A systematic review and meta-analysis of randomized controlled trials for physical activity among colorectal cancer survivors: directions for future research

Background Physical activity (PA) is critically important to cancer rehabilitation. However, PA levels are generally lower in colorectal cancer (CRC) survivors compared to other cancer survivors. The purpose of this study was to examine the effectiveness of PA interventions in increasing PA levels and to provide recommendations for developing PA interventions in CRC survivors. Methods A systematic literature search was conducted in Cochrane Library, Embase, PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, and Wan Fang Data from January 2010 to March 1, 2024. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of eligible studies, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method was used to evaluate the certainty of evidence. The random-effects model was used in meta-analysis, and data were analyzed using standardized mean differences and 95% confidence intervals. Results A total of 22 studies were included in this review, all of which were rated as having good methodological quality based on the PEDro scale. In the meta-analysis, nine of these studies involving 684 participants were included, and results showed that PA interventions have a positive effect on increasing total PA levels in CRC survivors ( Z = 2.79, p = 0.005). Results of subgroup analysis revealed that supervised PA interventions ( Z = 2.82, p = 0.005) and PA interventions with multiple intervention components ( Z = 3.06, p = 0.002) effectively increased total PA levels for CRC survivors. In addition, research evidence suggests that daily as the frequency ( Z = 4.28, p < 0.001), Moderate-to-vigorous physical activity (MVPA) as the intensity ( Z = 2.29, p = 0.022), aerobic combined with resistance exercise as the type of PA ( Z = 4.19, p < 0.001) is appropriate for increasing total PA levels in CRC survivors. Conclusions The findings of this review provide strong evidence supporting the positive role of PA interventions in improving total PA levels among CRC survivors. This study offers preliminary insights into the appropriate patterns of PA interventions ( e.g ., frequency, intensity, type) for enhancing total PA levels in CRC survivors. However, further high-quality clinical trials are needed to determine the optimal timing, duration, and delivery methods of PA interventions to maximize their effectiveness in this population.