Brown, J.C., Damjanov, N., Courneya, K.S., Troxel, A.B., Zemel, B.S., Rickels, M.R., . . . Schmitz, K.H. (2018). A randomized dose-response trial of aerobic exercise and health-related quality of life in colon cancer survivors. Psycho-Oncology, 27, 1221–1228.

To determine the dose-response effect of aerobic exercise on health-related quality of life outcomes among colon cancer survivors after treatment completion, including functional status, sleep, fatigue, fear of recurrence, and bowel function.

The intervention was a prescription for home-based aerobic exercise over six months–either low-dose aerobic exercise (150 minutes per week) or high-dose aerobic exercise (300 minutes per week). Each participant received a treadmill and a heart rate monitor. An exercise physiologist provided ongoing in-person, telephone, and email support, individualized to each participant, and monitored adherence to the exercise protocol.   Exercise intensity was prescribed at 50%-70% of age-predicted maximum heart rate and gradually increased for each participant to meet their goal.

• N = 39  
• AGE: Younger than 60, n = 25 (64%); older than 60, n = 14 (36%)
• MALES: 38%  
• FEMALES: 62%

• SITE: Single site   
• SETTING TYPE: Home    
• LOCATION: Philadelphia, PA

PHASE OF CARE: Transition phase after active treatment

Randomized controlled trial with three groups: usual care (usual recommendations for activity), low-dose aerobic exercise (150 minutes per week), and high-dose aerobic exercise (300 minutes per week).

Medical Outcomes Survey Short Form (SF-36), Functional Assessment of Cancer Therapy–Colorectal (FACT-C), Pittsburgh Sleep Quality Index (PSQI), Fear of Cancer Recurrence Inventory (FCRI), Fatigue Symptom Inventory (FSI), North Central Cancer Treatment Group questionnaire (bowel function)

Physical health score in SF-36 improved by 1.2 (d = 0.08) in the low-dose group and 13.1 (d = 0.58) in the high-dose group. FACT-C scores increased by 7.6 (d = 0.49) in the low-dose group and 6.8 (d = 0.58) in the high-dose group. PSQI scores decreased by 0.3 in the low-dose group (d = -0.11) and by 1.1 (d = -0.3) in the high-dose group. PSQI subscales of sleep quality and sleep latency showed improvement. FSI scores increased by 0.8 (d = 0.08) in the low-dose group and decreased by 6 (d = -0.75) in the high-dose group. There were no changes observed in mental health scores of SF-36, FCRI scores, or bowel function scores.

The six-month home-based aerobic exercise intervention for survivors of colon cancer improved health-related outcomes, including physical function, quality of life, sleep quality, and fatigue. Improvements were dose-related, such that a higher dose of aerobic exercise resulted in greater improvement in outcomes.

• Small sample (< 100)
• Risk of bias (no blinding)
• Findings not generalizable
• Other limitations/explanation: The home-based intervention included giving each participant a treadmill and individualized support from an exercise physiologist for six months, which may not be feasible for the larger population.

Moderate intensity aerobic exercise in excess of the recommended 150 minutes per week showed clinically meaningful improvements in health-related outcomes, including physical function, quality of life, sleep quality, and fatigue in survivors of colon cancer who have completed treatment.