©Psy,Soc,&Educ,2017,Vol.9(2)
© Psychology, Socie y, & Educa ion, 2017. Vol. 9(2), pp. 201-226
ISSN 2171-2085 (p in ) / ISSN 1989-709X (online)
Doi10.25115/psye. 9i2.698
Fac o s ha p omo e o hinde physical ac i i y pa icipa ion
in pa ien s wi h colo ec al cance : A sys ema ic e iew
Ma ía ROMERO-ELÍAS, Da id GONZÁLEZ-CUTRE,
Vicen e J. BELTRÁN-CARRILLO and Edua do CERVELLÓ
Spo Resea ch Cen e , Miguel He nández Uni e si y o Elche, Spain
(Recei ed on Ma ch 22, 2017; Accep ed on Ap il 16, 2017)
ABSTRACT:Di e en s udies o pa ien s wi h colo ec al cance ha e shown ha physical ac i i y has
posi i e physical and psychosocial e ec s. Howe e , mos pa ien s do no comply wi h he
ecommended c i e ia o physical ac i i y. The aim o he p esen s udy was o analyze, by means o a
sys ema ic e iew o he li e a u e, he ac o s associa ed wi h physical ac i i y pa icipa ion in pa ien s
wi h colo ec al cance . Fo his pu pose, we conduc ed a sea ch in he da abases WEB OF SCIENCE,
SCOPUS and SPORTDISCUS up o Feb ua y o 2016. A e he selec ion p ocess, 23 ull- ex a icles
we e e ained. The esul s allowed iden i ying ou la ge ca ego ies o ac o s ela ed o physical
ac i i y pa icipa ion in his popula ion: sociodemog aphic ac o s, heal h ac o s (speci ic and
nonspeci ic o he disease), p io expe ience and p e e ences, and mo i a ional ac o s. Among he
esul s ob ained, como bidi y and he eceip o adju an he apy (wi h i s co esponding side e ec s,
such as a igue and nausea) we e ela ed o less physical ac i i y. Va iables such as posi i e a i ude,
amily suppo , sa is ac ion o basic psychological needs, and sel -de e mined mo i a ion we e shown
o be acili a o s o physical ac i i y. Taking in o accoun hese esul s, i is necessa y o de elop
p og ams o physical ac i i y adap ed o he pa icula cha ac e is ics o his popula ion and based on
mo i a ional s a egies ha p omo e adhe ence o physical ac i i y.
Keywo ds: physical exe cise, mo i a ion, ba ie s, ea men , heal h
Fac o es que p omue en o di icul an la p ác ica de ac i idad ísica en pacien es con cánce
colo ec al: Una e isión sis emá ica
RESUMEN: Di e en es es udios con pacien es de cánce colo ec al han demos ado que el eje cicio
ísico iene e ec os ísicos y psicosociales posi i os. Sin emba go, la mayo ía de pacien es no cumple
los c i e ios de ac i idad ísica ecomendados. El obje i o del p esen e es udio ue analiza , a a és de
una e isión sis emá ica de la li e a u a, los ac o es asociados con la p ác ica de ac i idad ísica en
pacien es con cánce colo ec al. Pa a ello se ealizó una búsqueda en las bases de da os WEB OF
SCIENCE, SCOPUS y SPORTDISCUS has a eb e o de 2016. T as el p oceso de selección, se
e u ie on 23 a ículos a ex o comple o. Los esul ados pe mi ie on iden i ica cua o g andes
ca ego ías de ac o es elacionados con la p ác ica de ac i idad ísica en es a población: ac o es
sociodemog á icos, ac o es de salud (especí icos y no especí icos de la en e medad), p e e encias y
expe iencias p e ias, y ac o es mo i acionales. En e los esul ados ob enidos, cabe des aca que la
como bilidad y la ecepción de e apia adyu an e (con sus co espondien es e ec os secunda ios como
Physical ac i i y in pa ien s wi h colo ec al cance
©Psy,Soc,&Educ,2017,Vol.9(2)
202
a iga y náuseas), se elaciona on con una meno ealización de ac i idad ísica. Va iables como la
ac i ud posi i a, el apoyo amilia , la sa is acción de las necesidades psicológicas básicas y la
mo i ación au ode e minada, se mos a on como acili ado es de la pa icipación en ac i idad ísica.
Teniendo en cuen a es os esul ados, es necesa io desa olla p og amas de ac i idad ísica ajus ados a
las ca ac e ís icas pa icula es de es a población y basados en es a egias mo i acionales que
a o ezcan la adhe encia a la p ác ica.
Palab as cla e: eje cicio ísico, mo i ación, ba e as, a amien o, salud.
Co espondence: Da id González-Cu e, Cen o de In es igación del Depo e, Uni e sidad Miguel
He nández de Elche, A enida de la Uni e sidad s/n, 03202 Elche (Alican e). E-mail: dgonzalez-
[email p o ec ed]
INTRODUCTION
Cance is cu en ly one o he majo causes o mo ali y wo ldwide. In 2012, he e we e abou
14 million new cases and 8.2 million cance - ela ed dea hs (WHO, 2015). Fo example, cance
ep esen s he second cause o dea h in he Uni ed S a es and is expec ed o exceed
ca dio ascula disease as he leading cause o dea h in he coming yea s (Siegel, Mille , &
Jemal, 2015). I was es ima ed ha 595690 Ame icans would die o cance in 2016, which
ansla es in o abou 1630 people pe day (Ame ican Cance Socie y, 2016). In Spain, he
es ima ion 2015 was o 227076 cases, wi h an inc ease ha occu s o a g ea e ex en in he
popula ion ≥ 65 yea s (Spanish Socie y o Medical Oncology, 2014). App oxima ely 30% o
cance dea hs a e ela ed o i e beha io al isk ac o s: high body mass index, low in ake o
ui and ege ables, smoking, alcohol consump ion, and lack o physical ac i i y (WHO,
2015).
Besides he human su e ing in ol ed in cance , i has been es ima ed ha his disease causes a
high economic cos o heal h sys ems. Fo example, he o al cos o cance in 2008 in he
Uni ed S a es was a ound $ 228 billion. This si ua ion is a se ious public heal h p oblem, such
ha esea ch o he ac o s ha can p e en o alle ia e he disease is a p io i y o go e nmen s
(Ame ican Cance Socie y, 2010).
Speci ically, in he Uni ed S a es, colo ec al cance is he hi d cause o dea h by cance in men
and women, and he second cause when bo h sexes a e combined. In Eu ope, colo ec al cance
held he second posi ion in incidence a e b eas cance in 2012, and 49190 dea hs om
colo ec al cance we e es ima ed in 2016 (Spanish Ne wo k o Cance Regis e s, 2014). Fi e o
en-yea su i al a es o pa ien s wi h colo ec al cance a e 65% and 58%, espec i ely
(Siegel e al., 2015).
