title: Physical activity and survival of colorectal cancer patients: Population-based study from Germany.
abstract: Increasing evidence shows physical activity to be associated with improved colorectal cancer (CRC) prognosis. However, large-scale prospective patient cohorts, comprehensively ascertaining physical activity, comprehensively considering potential variation by CRC stage and considering specific outcome measures, are sparse. Therefore, we aimed to evaluate the association of lifetime and latest prediagnostic leisure time physical activity with relevant prognostic outcomes in a large population-based cohort of CRC patients. 3,121 patients, diagnosed with CRC in 2003-2010 (median age: 69 years), were interviewed on sociodemographic and lifestyle factors, medication and comorbidities. Cancer recurrence, vital status and cause of death were documented over a median follow-up time of 4.8 years. Associations between lifetime and latest prediagnostic leisure time physical activity and overall, CRC-specific, recurrence-free and disease-free survival were evaluated with Cox regression. Latest but not lifetime leisure time physical activity [in metabolic task hours per week (MET-h/wk)] was associated with decreased overall and CRC-specific mortality (>56.2 vs. ≤13.2 MET-h/wk: adjusted hazard ratio (aHR)Overall/latest= 0.75; 95% confidence interval (CI) = 0.61-0.91; aHRCRC-specific/latest= 0.81; 95% CI = 0.64-1.02). In particular lifetime and latest walking were associated with decreased mortality (>20 vs. 0-10 MET-h/wk of walking: aHROverall/latest= 0.66; 95% CI = 0.56-0.77; aHRCRC-specific/latest= 0.72; 95% CI = 0.60-0.87; aHROverall/lifetime= 0.78; 95% CI = 0.66-0.93; aHRCRC-specific/lifetime= 0.71; 95% CI = 0.58-0.86). Associations were particularly pronounced for lifetime walking in metastatic (stage IV) and for latest walking in nonmetastatic disease patients. Prediagnostic physical activity was associated with improved CRC prognosis. Associations might be restricted to certain activities or depend on (non)metastatic disease state. Further optimization of activity recommendations and increase of recommendation adherence may help to improve patients' prognosis.
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Viola
authors.initials: V
authors.lastname: Walter
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Lina
authors.initials: L
authors.lastname: Jansen
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Knebel
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoffmeister
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.|Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.|German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D018572:Disease-Free Survival; D015444:Exercise; D005260:Female; D005858:Germany; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors; D016138:Walking
keywords: colorectal neoplasms; physical activity; prognosis; recurrence; survival