A Systematic Review and Meta-Analysis of Physical Activity Interventions in Colorectal Cancer Survivors: An Evidence...

Aims: Recommendations for cancer survivors concur regarding physical activity (PA), and elucidating factors governing PA uptake among colorectal cancer (CRC) survivors is needed. This study examined the impact of PA interventions and investigated the variation in PA across several characteristics, including race/ethnicity. Design: We performed a systematic review and aggregate data meta-analysis of randomized controlled trials (RCTs) of PA interventions. Data Sources: We used studies from CENTRAL, PubMed (NCBI), PsycINFO (EBSCOhost), CINAHL (EBSCOhost) with full text, Scopus (ELSEVIER), and the Web of Science (CLARIVATE) (1 May 1993-1 September 2023). Methods: For the meta-analysis, the inverse variance heterogeneity (IVhet) model was used to pool standardized mean difference effect sizes (Hedge's g) for our primary outcome, changes in PA. Results: Sixteen studies representing 1668 participants were included in the meta-analysis. A moderate, statistically significant increase in PA was observed (g = 0.44, 95% CI 0.12-0.76; p = 0.01). However, a large amount of inconsistency was observed (I² = 80.8%, 95% CI, 36.1% to 90.9%), as well as major asymmetry suggestive of small-study effects (publication bias, LFK = 3.04). Only 28% of trials reported race/ethnicity, limiting equity analyses. Subgroups comparing atheoretical vs. theory-based interventions did not differ statistically. Meta-regression results suggested associations with specific behavior change theories and delivery features. Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment, the overall certainty of evidence was considered low. Conclusions: There is low-certainty evidence that PA interventions may improve PA among CRC survivors. Future trials should (i) recruit and report diverse samples in a clear and transparent manner, (ii) explicitly map theory constructs to techniques and test mechanisms, and (iii) report fidelity and clinically meaningful thresholds alongside behavioral outcomes.