Due o colo ec al cance , pa ien s li e wi h physical and psychological sequelae ha g ow
wo se wi h ea men . Some o he symp oms a e: in es inal dys unc ion, su ge y pain, s oma,
a igue, muscle weakness, al e a ion o body image, anxie y, and dep ession (Downing e al.,
2015; Zabo a, B in zenho eSzoc, Cu bo , Hooke , & Pian adosi, 2001). To alle ia e hese
sequelae, he e is inc easingly mo e scien i ic e idence o he physical and psychological
bene i s o physical ac i i y, bo h du ing and a e ea men o his disease (Ga cia &
Thomson, 2014). Speci ically, in colo ec al cance , i was ound ha egula exe cise and
Physical ac i i y in pa ien s wi h colo ec al cance
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203
imp o ed physical condi ion a e associa ed wi h many indica o s o quali y o li e (Cou neya,
F ieden eich, A hu , & Bobick, 1999a; Cou neya e al., 2004; Cou neya, Mackey, & Jones,
2000), wi h a lowe p obabili y o ecu ence (Meye ha d , Hesel ine e al., 2006) and lowe
isk o dea h (Meye ha d e al., 2008). In he s udy o Meye ha d , Hesel ine e al. (2006), i
was ound ha pa ien s who walked a leas 6 hou s pe week a mode a e in ensi y had a 47%
highe chance o su i ing he disease. Ano he s udy (Meye ha d , Gio annucci e al., 2006)
wi h 600 women diagnosed wi h colo ec al cance showed ha hose who inc eased hei
physical exe cise a e diagnosis had a 52% lowe chance o dying om he disease compa ed
wi h hose who we e no exe cising. Howe e , hose who dec eased he amoun o exe cise had
a 32% highe chance o dying om he disease. Mo eo e , hose who did physical exe cise
equi alen o walking 6 hou s pe week we e mo e likely o ha e a longe li e han hose who
did less o no exe cise.
In spi e o he desc ibed bene i s, only 35% o colo ec al cance su i o s in he Uni ed S a es
pe o m he ecommended physical ac i i y (Blancha d, Cou neya, & S ein, 2008), and 17.1%
in Canada (Cou neya, Ka zma zyk, & Bacon, 2008). In addi ion, a ious s udies ca ied ou in
Canada (see Vallance & Cou neya, 2012) show ha , a e diagnosis, physical ac i i y dec eases
on a e age abou 2 hou s pe week, and only 5-10% o he pa ien s pa icipa e in physical
ac i i y du ing ea men , and 20-30% a e ea men . A e o e coming he disease, pa ien s
inc ease hei physical ac i i y pa icipa ion bu wi hou eaching he ini ial le els. The e is also
a g ea e dec ease o physical ac i i y when combining a ious ea men s such as su ge y,
chemo he apy, and adio he apy, in compa ison o ecei ing jus one o hem (I win e al.,
2004). Howe e , 80% o he pa ien s eel capable o pa icipa ing in physical ac i i y, and 70%
a e in e es ed in i so, in o de o de elop any in e en ion, i is essen ial o know he ac o s
ha p omo e o hinde physical ac i i y pa icipa ion in his collec i e (Vallance & Cou neya,
2012).
Taking in o accoun ha he e a e al eady plen y o s udies ha ha e analyzed his p oblem in
colo ec al cance pa ien s, he aim o his s udy was o pe o m a sys ema ic e iew o mo e
clea ly in e p e all he ac o s ela ed o hese pa ien s' pa icipa ion in physical ac i i y. The e
a e se e al sys ema ic e iews o he ac o s ela ed o he physical ac i i y pa icipa ion in
pa ien s wi h cance , all o hem including di e en ypes o cance (Pa k & Ga ey, 2007).
Some au ho s ha e e en sys ema ically analyzed he e ec s o exe cise in pa ien s wi h
colo ec al cance (C ame , Lauche, Klose, Dobos, & Langho s , 2014; Kampsho e al., 2014;
Husebø, Dy s ad, Sø eide, & B u, 2013). Howe e , o da e he e is no sys ema ic e iew o he
ac o s associa ed wi h physical ac i i y pa icipa ion in pa ien s wi h colo ec al cance , so his
is he i s one o be pe o med.
This e iew is ocused on colo ec al cance because i is he second mos common ype o
cance in Eu ope and he Uni ed S a es, and he mos equen in some coun ies like Spain
(Spanish Socie y o Medical Oncology, 2014), p esen ing a mode a e su i al a e. Gi en i s
high incidence, bu a he same ime i s posi i e p ognosis, we hink ha i is in e es ing o
ocus on his ype o cance o mo e speci ically deepen ou knowledge o he ac o s ela ed o
he le els o physical ac i i y. In addi ion, he a iables con ibu ing o p edic physical ac i i y
Physical ac i i y in pa ien s wi h colo ec al cance
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204
appea o a y as a unc ion o he ype o cance , which indica es he need o analyze each one
sepa a ely (Vallance & Cou neya, 2012).
METHOD
Da a sou ces and sea ch e ms
The elec onic sea ch was made by means o he WEB OF SCIENCE, SCOPUS and
SPORTDISCUS da abases up o Feb ua y o 2016. The sea ches included di e se
combina ions o ou se s o e ms: 1) Te ms ela ed o cance : colo ec al cance , cance s age
and ea men ; (2) Te ms abou physical ac i i y: physical ac i i y, exe cise and aining; 3)
In luen ial ac o s in physical ac i i y pa icipa ion: acili a o s, ba ie s, sociodemog aphic and
psychosocial ac o s, mo i a ion and adhe ence; 4) Mo i a ional heo ies: heo y o planned
beha io , sel -de e mina ion heo y, sel -e icacy heo y, and socio-ecological model. The
comple e sea ch s a egies a e no p esen ed o he sake o b e i y, bu hey can be eques ed
om he au ho s.
Consul a ion o publica ions and cons uc ion o he ca alogue
The selec ion o he s udies ocused on he ac o s associa ed wi h physical ac i i y
pa icipa ion in pa ien s wi h colo ec al cance (Figu e 1). We conduc ed wo le els o
sc eening. Fi s , we sea ched o combina ions o all he keywo ds in all he da abases, eaching
19213 iden i ied egis e s. Ano he 18 addi ional egis e s we e iden i ied in he e e ences lis s
o he a icles, ob aining a o al o 19231 eco dings. We included all he e e ences in he
p og am “EndNo e” o de ec duplica es, inding a o al o 15532, which we e dele ed.
