A Dietary and Physical Activity Interventions for Colorectal Cancer Survivors: A Randomized Controlled Trial


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Judy Ho1,Daniel Fong2,Chun-fan Lee3,Duncan Macfarlane3,Ester Cerin4,Antoinette Lee5,Leung Sharron6,Wynnie Chan7,Ivy Leung8,Sharon Lam1,Aliki Taylor9,Weijie Gong10,Kar-keung Cheng9
1Department of Surgery, The University of Hong Kong,2School of Nursing, The University of Hong Kong,3School of Public Health, The University of Hong Kong,4Institute of Health and Ageing, Australian Catholic University,5Department of Psychiatry, The University of Hong Kong,6School of Nursing, Hong Kong Baptist Hospital,7School of Professional and Continuing Education, The University of Hong Kong,8Department of Dietetics, Queen Elizabeth Hospital,9Department of Public Health, Epidemiology and Biostatistics, University of Birmingham,10



Physical activity (PA), dietary fibre, and low intake of red/processed meat are protective factors of colorectal cancer (CRC). There have been few randomized controlled trials (RCTs) on lifestyle interventions of CRC survivors. We conducted the first RCT in an Asian population to assess the acceptability and feasibility of lifestyle interventions in Chinese CRC survivors.


A 2x2 factorial RCT of 12-month theory-based PA and dietary interventions was conducted. CRC survivors within one year after completing main cancer treatment were randomized to receive PA and/or dietary interventions or usual care. Subjects underwent interventions received individual consultation, fortnightly motivational phone calls, monthly stage-of-change matched educational pamphlets and quarterly newsletters, and attended quarterly group meetings. All subjects were assessed at baseline, 6, 12, 18 and 24 months. Intervention effects were assessed by linear mixed effects models wth multiple imputation.


Two hundred and twenty-three subjects [mean age 65 years (range: 25-88); 92 (37%) female] were randomized and received their assigned interventions. Fifty-six subjects received PA interventions only, 56 received dietary interventions only, 55 received both interventions, and 56 received usual care. Thirty-one (14%) subjects dropped out due to recurrence, death or lost-to-follow-up. PA by dietary interactions were insignificant. At 24 months, dietary interventions reduced weekly red meat intake by 2.1 servings (95% confidence interval [CI]=1.1 to 3.2, p<0.001), increased daily whole grain intake by 0.21 servings (95% CI=0.04 to 0.38, p=0.017), and reduced daily refined grain intake by 0.36 servings (95% CI=0.14 to 0.58, p=0.001). PA interventions increased the duration of weekly vigorous/moderate intensity PA by 63 minutes (95% CI=18 to 144, 0.126) despite its insignificance.


Our lifestyle interventions effectively improved dietary intakes and possessed potential in enhancing PA levels in Chinese CRC survivors.