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Table 1 Matrix of evidence

From: Impact of physical activity and diet on colorectal cancer survivors’ quality of life: a systematic review

Study (year) Purpose Sample size Study design (LOE) Data collection method and instruments Findings and conclusions Comments
Anderson, Steele, and Coyle (2013) To evaluate patients’ perceptions regarding their need for advice concerning activity and diet, as well as their belief in the role played by lifestyle in lowering the risk of cancer recurrence 40 CRC survivors Focus group discussion Interview schedule The results revealed a high level of willingness among cancer survivors to obtain diet-related advice that can help them prevent symptoms It is critical for healthcare providers to be capable of offering advice to survivors regarding suitable dietary choices
Cercek and Holt (2017) To describe the situation of CRC survivors who do not adequately follow surveillance guidelines and who receive inadequate patient care Not indicated Literature review Review of previous research The results of the review indicated the need for gastroenterologists to improve their roles regarding coordinating the management of CRC survivors It is necessary to include increased surveillance as part of a coordinated management program for CRC survivors
Chen et al. (2017) To assess the sufficiency of a four-week trimodal rehabilitation program for improving elderly patients’ functional capacity following cancer surgery 116 elderly patients prepared for CRC surgery Randomized control trial Measurement questionnaire The results indicated that the trimodal rehabilitation program had a positive effect on levels of PA, as well as on functional walking ability The results indicate the potential to improve PA and physical function among elderly cancer patients
Courneya et al. (2014) To provide an update on the Colon Health and Life-Long Exercise Change (CHALLENGE) trial, which is a three-year exercise program concerning disease-free survival 250 patients Randomized controlled trial Questionnaire The CHALLENGE trial was proven to be effective as a randomized controlled trial assessing the effect of an exercise program on disease-free survival The results indicate the need to devise similar programs to positively implement disease-free survival
Davies, Batehup, and Thomas (2011). To update, through a review, existing literature concerning the role of diet and physical activity (PA) on cancer incidence 43 records Literature review Comprehensive review of the literature The results from the review indicated that a low-fat, high-fibre diet plays a protective role in preventing the progression and recurrence of cancer The need for a suitable diet is evident, suggesting the importance of implementing dietary interventions for cancer survivors
Devin et al. (2016) To compare the effects of 4 weeks of moderate- and high-intensity exercise (HIE) training on the body composition of CRC survivors 47 post-treatment CRC survivors Randomized controlled trial Questionnaire The results indicated that HIE, in comparison to short-term training, is a safe, feasible, and effective intervention offering clinically significant improvement in cardiorespiratory fitness as well as body composition The findings clarify the need for effective HIE programs for CRC survivors
Doyle et al. (2006) To summarize the findings of the American Cancer Society regarding the information-seeking behaviours of cancer survivors Not indicated Literature analysis Review of research findings The researchers indicate issues related to the availability of information concerning nutrition and PA, and the potential for patients to make informed decisions when provided with such information The report indicates the need to provide relevant information on the nutritional- and PA-related needs of cancer survivors
D’Souza, Daudt, and Kazanjian (2016) To investigate the sociodemographic, physically limiting, and behavioural factors that influence leisure-time PA among CRC survivors 2378 studies, conducted between 1997 and 2010 Meta-analysis Review of previous surveys on the topic It was revealed through multivariable regression models that compliance with PA is limited among racial minorities and individuals with ≥ 2 physically limiting enduring conditions, and also among current tobacco users The findings indicated a need for greater efforts to increase the various patient groups’ compliance with leisure-time PA requirements
Eakin et al. (2015) To investigate the implementation of evidence-based lifestyle interventions targeting cancer survivors 900 participants Survey Questionnaire The results indicated the importance of resources and guidelines in regard to the implementation of evidence-based lifestyle interventions Interventions for cancer survivors are critical, as a result of the various challenges they face after diagnosis
El-Shami (2015) To review literature concerning guidelines for the management of long-term care for CRC survivors Not indicated Literature review Review and analysis of research on the topic The results indicate the importance of communication and coordination of care between oncologists and primary care physicians It is critical that long-term care for CRC survivors is considered in post-treatment interventions
