Exercise during adjuvant treatment for colorectal cancer: treatment completion, treatment-related toxicities, body composition, and serum level of adipokines

Figures & data

Figure 1 Flow chart of participant inclusion in the study.

Figure 2 (A and B) Subcutaneous fat area (SFA) and skeletal muscle area (SMA) of cross-sectional images, marked in green and red, respectively, were measured by using Image J (ver. 1.80, National Institutes of Health). (C) Muscle to fat ratio (MFR) was calculated by dividing the SMA by the SFA. MFRs were significantly reduced during the adjuvant treatment in the control group, but not in the exercise group. (D) MFR changes before and after adjuvant treatment were significantly different between the control and exercise groups. *p<0.05.

Abbreviation: N/S, not significant.

Table 1 Baseline characteristics of the study patients (N=39)

		No. of patients (%)	Intervention, n (%)		P
			Exercise	Control
Age, years	<65	26(67)	19(49)	7(18)	0.098
	≥65	13(33)	6(15)	7(18)
Sex	Male	18(46)	14(36)	4(10)	0.099
	Female	21(54)	11(28)	10(26)
BSA, m^2	<1.6	12(31)	8(21)	4(10)	0.824
	≥1.6	27(69)	17(44)	10(26)
BMI, kg/m^2	<18	4(10)	2(5)	2(5)	0.535
	≥18	35(90)	23(59)	12(31)
Location	Rt. colon	7(18)	5(13)	2(5)	0.842
	Lt. colon	20(51)	12(31)	8(21)
	Rectum	12(31)	8(21)	4(10)
Pathology	well	0(0)	0(0)	0(0)	0.177
	moderate	36(92)	22(56)	14(36)
	poorly	3(8)	3(8)	0(0)
Stage	I	2(5)	1(3)	1(3)	0.882
	II	16(41)	10(26)	6(15)
	III	21(54)	14(36)	7(18)
Operation	AR	18(46)	10(26)	8(21)	0.698
	LAR	10(26)	7(18)	3(8)
	Total colectomy	1(3)	1(3)	0(0)
	Hemicolectomy	10(26)	7(18)	3(8)
CCRT	None	34(87)	22(56)	12(31)	0.838
	Yes	5(13)	3(8)	2(5)
ADJ chemo	5FU/LV	5(13)	3(8)	2(5)	0.838
	FOLFOX	34(87)	22(56)	12(31)
Performance	ECOG 0	39(100)	25(64)	14(36)	N/A
	ECOG 1	0(0)	0(0)	0(0)
CEA	<5 ng/mL	35(90)	23(59)	12(31)	0.535
	≥5 ng/mL	4(10)	2(5)	2(5)
CA 19–9	<36 U/mL	38(97)	24(62)	14(36)	0.448
	≥36 U/mL	1(3)	1(3)	0(0)
KRAS	Wild type	18(60)	15(50)	3(10)	1
	Mutant	12(40)	10(33)	2(7)
NRAS	Wild type	29(97)	24(80)	5(17)	0.649
	Mutant	1(3)	1(3)	0(0)

Abbreviations: BSA, body surface area; BMI, body mass index; AR, anterior resection; LAR, lower anterior resection; CCRT, concurrent chemo-radiation therapy; ADJ chemo, adjuvant chemotherapy; 5FU/LV, 5-fluorouracil/leucovorin; FOLFOX, fluoropyrimidine plus oxaliplatin; ECOG, Eastern Cooperative Oncology Group; CEA, carcinoembryonic antigen; CA 19-9, carbohydrate antigen 19-9; N/A, not applicable.

Table 2 Effect of exercise intervention on chemotherapy completion rates and treatment-related toxicities

		No. of patients (%)	Intervention, n (%)		P
			Exercise	Control
Dose reductions or premature termination	None	26(67)	20(51)	6(15)	0.018
	Required	13(33)	5(13)	8(21)
Nausea	gr0-2	21(54)	17(44)	4(10)	0.018
	gr3-4	18(46)	8(21)	10(26)
Anorexia	gr0-2	37(95)	25(64)	12(31)	0.052
	gr3-4	2(5)	0(0)	2(5)
Neutropenia	gr0-2	30(77)	21(54)	9(23)	0.161
	gr3-4	9(23)	4(10)	5(13)
Thrombocytopenia	gr0-2	26(67)	17(44)	9(23)	0.813
	gr3-4	13(33)	8(21)	5(13)
Neurotoxicity	gr0-2	28(72)	21(54)	7(18)	0.024
	gr3-4	11(28)	4(10)	7(18)
Mucositis	gr0-2	32(82)	21(54)	11(28)	0.672
	gr3-4	7(18)	4(10)	3(8)

Abbreviation: gr, grade.

Table 3 Effect of exercise intervention on body compositions and serum levels of adipokines in patients undergoing adjuvant treatment

	Intervention (N)	At start of ADJ Tx	At completion of ADJ Tx	P
		Mean (SD)	Mean (SD)
MFR (SMA/SFA)	Exercise (25)	0.98 (0.45)	0.97(0.37)	0.742
	Control (14)	0.92 (0.28)	0.81(0.26)	0.039
Leptin (pg/mL)	Exercise (11)	459.6 (273.7)	530.9 (262.8)	0.073
	Control (5)	490.7 (188.8)	707.9 (291.2)	0.038
Adiponectin (pg/mL)	Exercise (11)	162.5 (7.5)	164.5 (6.2)	0.026
	Control (5)	168.1 (5.0)	165.8 (6.7)	0.418

Abbreviations: MFR, muscle to fat ratio; SMA, skeletal muscle area; SFA, subcutaneous fat area; ADJ Tx, adjuvant treatment.

Figure 3 (A) Serum levels of leptin were significantly increased during adjuvant treatment in the control group, but not in the exercise group. (B) Serum levels of adiponectin were significantly increased during adjuvant treatment in the exercise group, but tended to be decreased in the control group. (C and D) Changes in serum levels of both leptin and adiponectin before and after adjuvant treatment were not significantly different between the control and exercise groups. *p<0.05.

Abbreviation: N.S, not significant.