Journal of the National Comprehensive Cancer Network : JNCCN · 2026
Longitudinal Study on the Influence of Physical Activity in Managing Fatigue in Patients With Colorectal Cancer.
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Liu Louisa, Kazemian Elham, Loroña Nicole C, Shirazipour Celina, Gong Jun, Crowder Sylvia L, Nguyen Nathalie, Damerell Victoria, Mooney Kathi, Playdon Mary C, Ulrich Cornelia M, Li Christopher I, Shibata David, Toriola Adetunji T, Ose Jennifer, Peoples Anita R, Hardikar Sheetal, Siegel Erin M, Bower Julienne E, Gigic Biljana, Hoogland Aasha I, Li Xiaoyin, Small Brent J, Kaufman Howard, Jim Heather S L, Figueiredo Jane C
Аннотация
BACKGROUND: Fatigue is a prevalent and debilitating symptom among patients with cancer. Physical activity (PA) may help reduce fatigue and improve quality of life (QoL). This study evaluated longitudinal associations between PA, fatigue, and QoL across the cancer care continuum.
METHODS: Data were analyzed from 1,718 participants in a prospective multicenter cohort. Self-reported PA was assessed at baseline and up to 24 months post-diagnosis using a questionnaire based on the International PA Questionnaire (IPAQ). Metabolic equivalent task (MET)-minutes per week were calculated for walking, moderate, vigorous, and total physical activity. Fatigue and QoL were measured using the EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30). Mixed-effects models evaluated associations between PA and outcomes. Lagged fluctuation models examined temporal relationships, separating between-person and within-person effects.
RESULTS: PA levels increased steadily from diagnosis through 24 months, coinciding with reduced fatigue and improved QoL. Higher PA was consistently linked to better fatigue and QoL outcomes. Walking was associated with lower odds of severe fatigue at 6 months (odds ratio [OR], 0.78; 95% CI, 0.62-0.98; P=.031) and 12 months (OR, 0.74; 95% CI, 0.59-0.94; P=.014), with higher odds of better QoL at all follow-up points. Vigorous activity showed the strongest protective effect against fatigue at 24 months (OR, 0.65; 95% CI, 0.45-0.94; P=.023). In patients with nonmetastatic disease, protective associations were observed across all activity types and time points. Lagged models indicated that higher average vigorous activity predicted lower future fatigue (P<.001).
CONCLUSIONS: Greater PA, particularly walking, was associated with lower fatigue and improved QoL, especially in patients with early-stage disease. The posttreatment period (approximately 1 year post-diagnosis) may represent an important window for behavioral intervention. Findings support stage- and recovery phase-specific guidance and highlight walking as a scalable, low-risk target for survivorship care.
METHODS: Data were analyzed from 1,718 participants in a prospective multicenter cohort. Self-reported PA was assessed at baseline and up to 24 months post-diagnosis using a questionnaire based on the International PA Questionnaire (IPAQ). Metabolic equivalent task (MET)-minutes per week were calculated for walking, moderate, vigorous, and total physical activity. Fatigue and QoL were measured using the EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30). Mixed-effects models evaluated associations between PA and outcomes. Lagged fluctuation models examined temporal relationships, separating between-person and within-person effects.
RESULTS: PA levels increased steadily from diagnosis through 24 months, coinciding with reduced fatigue and improved QoL. Higher PA was consistently linked to better fatigue and QoL outcomes. Walking was associated with lower odds of severe fatigue at 6 months (odds ratio [OR], 0.78; 95% CI, 0.62-0.98; P=.031) and 12 months (OR, 0.74; 95% CI, 0.59-0.94; P=.014), with higher odds of better QoL at all follow-up points. Vigorous activity showed the strongest protective effect against fatigue at 24 months (OR, 0.65; 95% CI, 0.45-0.94; P=.023). In patients with nonmetastatic disease, protective associations were observed across all activity types and time points. Lagged models indicated that higher average vigorous activity predicted lower future fatigue (P<.001).
CONCLUSIONS: Greater PA, particularly walking, was associated with lower fatigue and improved QoL, especially in patients with early-stage disease. The posttreatment period (approximately 1 year post-diagnosis) may represent an important window for behavioral intervention. Findings support stage- and recovery phase-specific guidance and highlight walking as a scalable, low-risk target for survivorship care.