title: An increase in physical activity after colorectal cancer surgery is associated with improved recovery of physical functioning: a prospective cohort study.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Division of Human Nutrition, Wageningen University & Research, P.O Box 17, 6700 AA, Wageningen, The Netherlands.
authors.forename: Moniek
authors.identifier: 0000-0002-2368-0606
authors.initials: M
authors.lastname: van Zutphen
authors.affiliation: Division of Human Nutrition, Wageningen University & Research, P.O Box 17, 6700 AA, Wageningen, The Netherlands. renate.winkels@wur.nl.
authors.forename: Renate M
authors.initials: RM
authors.lastname: Winkels
authors.affiliation: Division of Human Nutrition, Wageningen University & Research, P.O Box 17, 6700 AA, Wageningen, The Netherlands.
authors.forename: Fränzel J B
authors.initials: FJ
authors.lastname: van Duijnhoven
authors.affiliation: Division of Human Nutrition, Wageningen University & Research, P.O Box 17, 6700 AA, Wageningen, The Netherlands.
authors.forename: Suzanne A
authors.initials: SA
authors.lastname: van Harten-Gerritsen
authors.affiliation: Division of Human Nutrition, Wageningen University & Research, P.O Box 17, 6700 AA, Wageningen, The Netherlands.
authors.forename: Dieuwertje E G
authors.initials: DE
authors.lastname: Kok
authors.affiliation: Department of surgery, Gelre Hospital, Apeldoorn, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: van Duijvendijk
authors.affiliation: Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes/Vlissingen, The Netherlands.
authors.forename: Henk K
authors.initials: HK
authors.lastname: van Halteren
authors.affiliation: Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Bibi M E
authors.initials: BM
authors.lastname: Hansson
authors.affiliation: Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands.
authors.forename: Flip M
authors.initials: FM
authors.lastname: Kruyt
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Ernst J Spillenaar
authors.initials: EJ
authors.lastname: Bilgen
authors.affiliation: Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
authors.affiliation: Department of Physical Therapy, Gelderse Vallei Hospital, Ede, The Netherlands.
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Dronkers
authors.affiliation: Division of Human Nutrition, Wageningen University & Research, P.O Box 17, 6700 AA, Wageningen, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Kampman
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D003107:Colorectal Surgery / Q000534:rehabilitation*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Colorectal cancer; Colorectal surgery; Epidemiology; Physical activity; Recovery of function; Rehabilitation