Open Access

Caroline Himbert, Jennifer Ose, Biljana Gigic, Richard Viskochi, Kelly Santuci, Tengda Lin, Anjelica Ashworth, Jessica N. Cohan, Courtney L. Scaife, Jolanta Jedrzkiewicz, Victoria Damerell, Katelyn M. Atkins, Jun Gong, Matthew G. Mutch, Corey Bernadt, Seth Felder, Julian Sanchez, Stacey A. Cohen, Mukta K. Krane, Nathan Hinkle, Elizabeth Wood, Anita R. Peoples, Jane C. Figueiredo, Adetunji T. Toriola, Erin M. Siegel, Christopher I. Li, David Shibata, Kenneth Boucher, June L. Round, Alexis B. Ulrich, Martin Schneider, Lyen C. Huang, Sheetal Hardikar, Cornelia M. Ulrich

• Background: Physical activity and BMI have been individually associated with cancer survivorship but have not yet been studied in combinations in colorectal cancer patients. Here, we investigate individual and combined associations of physical activity and BMI groups with colorectal cancer survival outcomes. Methods: Self-reported physical activity levels (MET hrs/wk) were assessed using an adapted version of the International Physical Activity Questionnaire (IPAQ) at baseline in 931 patients with stage I-III colorectal cancer and classified into ‘highly active’ and ’not-highly active’ (≥/ < 18 MET hrs/wk). BMI (kg/m2) was categorized into ‘normal weight’, ‘overweight’, and ‘obese’. Patients were further classified into combined physical activity and BMI groups. Cox-proportional hazard models with Firth correction were computed to assess associations [hazard ratio (HR), 95% profile HR likelihood confidence interval (95% CI) between individual and combined physical activity and BMI groups with overall and disease-free survival in colorectal cancer patients. Results: ‘Not-highly active’ compared to ‘highly active’ and ‘overweight’/‘obese’ compared to ‘normal weight’ patients had a 40–50% increased risk of death or recurrence (HR: 1.41 (95% CI: 0.99–2.06), p=0.03; HR: 1.49 (95% CI: 1.02–2.21) and HR: 1.51 (95% CI: 1.02–2.26), p= 0.04, respectively). ‘Not-highly active’ patients had worse disease-free survival outcomes, regardless of their BMI, compared to ‘highly active/normal weight’ patients. ‘Not-highly active/obese’ patients had a 3.66 times increased risk of death or recurrence compared to ‘highly active/normal weight’ patients (HR: 4.66 (95% CI: 1.75–9.10), p=0.002). Lower activity thresholds yielded smaller effect sizes. Conclusion: Physical activity and BMI were individually associated with disease-free survival among colorectal cancer patients. Physical activity seems to improve survival outcomes in patients regardless of their BMI.