Fisher et al. (2016) To investigate the benefits of post-diagnosis PA for CRC survivors 495 CRC patients;survey Survey Open-ended questionnaire The findings indicated the benefits of PA following cancer treatment, while also identifying barriers to effective implementation Addressing barriers to effective implementation is essential for realizing the benefits of PA
Forbes et al. (2017) To examine how an Internet-delivered, distance-based PA-behaviour-change program affects cancer survivors’ motivation to practice PA 95 breast cancer, prostate cancer, and CRC survivors Randomized controlled trial Structured questionnaire The Internet-based program was proven to have a negative impact on cancer survivors’ motivation It is possible that the results were limited by methodological challenges, including the means of measuring levels of motivation
Golsteijn et al. (2017) To investigate the role of PA in positively affecting the negative effects of cancer and related therapies Not indicated A literature study and interviews Interview protocol The results indicated the importance of general and cancer-specific PA as factors that improve the health and quality of life of cancer survivors It is critical for patients to adopt a positive lifestyle that includes PA
Grimmett et al. (2011) To examine the prevalence of health-related behaviours in CRC survivors, as well as the associations between health behaviours and quality of life. 495 CRC patients Survey Questionnaire The results indicated that most cancer survivors in the UK have suboptimal health behaviours It is critical that lifestyle change and positive health behaviours be promoted among cancer survivors
Grote et al. (2016) To examine the feasibility of blended aerobic and resistance training (CART) as a means of improving cancer survivors’ cardiometabolic health 11 cancer survivors Descriptive and longitudinal pilot study Scheduled interviews The study revealed a close relationship between CART and cancer survivors’ cardiometabolic health The importance of implementing appropriate PA programs is underlined in this research
Ho et al. (2016) To identify particular concerns of CRC survivors regarding various areas of their well-being, including physical, psychological, and social functioning 30 CRC survivors Focus group discussion Interview schedule Participants revealed considerable dissatisfaction with the information they receive regarding their treatment There is a need to address barriers to effective care and management of patients following treatment for CRC
Husson et al. (2015) To examine the longitudinal relationship between HRQoL and the PA of CRC survivors 9152 cancer survivors Telephone survey Questionnaire The results indicated a considerable positive relationship between PA and HRQoL. The relationship was found to be consistent up to 2 years following diagnosis The results underlined the need for a PA program for CRC survivors
Keesing, McNamara, and Rosenwax (2015) To focus on cancer survivors’ experiences and obtain their perspectives regarding survivorship care programs 11 qualitative studies Literature review Systematic review of qualitative literature The research revealed the importance of survivorship care programs for cancer survivors It is critical to implement effective programs that support the management of cancer survivors
Ko et al. (2010) To establish whether the relationship between CRC intervention and fruit and vegetable consumption among survivors is mediated by information processes 266 CRC survivors Randomized control trial Questionnaire Information processes, such as trust in and relevance of communications, were found to be important mediators between CRC interventions and fruit and vegetable consumption The results indicated the importance of devising effective communication processes to increase survivors’ adherence to CRC interventions and fruit and vegetable consumption
Krouse et al. (2017) To examine the (inadequately studied) relationships between HRQoL, PA, and bowel function in rectal cancer survivors 1063 rectal cancer survivors Multidimensional survey Questionnaire Fulfilling PA guidelines was shown to have a positive relationship with HRQoL It is essential, for CRC survivors, to develop and ensure adherence to PA in order to improve quality of life
Lawrence et al. (2017) To identify situations in which CRC survivors participate in PA and those in which they engage in sedentary behaviours, and to use this information to influence health-promotion interventions 31 cancer survivors Exploratory study Structured interview schedule The study revealed environments in which survivors of CRC are active and in which they are sedentary The findings showed the criticality of considering the home environment when devising interventions that encourage PA and discourage sedentary behaviour
Leong et al. (2017) To investigate the effect of follow-up and survivorship programs in regard to the management of cancer survivors Not indicated Literature review Review of the literature on follow-up and survivorship programs The results indicated the importance of effective follow-up and survivorship programs for addressing issues such as recurrence of disease Care providers should implement effective follow-up and survivorship programs as part of post-treatment management
Ligibel (2012) To investigate the association between diet, PA, and body weight (i.e., energy balance) and the chance of cancer recurrence and mortality in various forms of cancers Not indicated Literature review Review of the literature on lifestyle behaviour The review indicated the association between lifestyle factors and cancer prognosis This study, regarding the management of cancer survivors, provides recommendations for further research and for necessary lifestyle changes