The e o e, 3699 unique ci a ions emained, om which we excluded 3649 a e eading he
abs ac s because hey did no analyze he ela ions be ween physical ac i i y pa icipa ion and
colo ec al cance , so ha inally, 50 a icles emained, which we e downloaded in ull ex . We
hen es ablished he second sc eening sys em, which consis ed o applying he ollowing
exclusion c i e ia: 1) including o he di e en ypes o cance wi hou speci ying he esul s
sepa a ely o each one; (2) including o he heal hy beha io s wi hou speci ying he esul s
e e ed o physical ac i i y; 3) ocusing on ac o s o s a egies o p omo e physical ac i i y in
o de o p e en colo ec al cance , bu wi hou using a sample o pa ien s a ec ed wi h his
disease; 4) ocusing only on he e ec s o bene i s o physical ac i i y in his popula ion
wi hou co e ing he ac o s ela ed o physical ac i i y pa icipa ion. We elimina ed 27
egis e s o mee ing hese c i e ia, lea ing a o al o 23 inal egis e s in he p esen s udy.
Physical ac i i y in pa ien s wi h colo ec al cance
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Figu e 1. Flow cha o he selec ion p ocess o he s udies.
Selec ion p ocess and da a ex ac ion
The necessa y a iables o analyze he esul s a e g ouped in Table 1. The ollowing da a a e
included: e e ences; o al numbe o pa ien s, o men and women; age; cance s age a he
momen o he s udy; ea men ; heo e ical amewo k; design; measu e o physical ac i i y;
and esul s ela ed o he acili a o s and ba ie s o physical ac i i y pa icipa ion. Cance
s age (see oo no e o Table 1), ype o ea men (su ge y, adio he apy, chemo he apy) and
whe he o no hey we e ecei ing ea men a he ime o he s udy o i had al eady
concluded we e included in his e iew. In addi ion, we indica e he design o he s udies,
di iding hem in o c oss-sec ional, longi udinal, expe imen al, and quali a i e. We also aimed
o iden i y whe he he s udies a e suppo ed by a heo e ical amewo k, as his would guide
in e en ions o p omo e physical ac i i y wi h his collec i e in a mo e s uc u ed way,
unde s anding how beha io al change occu s (Biddle, Mu ie, Go ely, & Blamey, 2012).
Las ly, we highligh he impo ance o analyzing how physical ac i i y is measu ed, ei he by
means o mo e subjec i e measu es like ques ionnai es, o mo e objec i e measu es like
accele ome e s. All hese aspec s a e impo an when analyzing he ac o s ha in luence
physical ac i i y pa icipa ion in his popula ion.
19213 s udies iden i ied o
sc eening
18 addi ional egis e s iden i ied om
o he sou ces
15532 duplica e e en s
3699 unique egis e s
iden i ied
3649 excluded egis e s
27 ull- ex egis e s excluded:
They include o he di e en ypes o cance wi hou
speci ying he esul s o each ype. n = 14
They include o he heal hy beha io s wi hou speci ying
he esul s e e ing o physical ac i i y.n = 6
S udies o p e en ion o cance by means o physical
ac i i y, bu wi hou using a sample o pa ien s wi h his
disease. n = 5
They ocus on he e ec s/bene i s o physical ac i i y in
his popula ion bu wi hou including he ac o s ela ed
o i s
p
a ici
p
a ion. n= 2
50 ull- ex a icles
analyzed o decide hei
eligibili y
23 s udies included in he
sys ema ic e iew
Physical ac i i y in pa ien s wi h colo ec al cance
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206
Table 1. S udies ha Analyze he Fac o s Rela ed o Physical Ac i i y Pa icipa ion in Pa ien s wi h Colo ec al Cance
REFERENCES NUMBER OF
PATIENTS AGE (yea s) CANCER
STAGE TREATMENT THEORETICAL
FRAMEWORK DESIGN MEASURE
OF PA RESULTS
Bu a e al.
(2012)
1371 To al
56% males
44% emales
≥ 65 = 69%
M = 69.5, SD =
9.7
I = 28%
II = 39%
III = 28%
IV = 5%
S = 67.54%
RT = 0.07%
CT = 1.02%
S + RT = 22.90%
S + CT = 24.58%
S + RT + CT = 6.41%
No used C oss-
sec ional
Eu opean
P ospec i e
In es iga ion in o
Cance (EPIC)
Physical
Ac i i y
Ques ionnai e
Being younge , male, employed, no
smoking, lowe body mass index,
being only in chemo he apy
ea men and no ha ing
como bidi ies→↑MVPA
Chambe s e al.
(2009)
978 To al
55.8% males
44.2% emales
20-49 = 7.6%
50-59 = 20.3%
60-69 = 35%
≥ 70 = 37.2%
I = 28.7%
II = 30.6%
III = 25.8%
IV = 0.7%
No speci ied No used
Longi udinal
5, 12, 24 and
36 mon hs
pos diagnosis
Ac i e Aus alia
Su ey
↑Soma iza ion →↓PA
↑Nega i e assessmen o he impac
o cance →↓PA
↑Fa igue →↓PA
↑Smoking →↓PA
↑Obesi y →↓PA
Chung e al.
(2013)
422 To al
63% males
37% emales
M = 59.69, SD
= 10.87
I = 95
II = 102
III = 103
IV = 16
Un inished = 31.27 %
Finished = 68.72 %
No used
C oss-
sec ional
Exe cise
& Quali y o Li e
Ques ionnai e
In ea men :
Wi hou changes in LPA, MPA and
TPA. ↓VPA
End o ea men :
Wi hou changes in MVPA s. p e-
ea men .↑LPA and TPA
Cou neya e al.
(1999b)
66 To al
57.57% males
42.42% emales
M = 60.8, SD =
11.5
I = 6%
II = 29%
III = 26%
IV = 5%
Did no ecei e AT =
27.3%
RT = 7.6%
CT = 46.9%
RT + CT = 18%
Theo y o planned
beha io
C oss-
sec ional
Godin Leisu e Time
Exe cise
Ques ionnai e
(GLEQ)
In en ion and p e-diagnosis PA
→PA pos ope a ion
Cou neya e al.
(2004)
102 To al
58.1% males
41.9% emales
M = 60.3, SD =
10.4
III–IV = 80.6%
S = 100%
RT = 20.4%
CT = 64.5%
Only S = 34.4%
S + CT = 46.2%
S + RT + CT = 19.4%
All pa ien s we e
ope a ed in he pas 3
mon hs
Theo y o planned
beha io Expe imen al
Godin Leisu e Time
Exe cise
Ques ionnai e
(GLEQ)
Expe imen al g oup: Highe le els
o PA, beha io al con ol, lowe
wo k s a us, and less adju an
ea men →↑PA
Con ol g oup: highe le els o PA
and mo e in en ion →↑PA
Cou neya e al.
(2005)
69 To al
56.5% males
43.5% emales
< 60 = 39.1%
> 60 = 60.9%
No speci ied
Only S = 39.1%
S + CT = 42%
S + RT + CT = 18.8%
All pa ien s we e
ope a ed in he pas 3
mon hs
No used Expe imen al
Godin Leisu e Time
Exe cise
Ques ionnai e
(GLEQ)
Ba ie s: Lack o ime,adju an
ea men , side e ec s and a igue
Physical ac i i y in pa ien s wi h colo ec al cance
©Psy,Soc,&Educ,2017,Vol.9(2)
207
D’And ea e al.
