Post-diagnosis physical activity and sedentary behaviour and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis

Georgios Markozannes, Nerea Becerra-Tomás, Margarita Cariolou, Katia Balducci, Rita Vieira, Sonia Kiss, Dagfinn Aune, Darren C Greenwood, Marc J Gunter, Ellen Copson, Andrew G Renehan, Martijn Bours, Wendy Demark-Wahnefried, Melissa M Hudson, Anne M May, Folakemi T Odedina, Roderick Skinner, Karen Steindorf, Anne Tjønneland, Galina VelikovaMonica L Baskin, Rajiv Chowdhury, Lynette Hill, Sarah J Lewis, Jaap Seidell, Matty P Weijenberg, John Krebs, Amanda J Cross, Konstantinos K Tsilidis, Doris S M Chan*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

5 Citations (Scopus)


Low physical activity and high sedentary behaviour have been clearly linked with colorectal cancer development, yet data on their potential role in colorectal cancer survival is limited. Better characterisation of these relationships is needed for the development of post-diagnosis physical activity and sedentary behaviour guidance for colorectal cancer survivors. We searched PubMed and Embase through 28 February 2022 for studies assessing post-diagnosis physical activity, and/or sedentary behaviour in relation to all-cause and cause-specific mortality and recurrence after colorectal cancer diagnosis. Total and recreational physical activity were assessed overall and by frequency, duration, intensity, and volume using categorical, linear, and non-linear dose-response random-effects meta-analyses. The Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel interpreted and graded the likelihood of causality. We identified 16 observational studies on 82,220 non-overlapping patients from six countries. Physical activity was consistently inversely associated with colorectal cancer morbidity and mortality outcomes, with 13%-60% estimated reductions in risk. Sedentary behaviour was positively associated with all-cause mortality. The evidence had methodological limitations including potential confounding, selection bias and reverse causation, coupled with a limited number of studies for most associations. The CUP Global Expert panel concluded limited-suggestive evidence for recreational physical activity with all-cause mortality and cancer recurrence. Total physical activity and its specific domains and dimensions, and sedentary behaviour were all graded as limited-no conclusion for all outcomes. Future research should focus on randomised trials, while observational studies should obtain objective and repeated physical activity measures and better adjustment for confounders.

Original languageEnglish
Pages (from-to)426-444
Number of pages19
JournalInternational Journal of Cancer
Issue number3
Early online date1 May 2024
Publication statusE-pub ahead of print - 1 May 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.


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