McGowan et al. (2017) To discern CRC survivors’ preferences regarding PA programs and counselling 600 CRC survivors Population-based, cross-sectional mailed survey Questionnaire The evidence indicated a high level of preference for participation in a PA program The results indicate the need for PA programs that are tailored to cancer survivors
Meyerhardt et al. (2013) To evaluate the policy and procedures developed by the American Society of Clinical Oncology One report Literature review Review of findings The society was determined to develop relevant guidelines for post-treatment management for cancer survivors Surveillance following treatment is critical to avoid the risk of recurrence
Miller et al. (2008) To assess the use of dietary supplements and their association with micronutrient intake and diet quality among breast cancer, prostate cancer, and CRC survivors (≥ 65 years) at five or more years post-diagnosis 753 survivors Telephone screening interviews Interview schedule In terms of the use of dietary supplements, demographics, disease, and health-related factors were revealed to play a critical role in reducing nutrient deficiencies in cancer survivors, which is similar to the situation for the general population The results indicated the potential for supplements to ensure, among cancer survivors, adequate intake of the nutrients necessary for good HRQoL
Moug et al. (2016) To assess evidence of the viability of performance of lifestyle interventions for CRC patients, as well as the short- and long-term advantages Meta-analysis Systematic review of previous research Fourteen RCTs The reviewed randomized controlled studies revealed the benefits of lifestyle interventions for cancer survivors The results indicated the feasibility of and need for lifestyle interventions post-cancer treatment
Pinto et al. (2012) To investigate the efficacy of home-based PA interventions 46 patients Randomized controlled trial Questionnaire PA intervention was revealed to be effective for promoting healthy lifestyles and good quality of life among cancer survivors This evidence indicates the need for effective home-based PA interventions for the management of cancer survivors
Rock et al. (2012) To provide a summary of findings from the American Cancer Society regarding cancer survivors’ information-seeking concerning nutrition and PA, and the role this plays in cancer survivorship Not indicated Research analysis Analysis of research findings The results indicated the importance of dietary and PA recommendations for HRQoL It is important for healthcare providers to use recommendations to provide advice on appropriate diet and PA for cancer survivors
Sellar et al. (2017) To examine the feasibility and effectiveness of a 12-week supervised exercise training program for CRC survivors 29 CRC survivors Randomized controlled trial Questionnaire Participants engaging in the exercise training program reported better health outcomes than did the control group The results indicate the need for an effective and feasible exercise training program to improve the quality of life of cancer survivors
Thraen-Borowski et al. (2013) To examine, in older, long-term CRC survivors, the connection among PA, social participation, and HRQoL 1768 male and female CRC survivors Survey Questionnaire The study revealed an association between PA and physical health, and between social participation and psychological health, among older, long-term CRC survivors The results indicate the need for a comprehensive intervention program involving PA and social participation in order to improve HRQoL among CRC survivors
Vallance et al. (2015) To determine the associations of impartially assessed, moderate-to-vigorous–intensity PA and sedentary time with psychological health in colon cancer survivors 180 colon cancer survivors Mailed survey Quantitative measures The results of the study did not indicate any association between moderate-to-vigorous–intensity PA and sedentary time and depression symptoms. However, there was an association between objectively assessed moderate-to-vigorous–intensity PA and satisfaction It is critical to establish programs that increase PA and reduce sedentary time
van Putten et al. (2016) To examine the connection between a variety of factors (symptom- and function-related, sociodemographic, and clinical) concerning the PA of CRC survivors 9956 CRC survivors Survey Validated questionnaires The study revealed a number of functioning-related and symptom-related factors that hinder PA among cancer survivors It is essential to address the sociodemographic factors that impact the adoption of PA among CRC survivors
Winkels et al. (2016) To assess CRC survivors’ level of compliance with eight recommendations of The World Cancer Research Foundation/American Institute for Cancer Research regarding PA, diet, and body weight 1774 CRC survivors Survey Questionnaires The results indicated a low rate of adherence to the recommendations; only 12% complied with six or more of the eight recommendations, 65% adhered to between five and six; and 23% adhered to four or less There is room for improvement in lifestyle choices in order to ensure greater adherence with recommendations concerning diet, physical exercise, and body weight