(2014) 2378 To al 18-65 No speci ied No speci ied No used C oss-
sec ional
USA Na ional
Heal h In e iew
Su ey
Hispanics and non-Hispanic blacks
( s. Whi es) and cu en smoke s
→↓PA
Highe educa ional le el, ewe
ch onic condi ions, cu en d inke s
→↑PA
Dennis e al.
(2013)
444 To al
55% males
45% emales
36-91 (M = 69)
≥ 60 = 80% No speci ied
P e- ea men = 12.16%
In ea men = 13.96%
Comple ed 6 mon hs
ago = 15.09%
Comple ed mo e han 6
mon hs ago = 40.1%
Cance - ee g oup =
18.69%
No used
C oss-
sec ional
Li es yle su ey o
people wi h
colo ec al cance
P e e ences: G oup-based PA
p og ams
Ba ie s: S oma and ea men -
ela ed a igue
VPA ( om - o +): P e- ea men , in
ea men , pos - ea men , < 6
mon hs and > o 6 mon hs pos -
ea men and cance - ee g oup
Fishe e al. (2016)
478 To al
59% males
41% emales
31-97 (M = 68)
No speci ied
Finished = 73%
No inished = 16%
Unknown = 5%
No used C oss-
sec ional
Godin Leisu e Time
Exe cise
Ques ionnai e
(GLEQ)
Ba ie s: Fa igue, ageing, and
como bidi ies
↑Ba ie s →↓PA
Bene i s: imp o emen o physical
condi ion, imp o emen o heal h
and main enance/weigh loss
Hawkes e al.
(2015)
410 To al
54% males
46% emales
M = 66.3, SD =
10.1
Insu icien PA
I = 90.2%
II = 85.1%
III = 89.1%
Su icien PA
I = 9.8%
II = 14.9%
III = 10.9%
S = 96%
AT = 24%
Ecological model
o heal h beha io
Expe imen al
Godin Leisu e Time
Exe cise
Ques ionnai e
(GLEQ)
Being e i ed, ha ing p i a e heal h
insu ance, ha ing heal hy body
weigh , p e-diagnosis physical
ac i i y, ha ing a habi , high le el o
sel -e icacy, wa ching less TV,
high quali y o physical li e, eeling
well-being and being a pa o he
in e en ion g oup →↑PA pos 12
mon hs
Husson e al.
(2015)
1643 To al
56.11% males
43.88% emales
< 65 = 28.97%
65-75 = 39.07%
> 75 = 31.96%
I = 30.66%
II = 36.33%
III = 29.66%
IV = 3%
Only S = 46.33%
S + RT = 24.33%
S + CT = 20.66%
S + RT + CT = 8.66%
Only CT = 1.33%
No used Longi udinal
Eu opean
P ospec i e
In es iga ion In o
Cance (EPIC) PA
Ques ionnai e
↓Knowledge abou heal h →↓PA
Kang e al. (2014)
427 To al
63% males
37% emales
< 60 = 52.9%
≥ 60 = 47.1%
I = 95
II = 102
III = 106
IV = 18
Un inished = 30.9%
Finished = 67%
No used
C oss-
sec ional
Ques ion abou
pa icipa ion o no
in PA and whe he
o no
ecommenda ions o
he ACSM a e me
Ba ie s ( om + o -):
1s Fa igue
2nd Low physical condi ion
3 d Low heal h s a us
4 h Lack o ime and in o ma ion
↑T ea men →↓PA
Physical ac i i y in pa ien s wi h colo ec al cance
©Psy,Soc,&Educ,2017,Vol.9(2)
208
Lynch e al. (2016)
185 To al
55.14% males
44.86% emales
18-80 (M =
64.2, SD = 10.3)
I = 22%
II = 28%
III = 41%
Only S = 57.84%
S + AT = 42.16%
Adju an he apy
inished
No used
C oss-
sec ional
Accele ome e
Males, mo e como bidi ies, highe
BMI and ime slo 6 pm-8 pm
→↑Seden a y beha io
Women, low educa ional le el and
lowe BMI →↑LPA
Mo e amily income, being
employed, lowe BMI, younge ,
and ime slo s 4 pm-5 pm and 6 pm-
10 pm →↑MVPA
Lynch e al. (2007)
1966 To al
60% males
40% emales
20-49 = 8.5%
50-59 = 19.43%
60-69 = 33.31%
70-80 = 38.25%
No speci ied No speci ied No used Longi udinal Ac i e Aus alia
Su ey
High educa ional le el, no smoking,
no a igue →↑PA in males
Only su ge y, heal hy BMI, li ing
ou side he capi al, no smoking, no
a igue →↑PA in women
Lynch e al. (2010)
Time 1
538 To al
63% males
37% emales
Time 2
403 To al
61.5% males
38.5% emales
Time 1
20-49 = 8.9%
50-59 = 19.7%
60-69 = 31.1%
≥ 70 = 40.3%
Time 2
20-49 = 8.9%
50-59 = 19.4%
60-69 = 29.0%
≥ 70 = 42.7%
Time 1
I = 25.5%
II = 35%
III = 30.6%
IV = 8.9%
Time 2
I = 26%
II = 38%
III = 29.4%
IV = 7.1%
Time 1
S = 56.9%
S + AT = 43.1%
Time 2
S = 58%
S + AT = 41.4%
All he pa ien s we e
ope a ed in he pas 3
mon hs
Ecological model
o heal h beha io
Longi udinal
5 and 12
mon hs pos -
diagnosis
No measu ed
Ba ie s 5 and 12 mon hs ( om + o
-):
1s Cance -speci ic ba ie s
2nd Ba ie s om pe sonal a ibu es
3 d Ba ie s om social en i onmen
4 h Ba ie s om physical
en i onmen
McGowan, Speed-
And ews,
Blancha d e al.
(2013)
600 To al
58.33% males
41.67% emales
< 65 = 39%
≥ 65 = 61%
44% Ea ly
s age diagnosis
RT = 24%
10% s ill ecei e
ea men
No used
C oss-
sec ional
Godin Leisu e Time
Exe cise
Ques ionnai e
(GLEQ)
Olde , lowe educa ional le el,
lowe yea ly income, mo e ime
elapsed since diagnosis, ewe
elapses, s oma, in ea men and
ac i e s. seden a y →
↓ in e es in PA
McGowan, Speed-
And ews, Rhodes
e al. (2013)
600 To al
58.3% males
41.7% emales
< 65 = 39%
≥ 65 = 61%
M = 67.3
I = 12.6%
II = 11.5%
III = 21.5%
IV = 11.33%
Unknown =
43%
RT = 24.3%
CT = 55.5%
No speci ied when hey
ecei ed ea men
No used
C oss-
sec ional
Ques ions abou
ype, equency, and
du a ion o PA in
he pas mon h
Males, ma ied, social o egula
d inke s, good heal h and ≥ 5 yea s
since he diagnosis →↑PA
Mo ielli e al.
