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Physical activity and quality of life among long-term colorectal cancer survivors

Eyl, Ruth Elisa

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Physical activity has been shown to be effective in the primary prevention of CRC. Despite the growing interest for the role of PA in tertiary prevention, research on PA and QOL specifically among long-term CRC survivors is scarce. This dissertation aimed to investigate whether PA is associated with better QOL and to identify potential determinants that prevent long-term CRC survivors from being physically active. Results from the literature review showed that only few studies investigated the association between PA and QOL especially in long-term survivors. Summarizing the findings of the included studies, higher as well as lower intensities of post-diagnosis PA were positively associated with CRC survivors´ QOL, however, most studies were based on a cross-sectional and observational study design.

In the DACHS study, PA was assessed shortly after CRC diagnosis, asking for pre-diagnosis PA and PA five years post-diagnosis, concurrent with QOL and fatigue. Therefore, a prospective assessment of pre-diagnosis PA with long-term factors such as QOL or fatigue was feasible. Results regarding the associations between PA and QOL as well as PA and fatigue suggest that pre-diagnosis PA might not provide any protection of cancer-related detriments neither in QOL nor in fatigue among long-term CRC survivors. Pre-diagnosis work-related PA and vigorous PA were even associated with decreased QOL in some domains and increased physical, cognitive, and affective fatigue. However, the results of the analyses support and emphasize the need of ongoing PA after CRC diagnosis to improve QOL and reduce fatigue in this population.

In a further analysis within the DACHS study, cancer-specific factors such as having a stoma, socio-demographic factors such as living in a small town or city, older age, or being divorced as well as lifestyle factors such as being a current smoker, or being obese were associated with physical inactivity among long-term CRC survivors. Moreover, baseline PA was identified as a strong predictor of physical inactivity five years later. Further subgroup analyses showed that the association between BMI and physical inactivity was stronger in women than in men.

The results of this dissertation are promising since it can be concluded that it is never too late to start exercising to improve the QOL of long-term CRC survivors and that PA is positively associated with QOL, even if completed at low intensity. This information might be motivating for CRC survivors who experience the cancer disease as a teachable moment, and therefore are more receptive for a lifestyle change. In addition, CRC survivors such as older survivors or survivors with poor health who may not be able to participate in higher intensity PA, have the potential to improve their QOL with low intensity PA. Subgroups of survivors who suffer from detriments in QOL five years after diagnosis as well as groups at higher risk for post-diagnosis physical inactivity were identified. In clinical practice, addressing high-need groups among CRC survivors might help to contribute to the development of specific, individually-tailored PA interventions to overcome physical inactivity and improve the long-term well-being of CRC survivors. Although guidelines such as the S3-guideline “colorectal cancer” point out the necessity for physicians to recommend PA to CRC patients, health care providers often do not prescribe PA to cancer patients. However, the encouragement by health care providers to engage in PA is crucial for cancer patients to participate in PA interventions. Therefore, it is important that health care providers motivate and encourage cancer survivors to be physically active also in the years of survivorship.

The findings of this dissertation add to the limited evidence on the crucial role of PA among long-term CRC survivors. However, more prospective studies and randomized controlled trials are needed to further evaluate and confirm the causality of the findings, in order to provide more solid evidence for individual PA recommendations and strategies to overcome barriers to PA. Moreover, prospective studies should focus on the association between PA and QOL or fatigue at multiple points in time pre- and post-diagnosis to determine if and how the effect of the association changes. In addition, future studies should complement self-reported PA information by using objective activity monitoring to minimize reporting bias. Future studies may also consider incorporating QOL questionnaires that cover psychological as well as physical aspects specifically relevant for long-term cancer survivors to gain a greater understanding of the specific needs relevant for this population.

Item Type: Dissertation
Supervisor: Arndt, Priv.-Doz. Dr. med. Volker
Place of Publication: Heidelberg
Date of thesis defense: 9 July 2019
Date Deposited: 24 Jul 2019 10:19
Date: 2019
Faculties / Institutes: Service facilities > German Cancer Research Center (DKFZ)
Subjects: 610 Medical sciences Medicine
Controlled Keywords: Epidemiologie
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