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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)


Sample size

Study design (LOE)

Data collection method and instruments

Findings and conclusions


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


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


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


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



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


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



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


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


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


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


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


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


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


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



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


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



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