(2016)
18 To al
66.7% males
33.3% emales
34-73 (M =
57.5)
72% IIIB
All ecei ed
neoadju an he apy
Theo y o planned
beha io Expe imen al
Godin Leisu e Time
Exe cise
Ques ionnai e
(GLEQ)
Bene i s: ca dio ascula endu ance,
quali y o li e, sel -es eem, be e
physical unc ioning
Damage: Fa igue, dia hea, and skin
i i a ion
Ba ie s: Side e ec s o neoadju an
he apy and lack o mo i a ion
Physical ac i i y in pa ien s wi h colo ec al cance
©Psy,Soc,&Educ,2017,Vol.9(2)
209
Peddle e al.
(2008)
413 To al
54% males
46% emales
20-80 (M = 60,
SD = 7.5)
48% did no
know cance
s age. No hing
mo e speci ied
CT = 53%. A leas 1
yea ago
S = 96%. No speci ied
when hey we e
ope a ed
Sel -
de e mina ion
heo y
C oss-
sec ional
Godin Leisu e Time
Exe cise
Ques ionnai e
(GLEQ)
↑Educa ional le el, iden i ied and
in ojec ed egula ion →↑PA
Speed-And ews e
al. (2014)
600 To al
58.3% males
41.7% emales
31-92 (M =
67.3)
44.2% Ea ly
s age diagnosis
RT = 24%
CT = 55%
Adju an he apy
comple ed
Theo y o planned
beha io
C oss-
sec ional
Ques ion abou
le el o physical
ac i i y
Ba ie s: physical condi ion and
heal h s a us, musculoskele al issues
and ea men
Facili a o s: ha ing ime, doing i
wi h o he s, p oximi y o he acili ies
Speed-And ews e
al. (2012)
600 To al
58.33% males
41.67% emales
31-92 (M =
67.3)
< 65 = 39%
≥ 65 = 61%
I = 12.66%
II = 11.5%
III = 21.5%
IV = 11.33%
Unknown =
43%
RT = 24.3%
CT = 55.5%
Adju an he apy
comple ed
Theo y o planned
beha io
C oss-
sec ional
Godin Leisu e Time
Exe cise
Ques ionnai e
(GLEQ)
Being younge , unma ied, highe
educa ional and economic le el,
employed, no smoke s, social
d inke s, no adia ion he apy,
disease ee, be e heal h and ewe
como bidi ies →↑PA
Spence e al.
(2011)
10 To al
70% males
30% emales
42-74 (M =
57.8)
II = 40%
III = 60%
Chemo he apy
comple ed 4 weeks ago No used Expe imen al
Quali a i e
Ques ions abou he
le el o physical
ac i i y: no hing,
spo adic (< 3
sessions pe week)
o egula (≥ 3
sessions pe week)
Bene i s: Sel -es eem, heal hy
habi s, posi i i y, in en ion o
pe o m PA, lea ning abou he
impo ance o PA, physical
condi ion, eco e ing le els o
ene gy p io o ea men and
dec easing a igue.
P e e ences: Need o aine
supe ision. S a PA 2-4 weeks
pos - ea men , bu can also be done
du ing ea men , dec easing he
in ensi y.
Pos -p og am PA: in oduce s eng h
aining and e e yone in ends o
con inue.
an Pu en e al.
(2016)
5375 To al
Time 1 = 45.6%
o he o al
Time 2 = 29.32%
o he o al
Time 3 = 25.58%
o he o al
54.6% males
45.5% emales
< 55 = 7.6%
55-74 = 60%
≥ 75 = 32.4%
M = 69.6, SD =
9.5
I = 31.8%
II = 38.6%
III = 29.5%
Only S = 49.6%
S + RT= 23.1%
CT= 20.3%
S + RT + CT = 7%
No used Longi udinal
Eu opean
P ospec i e
In es iga ion in o
Cance (EPIC)
Physical Ac i i y
Ques ionnai e
Fa igue, dyspnea, side e ec s o
chemo he apy, u ina ion p oblems,
loss o appe i e, weigh loss, pain,
no so young, wi hou pa ne ,
obesi y, anxie y, dep ession, wo se
quali y o li e and physical
unc ioning→ ↓MVPA
↑PA males s. women
No e. ↑ = inc ease; ↓ = dec ease; → = ela ion; AT = adju an he apy; S = su ge y; RT = adio he apy; CT = chemo he apy; PA = physical ac i i y; LPA = ligh physical
ac i i y; MPA = mode a e physical ac i i y; VPA = igo ous physical ac i i y; MVPA = mode a e and igo ous physical ac i i y; TPA = o al physical ac i i y.
S age I: he umo a ec s he wall o he colon o ec um wi hou going h ough he muscula laye . Lymph ganglia no a ec ed. S age II: he umo has in il a ed all
he laye s o he wall o he colon o ec um. I can in ade he su ounding o gans. Lymph nodes no obse ably a ec ed. S age III: he cance has in aded he
neighbo ing o gans and a ec s he lymph nodes. S age IV: he cance has sp ead o dis an o gans o he colon o ec um, such as li e , lung o bones.
Physical ac i i y in pa ien s wi h colo ec al cance
©Psy,Soc,&Educ,2017,Vol.9(2)
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Rega ding ime schedule p e e ences o physical ac i i y in colo ec al cance pa ien s, a s udy
in Aus alia and Canada, measu ing he le els o ac i i y wi h accele ome e s, has ecen ly
been ca ied ou (Lynch e al., 2016). The esul s showed ha he pa ien s we e less seden a y
om eigh in he mo ning un il h ee in he a e noon and mo e seden a y om six in he
a e noon. The pe cen age o ime pe o ming mode a e- igo ous physical ac i i y was lowe
be ween en o'clock in he mo ning and h ee in he a e noon and highe om ou o en in he
a e noon.
Las ly, Spence e al. (2011) ca ied ou a s udy in Aus alia, analyzing pa ien s' p e e ences
a e chemo he apy by means o semis uc u ed in e iews. The pa ien s p e e ed o choose he
ype o exe cise and a gym wi h ai condi ioning o egula e body empe a u e and be able o
make mo e e o wi hou su e ing om he hea . They also p e e ed o s a he physical
ac i i y p og am be ween 2 and 4 weeks a e comple ing chemo he apy because hey hough
hey needed ime o eco e om i . Howe e , some p e e ed o s a la e bu o main ain
con ac wi h he hospi al du ing his ime o eco e y a e chemo he apy, so as no o lose hei
mo i a ion and commi men o he p og am. On ano he hand, hal o he pa ien s claimed ha
hey could ha e s a ed he p og am du ing he adju an ea men bu dec easing he in ensi y.
In con as , he o he hal said ha his would be e y di icul due o he a igue caused by he
ea men and he physical and emo ional ene gy equi ed o o e come hese symp oms.
