Modelling Substitution Of Sedentary Behavior With Standing Or Physical Activity To Study Associations With Quality Of Life In Colorectal Cancer Survivors

Eline VAN ROEKEL, Maastricht University, Netherlands
BOURS M. 1 , BREEDVELD-PETERS J. 1 , WILLEMS P. 2 , MEIJER K. 2 , KANT I. 3 , VAN DEN BRANDT P. 1 , BEETS G. 4 , SANDULEANU S. 5 , WEIJENBERG M. 1

1 Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
2 Department of Human Movement Science, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
3 Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
4 Department of Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
5 Department of Internal Medicine, Division of Gastroenterology and Hepatology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands

Purpose: Previous research indicates that sedentary behavior (sitting/lying at low energy expenditure while awake) is unfavorably associated with health-related quality of life (HRQoL) of colorectal cancer (CRC) survivors. Using isotemporal substitution modelling, we studied how substituting sedentary behavior with standing or physical activity was associated with multiple HRQoL outcomes in 2-10 years post-diagnosis CRC survivors.
 
Methods: A cross-sectional study was conducted in stage I-III CRC survivors (n = 145) diagnosed between 2002-2010 at Maastricht University Medical Center+, the Netherlands. Participants wore the thigh-mounted MOX activity monitor 24 hours/day for seven consecutive days to assess time spent in sedentary behavior, standing, and physical activity during waking hours. Validated questionnaires were used to assess HRQoL outcomes, comprising global quality of life, physical, role, and social functioning, and disability (scales: 0-100), fatigue (20-140), depression, and anxiety (0-21). Isotemporal substitution modelling was applied to analyze associations with HRQoL of substituting 1 hour/day of sedentary time with equal time in standing or physical activity.
 
Results: On average, participants spent 10.2 hours/day sedentary (standard deviation, 1.7), 3.4 hours/day standing (1.3), and 1.7 hours/day in physical activity (0.8). In confounder-adjusted isotemporal models, a significantly higher physical functioning score was observed for substituting 1 hour/day of sedentary time with standing (unstandardized regression coefficient [β], 3.1; 95% confidence interval [CI]: 0.5,5.7) or with physical activity (5.6; 0.7,10.6). Additionally, substituting sedentary time with standing was associated with significantly lower levels of disability (β, -3.0; 95% CI: -4.9,-1.1) and fatigue (-4.0; -7.6,-0.3). No significant associations were observed with other HRQoL outcomes.
 
Conclusions: Our results suggest that substituting sedentary behavior with standing or physical activity may be beneficially associated with certain HRQoL outcomes in CRC survivors. Prospective studies are warranted to confirm whether actual substitution of sedentary behavior with these activities may improve HRQoL in CRC survivors.
 
Funding source: Dutch Cancer Society.