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Physical activity patterns after diagnosis and survival of prognostic colorectal cancer subgroups.

Karel C Smit1, Jeroen W G Derksen1, Anne-Sophie van Lanen2

  • 1Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.

JNCI Cancer Spectrum
|December 15, 2025
PubMed
Summary

Increasing physical activity after colorectal cancer diagnosis improves survival. Patients who became more active early on, or later for those with advanced disease, experienced longer overall survival.

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Area of Science:

  • Oncology
  • Exercise Science
  • Public Health

Background:

  • Physical activity (PA) is linked to better survival in colorectal cancer (CRC) patients.
  • Limited research exists on how PA changes post-diagnosis impact survival.
  • This study investigates PA changes and their association with overall survival (OS) in CRC patients across different stages and treatments.

Purpose of the Study:

  • To examine the association between changes in physical activity (PA) from colorectal cancer (CRC) diagnosis onward and overall survival (OS).
  • To analyze these associations across subgroups based on cancer stage and treatment modalities.
  • To understand the temporal relationship between PA shifts and survival outcomes in CRC patients.

Main Methods:

  • Analysis of two large CRC cohorts (PLCRC and COLON) with follow-up until February 2024.
  • Inclusion of 3395 surgery-only patients, 2406 (neo-)adjuvant therapy patients, and 669 metastatic CRC (mCRC) patients.
  • PA assessed using the SQUASH questionnaire at diagnosis (T0) and 6, 12, 24 months post-diagnosis (T6-T24), quantifying moderate-to-vigorous activity (MET hours/week).
  • Multivariable Cox proportional hazards models used to examine associations between PA changes (inactive vs. active tertiles) and OS.

Main Results:

  • For surgery-only patients, transitioning from inactivity to activity between T0 and T6 was linked to improved OS (HR=0.58).
  • For patients receiving (neo-)adjuvant therapy, PA changes between T6 and T12 showed a significant association with OS (HR=0.53).
  • Metastatic CRC (mCRC) patients also showed a significant association between PA changes from T6 to T12 and OS (HR=0.53).

Conclusions:

  • Increasing physical activity post-diagnosis is significantly associated with prolonged survival in colorectal cancer patients.
  • The timing of this benefit varies: early months for surgery-only patients, and later (6-12 months) for those undergoing therapy or with metastatic disease.
  • Further validation through interventional studies is recommended to confirm these findings.