Howe e , almos e e yone belie ed ha i hey had pe o med exe cise du ing ea men , hey
would ha e el be e when he ea men was inished.
In his s udy, he pa ien s also posi i ely alued he supe ised indi idualized aining, adap ed
o hei cha ac e is ics, being able o choose he schedule, place, ype o session, e c. In ac ,
hey exp essed di icul y o con inue he physical ac i i y p og am wi hou he aine 's suppo
and ollow-up. They all conside ed he aine 's supe ision necessa y o achie e g ea e
mo i a ion and inc ease hei le els o sel -con idence. Conce ning g oup physical ac i i y,
hey hough ha i would be mo e economical, hey would ha e mo e social suppo , and
would sha e expe iences. Howe e , mos p e e ed o ca y ou he physical ac i i y p og am
indi idually and, i i was done in a g oup, hey p e e ed hei classma es o be cance
su i o s o people whose li e had ecen ly been a isk. Las ly, a e he p og am, all he
pa icipan s in ended o con inue doing physical ac i i y and p oposed o include s eng h
aining and o main ain he le el o ae obic exe cise. They poin ed ou ha i would be di icul
o con inue he equency and he in ensi y o he wo kou s wi hou he supe ision o he
aine .
Mo i a ional ac o s
Nex , we p esen he ac o s associa ed wi h he mo i a ional heo ies ha explain human
beha io , ying o unde s and which a iables a e ela ed o he physical ac i i y pa icipa ion
in his popula ion. On he one hand, some s udies ha e ound highe le els o pe cei ed sel -
e icacy in pa ien s who pe o m mo e physical ac i i y (Hawkes e al., 2015). On he o he
hand, based on he heo y o planned beha io , Cou neya e al. (1999b) ound ha he in en ion
o exe cise and exe cise p e-diagnosis we e ela ed o pos -su ge y exe cise. Mo eo e , he
a i ude owa ds exe cise was he only a iable ha co ela ed signi ican ly wi h he in en ion o
Physical ac i i y in pa ien s wi h colo ec al cance
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217
exe cise. F om his same heo y, Mo ielli e al. (2016), ying o unde s and he in luence o
p io expec a ions be o e he physical ac i i y p og am, e ealed ha pa ien s pe cei ed
exe cise du ing chemo he apy as mo e pleasan and less di icul han an icipa ed.
Con inuing wi h he heo y o planned beha io , among he mos equen belie s abou he
bene i s o physical ac i i y (beha io al belie s), Speed-And ews e al. (2014) ound ha
pa ien s belie ed ha physical ac i i y imp o ed physical i ness, i could imp o e hei well-
being and ene gy le els, and hey el be e a e exe cising. Wi h ega d o no ma i e belie s,
he mos common belie was ha physical ac i i y should be app o ed by he membe s o he
amily, he oncologis s, and one's bes iend. As ega ds con ol belie s, he ac o s ha made
hem eel less con iden o being able o o e come ba ie s we e medical o heal h p oblems,
pain, and he ac o e u ning o ea men (Speed-And ews e al., 2014). In his sense,
Cou neya e al. (2004) ound ha pa ien s who pe cei ed less beha io al con ol, ha is, hey
el less capable o ca ying ou ac i i y, showed less adhe ence o physical ac i i y.
Using he ecological model o heal h beha io as he concep ual e e ence amewo k, Lynch e
al. (2010) ound ha disease-speci ic ba ie s ( a igue, no eeling well enough o be physically
ac i e, dia hea, and incon inence) and pe sonal a ibu es ( ea o inju y, lack o enjoymen
and in e es , and being seden a y) we e he g ea es ba ie s bo h a i e and a wel e mon hs
a e diagnosis, ollowed by social en i onmen (lack o ime, no ha ing he suppo o amily,
iends, and doc o ) and physical en i onmen (lack o access o acili ies, he cen e pe cei ed
as unsa e and una ac i e). All o hese ba ie s we e nega i ely ela ed o pa icipa ion in
physical ac i i y, excep o he disease-speci ic ba ie s. Con a y o expec a ions, pa icipan s
who showed a highe le el o physical ac i i y wel e mon hs a e diagnosis also had a g ea e
numbe o in ensi y o disease-speci ic ba ie s. Pe haps he symp oms and side e ec s o he
disease and ea men had dec eased in gene al in his popula ion, bu hey we e mo e e iden
among hose who submi ed hei body o a g ea e physical bu den by exe cising.
Las ly, Peddle e al. (2008) analyzed he ac o s ha in luenced physical ac i i y pa icipa ion
in hese pa ien s om sel -de e mina ion heo y. The esul s showed ha pe cei ed au onomy
suppo in close people was posi i ely linked o sa is ac ion o he needs o au onomy,
compe ence, and ela edness, and wi h iden i ied egula ion (a kind o mo i a ion cha ac e ized
by aluing he bene i s o an ac i i y). Rela edness posi i ely p edic ed iden i ied egula ion
and in ojec ed egula ion (a kind o mo i a ion cha ac e ized by a eeling o guil ), au onomy
posi i ely p edic ed in ojec ed egula ion, and pe cei ed compe ence posi i ely p edic ed
iden i ied egula ion. Bo h iden i ied egula ion and in ojec ed egula ion posi i ely p edic ed
physical ac i i y.
DISCUSSION AND CONCLUSIONS
The aim o his s udy was o p o ide a global iew o he ac o s ha acili a e o hinde he
physical ac i i y pa icipa ion in pa ien s wi h colo ec al cance by means o a sys ema ic
e iew o he li e a u e. This is he i s sys ema ic e iew ha speci ically analyzes hese
ac o s in colo ec al cance . F om all he in o ma ion collec ed in his e iew, we eached
Physical ac i i y in pa ien s wi h colo ec al cance
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a ious conclusions ha will allow us o es ablish ecommenda ions o he p omo ion o
physical ac i i y in his popula ion.
Fi s , among he sociodemog aphic ac o s, he ollowing a o pa icipa ion in physical
ac i i y in pa ien s wi h colo ec al cance : being male, whi e, younge , highe educa ional le el
and highe economic s a us, ha ing a job ha does no in ol e a e y ex ensi e wo k schedule,
ha ing less occupa ional expe ience, o being e i ed. Howe e , some con adic o y esul s
eme ge when analyzing he in luence o ma i al s a us and pe sonal ela ionships on physical
ac i i y. Speed-And ews e al. (2012) ound ha being single is ela ed o doing mo e physical
ac i i y, whe eas an Pu en e al. (2016) ound ha ha ing a couple ela ionship a o s he
pa icipa ion in mode a e and igo ous physical ac i i y. I is ue ha conjugal obliga ions can
cause people o ha e less ime o do physical ac i i y, bu he pa ne 's suppo o ca y ou
physical ac i i y du ing he disease seems essen ial (Mackenzie, 2015).
