Modeling how substitution of sedentary behavior with standing or physical activity is associated with health-related quality of life in colorectal cancer survivors

Abstract

PurposePrevious research indicates that sedentary behavior is unfavorably associated with health-related quality of life (HRQoL) of colorectal cancer (CRC) survivors. Using isotemporal substitution modeling, we studied how substituting sedentary behavior with standing or physical activity was associated with HRQoL in CRC survivors, 2–10 years post-diagnosis.MethodsA cross-sectional study was conducted in stage I–III CRC survivors (n = 145) diagnosed at Maastricht University Medical Center+, the Netherlands (2002–2010). Sedentary, standing, and physical activity time were measured by the thigh-mounted MOX activity monitor. HRQoL outcomes comprised global quality of life, physical, role, and social functioning, and disability (scales: 0–100), fatigue (20–140), and depression and anxiety (0–21). Isotemporal substitution modeling was applied to analyze associations with HRQoL of substituting sedentary time with equal time in standing or physical activity.ResultsOn average, participants spent 10.2 h/day sedentary (SD, 1.7), 3.4 h/day standing (1.3), and 1.7 h/day in physical activity (0.8). In confounder-adjusted isotemporal models, substituting sedentary time with standing or with physical activity was associated with significantly better physical functioning (regression coefficient [β], i.e., difference in outcome score per 1 h/day of sedentary time substituted with standing or physical activity, 3.1; 95 % confidence interval [CI] 0.5, 5.7; and 5.6; 0.7, 10.6, respectively). Substituting sedentary time with standing was also associated with significantly lower disability (β, −3.0; 95 % CI −4.9, −1.1) and fatigue (−4.0; −7.6, −0.3).ConclusionsOur results suggest that substituting sedentary behavior with standing or physical activity may be beneficially associated with certain HRQoL outcomes in CRC survivors. Prospective studies are warranted to confirm whether actual substitution of sedentary behavior with these activities may improve HRQoL in CRC survivors.Electronic supplementary materialThe online version of this article (doi:10.1007/s10552-016-0725-6) contains supplementary material, which is available to authorized users.

Postdiagnosis sedentary behavior and health outcomes in cancer survivors: A systematic review and meta‐analysis

“…32,36 Fatigue Two prospective studies on sedentary behavior and fatigue, both conducted in breast cancer survivors, produced contrasting outcomes. Five studies showed no association, 32,34,42,44,46 three publications identified statistically significant, positive associations, 30,47,48 and 1 study identified significant positive associations when MVPA was included in the model, but not when light physical activity was included. 37 Results from cross-sectional studies were also mixed.…”

“…41 Regression coefficients ranged from 0.03 (95% CI, −0.05, 0.12) to 8.4 (95% CI, 0.05, 16.3). 37 A single cross-sectional study identified a statistical association at the 50th percentile of sedentary time, 43 but 6 cross-sectional studies (7 publications) in prostate, 32 colon/colorectal, 45,47,48 and breast cancer survivors 39,41 did not identify any significant associations. One prospective study did identify a statistically significant, positive association between sedentary time and depression (F = 4.97; P = .03), 40 whereas another did not (P for trend = .54).…”

“…Six of these studies were prospective in design. 31 32,37,43,45,47 and pain. 33 Sedentary time was assessed by using a device (eg, accelerometer) in 13 publications 30,32,33,35,37,40,41,[43][44][45][46][47][48] and by self-report in 6 publications.…”

“…32,48 Depression and anxiety There were mostly null associations between postdiagnosis sedentary time and depression, anxiety, or distress (depression and anxiety). 32,37,43,45,47,48 Other patient-reported outcomes Neither prospective nor cross-sectional independent associations between sedentary time and pain were identified in 5 studies, and regression coefficients ranged from −0.06 (95% CI, −0.15, 0.03) to −1.31 (95% CI, −3.22, 0.60). 37 A single cross-sectional study identified a statistical association at the 50th percentile of sedentary time, 43 but 6 cross-sectional studies (7 publications) in prostate, 32 colon/colorectal, 45,47,48 and breast cancer survivors 39,41 did not identify any significant associations.…”

Integrative medicine in cancer survivors

“…A cross-sectional study of 145 colorectal cancer survivors also found that greater sedentary time was associated with lower physical functioning, higher fatigue scores, and lower quality of life and lower role functioning [12,13]. Similarly, in 98 prostate cancer survivors, there was a trend toward an association between sedentary lifestyle and poorer quality of life [14].…”