Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness
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REVIEW
Open Access
Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness Benjamin Singh1,2* , Sandra C. Hayes3, Rosalind R. Spence4, Megan L. Steele5, Guillaume Y. Millet1,6 and Laurent Gergele7
Abstract Background: This meta-analysis evaluated the safety, feasibility and effect of exercise among individuals with colorectal cancer. Methods: A database search (CINAHL, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing, Science Direct) for randomised, controlled, exercise trials involving individuals with colorectal cancer, published before January 1, 2020 was undertaken. Safety (adverse events), feasibility (withdrawal and adherence rates) and effect data (health outcomes including quality of life, QoL) were abstracted. Risk difference (RD) and standardised mean differences (SMD) were calculated to compare safety and effects between exercise and usual care (UC). Subgroup analyses were conducted to assess whether outcomes differed by exercise mode, duration, supervision and treatment. Risk of bias was assessed using the Physiotherapy Evidence Database tool. Results: For the 19 trials included, there was no difference in adverse event risk between exercise and UC (RD = 0.00; 95% CI:–0.01, 0.01, p = 0.92). Median withdrawal rate was 12% (0–22%) and adherence was 86% (42–91%). Significant effects of exercise compared to UC were observed for QoL, fatigue, aerobic fitness, upper-body strength, depression, sleep and reduced body fat (SMD = 0.21–0.66, p < 0.05). Subgroup analyses suggested larger benefits (p < 0.05) for QoL and fatigue for supervised interventions; for QoL, aerobic fitness and reduced body fat for ≥12week interventions; and for aerobic fitness when interventions were during chemotherapy. Conclusion: Although reporting of safety and compliance data was lacking in most trials, findings support that exercise is safe and feasible in colorectal cancer. Further, participation in mixed-mode exercise, including unsupervised exercise, leads to improvements in various health-related outcomes. Keywords: Colon, Colorectal, Rectal, Cancer, Neoplasm, Aerobic exercise, Resistance exercise, Exercise oncology
* Correspondence: [email protected] 1 Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France 2 Laboratoire Interuniversitaire de Biologie de la Motricité, Bâtiment IRMIS, 10 rue de la Marandière, 42270 Saint Priest en Jarez, France Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are inc
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