, were linked with reduced incidence of colorectal cancer and a higher level of exercise among cancer survivors might contribute to lots of health benefits for these individuals [4,5,6]. Some studies reported a favorable relationship between pre-diagnostic activity and prognosis of CRC [8, 14], while others indicated no significant association. Meyerhardt et al [10] reported that physical activity before the diagnosis was not associated with better prognosis among CRC survivors. It remains uncertain whether the beneficial effect of physical activity on CRC survival was influenced by other factors
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