Wi h ega d o heal h ac o s non-speci ic o he disease, we can conclude ha obese pa ien s
pe o m less o al physical ac i i y, while pa ien s wi h lowe body mass index pe o m mo e
mode a e and igo ous physical ac i i y. In addi ion, pa ien s who a e o e weigh o obese
pe cei e su gical complica ions as ba ie s o exe cise o a g ea e ex en . Among he ac o s
associa ed wi h psychological well-being, pa ien s wi h mo e s ess, anxie y, and dep ession
pe o m less physical ac i i y whe eas hose who ha e be e quali y o li e and physical
unc ioning pa icipa e mo e.
Rega ding disease-speci ic heal h ac o s, pa ien s who a e no ecei ing adju an ea men ,
ha e ewe como bidi ies, and pe cei e be e quali y o li e pe o m mo e physical ac i i y.
Du ing ea men , pa ien s pe cei e mo e ba ie s o exe cise ela ed o he side e ec s, such as
a igue, dia hea, o skin i i a ion (Mo ielli e al., 2016). Al hough in gene al, ecei ing
adju an ea men hinde s physical ac i i y pa icipa ion, one s udy (Bu a e al., 2012) ound
ha chemo he apy was a p edic o o mode a e and igo ous physical ac i i y. The au ho s o
his s udy y o explain his esul a guing ha he pa ien s who ecei ed chemo he apy we e
he heal hies , he younges , and wi h ewe como bidi ies, and pe haps hey also ecei ed mo e
ad ice abou physical ac i i y o alle ia e he side e ec s o chemo he apy.
Conside ing he in luence o p io expe ience and p e e ences on physical ac i i y, we ind ha
he pa ien s who exe cised he mos we e hose who pe o med physical ac i i y be o e
diagnosis (McGowan, Speed-And ews, Blancha d e al., 2013). Thus, lack o ime was only a
d awback o hose pa ien s who did no exe cise be o e diagnosis. Mo eo e , mos o he
pa ien s el capable o doing physical ac i i y, hey p e e ed o ecei e in o ma ion abou
physical ac i i y a e diagnosis h ough he pe sonal ad ice o a i ness expe , and p e e ed o
pa icipa e in g oup-based physical ac i i y p og ams. Ne e heless, i should be highligh ed
ha pa ien s wi h a s oma showed less p e e ence o g oup pa icipa ion in a i ness cen e .
Ha ing access o acili ies was also a ele an ac o o physical ac i i y pa icipa ion (Speed
And ews e al., 2014), and walking was he a o i e physical ac i i y bo h in summe and in
win e (McGowan, Speed-And ews, Blancha d e al., 2013). This esul could be due o he ac
ha walking is a simple and accessible ac i i y, i does no imply any cos and does no equi e
Physical ac i i y in pa ien s wi h colo ec al cance
©Psy,Soc,&Educ,2017,Vol.9(2)
219
much knowledge abou me hods o physical aining. Howe e , some ac i i ies could be mo e
ecommendable o achie e g ea e le els o in ensi y ha ansla e in o g ea e bene i s. As
poin ed ou in he li e a u e, physical ac i i y dec eases du ing and a e ea men in spi e o
he ac ha 150 minu es pe week o mode a e ac i i y, o 75 minu es o igo ous ac i i y, o
an equi alen combina ion a e ecommended (Rock e al., 2012; Schmi z e al., 2010). In his
ega d, i is likely ha pa ien s do no know wha o he ac i i ies hey can ca y ou , and
speci ic p og ams o his ype o pa ien s a e p obably no p o ided in i ness cen e s.
Pa ien s we e less seden a y om eigh in he mo ning un il h ee in he a e noon and mo e
seden a y om six in he a e noon, eaching highe le els o igo ous physical ac i i y om
ou o en in he a e noon (Lynch e al., 2016). Lea ning mo e abou he a iabili y o physical
ac i i y pa e ns a di e en momen s o he day may be help ul o conside mo e app op ia e
s a egies o p omo e physical ac i i y. In he ollowing sec ion, we p opose some
ecommenda ions om his e idence.
Las ly, we will discuss he mo i a ional ac o s ela ed o physical ac i i y beha io in hese
pa ien s. Acco ding o he heo y o planned beha io , he a i ude owa ds exe cise was he
only a iable ha was ela ed o he in en ion o exe cise, which in u n, was linked o
pe o ming mo e pos -su ge y physical ac i i y (Cou neya e al., 1999b). Wi h ega d o belie s
(Speed-And ews e al., 2014), hinking ha physical ac i i y would imp o e one's physical
condi ion, ene gy le el, and well-being was associa ed wi h pe o ming mo e physical ac i i y.
In addi ion, he pa ien s hough ha physical ac i i y should be suppo ed by ela i es, iends,
and doc o s. Las ly, medical o heal h p oblems, pain, and elapse and e u n o ea men , we e
he mos equen ly epo ed con ol belie s ha hinde ed physical ac i i y pa icipa ion. Based
on sel -de e mina ion heo y, one s udy showed ha au onomy suppo , sa is ac ion o he h ee
basic psychological needs (au onomy, compe ence and ela edness), and iden i ied and
in ojec ed egula ions we e impo an a iables o physical ac i i y pa icipa ion in pa ien s
wi h colo ec al cance (Peddle e al., 2008).
The esul s o his e iew ha e allowed us o so and classi y all he exis ing in o ma ion on
his opic o da e. When designing physical ac i i y p og ams o colo ec al cance pa ien s,
sociodemog aphic ea u es, heal h ac o s, p io expe ience and p e e ences, as well as ce ain
mo i a ional ac o s should all be alued. The di e en conclusions eached should be aken
in o accoun o he de elopmen o physical ac i i y in his popula ion, conside ing he
impo an bene i s ha can be achie ed.
RECOMMENDATIONS
D awing om he esul s ob ained in his e iew, we p esen he ollowing ecommenda ions o
p omo e physical ac i i y in pa ien s wi h colo ec al cance :
1) The exis ence o a less ac i e p o ile in hese pa ien s, oge he wi h he physical and
psychological side e ec s caused bo h by he disease i sel and by he ea men ,
e eals he need o c ea e speci ic p og ams o physical ac i i y a ge ing his
popula ion, which con empla e hei pe sonal ea u es. Special a en ion should be
paid o he p omo ion o physical ac i i y among olde pa ien s, women, and pa ien s
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wi h lowe socioeconomic s a us and educa ional le el, because hese sec o s o he
popula ion a e less in e es ed in doing physical ac i i y.
2) The p og ams should inco po a e mo i a ional s a egies o os e a posi i e clima e
du ing he sessions o physical ac i i y, ensu ing ha he pa icipan s eel espec ed
and alued. Social en i onmen s should no only be inclusi e bu also he s uc u e o
he exe cise acili ies should a o he inclusion o pa ien s wi h colo ec al cance . Fo
example, he inco po a ion o showe s and changing ooms ha comply wi h he
p i acy o pa ien s wi h a s oma, who may su e om a p oblem ela ed o body
image, would be desi able.
3) I would be in e es ing o in o m he pa ien s abou he bene i s o physical ac i i y o
hei disease, conduc ing semina s in he heal h cen e s. These semina s could include
es imonials om pa ien s who ha e al eady o e come he disease and who ca ied
ou physical ac i i y du ing i s cou se. This could imp o e pa ien s' a i ude owa ds
physical ac i i y and hei in en ion o exe cise.
4) P o essionals om he spo sciences should be inco po a ed in o he mul idisciplina y
medical eam so ha hey could ad ise pa ien s, ecommend he bes physical ac i i y
o each indi idual, and design indi idualized aining p og ams. The compe ence o
he p o essionals in cha ge o he di ec ion o physical ac i i y p og ams is essen ial
because colo ec al cance pa ien s a e in a delica e heal h si ua ion and need o be
assu ed ha hei exe cise will be ca ied ou in condi ions o sa e y o ob ain he mos
bene i s and ake as ew isks as possible.
5) I u u e s udies wi h accele ome e s con i m ha pa ien s wi h colo ec al pa icipa e
less in physical ac i i y in he mo ning, p og ams o ac i e es du ing wo king hou s
could be designed, and ac i e commu ing o e e yday ips could be os e ed.
Likewise, i would be in e es ing o de elop physical ac i i y p og ams in he
a e noon ime slo s which pa ien s usually dedica e o leisu e.
6) G oup ac i i ies o p omo e social ela ions among pa ien s who a e engaged in
exe cise p og ams could be designed, and also adap ing he aining loads o each
pe son and o e ing au onomy. Thus, mo e sel -de e mined mo i a ion would be
achie ed and, he eby, mo e in ol emen and adhe ence o physical ac i i y. To
achie e hese goals, i would also be necessa y o p omo e pa ien s' pe cep ion o
compe ence, so hey will eel capable o pa icipa e in physical ac i i y p og ams.
7) Family, iends, heal h p o essionals, and o he pa ien s/pee s should collabo a e in
he p omo ion o an ac i e and heal hy li es yle in people su e ing om colo ec al
cance . Social suppo can be essen ial o hese pa ien s o acqui e habi s o physical
ac i i y ha can con ibu e o alle ia ing he symp oms o hei disease and o
subs an ially imp o ing hei quali y o li e.
LIMITATIONS OF THE LITERATURE AND FUTURE RESEARCH DIRECTIONS
In spi e o he esul s ound in his e iew, we also iden i ied impo an gaps in he li e a u e
ha we shall de ail in he ollowing pa ag aphs. Fi s , i should be no ed ha , ou o all he
e iewed a icles, only 5 used an expe imen al design. The e is s ill a lack o knowledge abou
he ype, equency, du a ion, and in ensi y o physical ac i i y ha a e necessa y o op imize
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he physical and psychosocial bene i s and educe he isks in pa ien s wi h colo ec al cance a
di e en phases o ea men and as a unc ion o he ypes o ea men . Inc easing his
knowledge is essen ial o imp o e he he apeu ic e ec s o exe cise and o p omo e physical
ac i i y pa icipa ion in hese pa ien s. In addi ion, mo e s udies a e needed o implemen and
analyze he e ec o s a egies o mo i a e hese pa ien s o pa icipa e in physical ac i i y.
I is also necessa y o highligh ha only one s udy collec ed in o ma ion by means o
quali a i e echniques. The e is a lack o quali a i e s udies ha analyze in dep h he easons
ha lead pa ien s wi h colo ec al cance o pa icipa e in physical ac i i y, as well as he
ba ie s hey ind. I would be in e es ing o combine expe imen al designs wi h quali a i e
echniques o da a collec ion, a emp ing o con i m he psychosocial e ec s o speci ic g oup-
based physical ac i i y p og ams o his popula ion, as well as o iden i y possible p oblems
ha may a ise du ing he cou se o such p og ams. The eby, we would ob ain mo e i al and
comp ehensi e knowledge o design and implemen app op ia e p og ams o physical ac i i y
o hese pa ien s.
Ano he o he limi a ions ound in his e iew is ha mos o he s udies do no use a
heo e ical amewo k o e e ence. O he 23 a icles ha make up his sys ema ic e iew, only
5 s udies used he heo y o planned beha io , 2 applied he ecological model o heal h
beha io , and only 1 s udy is based on sel -de e mina ion heo y o analyze he ac o s ha
in luence adhe ence o physical ac i i y in pa ien s wi h colo ec al cance . Howe e , as some
au ho s indica e (Biddle e al., 2012), i is necessa y o apply heo e ical amewo ks ha guide
he s udies and allow us o unde s and he in o ma ion accu a ely and in a s uc u ed way.
Acco dingly, i is s iking ha only one s udy applied sel -de e mina ion heo y wi h colo ec al
cance pa ien s, aking in o accoun ha his heo y has p o en o be one o he mos ele an o
s udy beha io in heal h con ex s (Ng e al., 2012).
Besides, mos o he s udies measu e physical ac i i y by means o ques ionnai es, excep o
one s udy ha inco po a ed a mo e objec i e measu e using accele ome y. New s udies a e
necessa y o analyze he le els o physical ac i i y in pa ien s wi h colo ec al cance
objec i ely, in o de o de e mine hei ela ionships wi h di e en ac o s ha may inc ease o
dec ease hem. The inc easingly ad anced de elopmen o wea able de ices o acking
physical ac i i y could acili a e his ask acco dingly.
Las ly, ou o he 23 e iewed a icles, 11 s udies analyzed he ac o s associa ed wi h he
pe o mance o physical ac i i y du ing he complemen a y ea men o su ge y, ano he 9
we e ca ied ou a e inishing he ea men o only a mino i y o pa ien s was in ea men ,
and 3 s udies did no speci y he ime o ea men . F om ou iewpoin , he di e ences
be ween he ac o s ha p omo e o hinde physical ac i i y pa icipa ion du ing and a e he
complemen a y ea men o su ge y emain unclea . A g ea e analysis o hese ac o s
h oughou he en i e p ocess o he cance is necessa y (Milne, Wallman, Guil oyle, Go don,
& Cou neya, 2008), e en analyzing he ba ie s ha may appea du ing a “chemo he apy
week” compa ed o a week o es om chemo he apy, o know mo e speci ically how he side
e ec s o he ea men a ec he le els o physical ac i i y. Basically, al hough knowledge o
he ac o s ha p omo e physical ac i i y pa icipa ion in pa ien s wi h colo ec al cance has
Physical ac i i y in pa ien s wi h colo ec al cance
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ad anced, we mus con inue del ing in o his so ha his popula ion can bene i om he
posi i e e ec s o physical ac i i y, e en mo e so when aking in o accoun he high incidence
and se e i y o he disease.
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