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J Clin Oncol. 2019 Oct 10;37(29):2620-2631. doi: 10.1200/JCO.19.01019. Epub 2019 Aug 13.

Associations of Physical Activity With Survival and Progression in Metastatic Colorectal Cancer: Results From Cancer and Leukemia Group B (Alliance)/SWOG 80405.

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Brigham and Women's Hospital, Boston, MA.
Dana-Farber/Partners CancerCare, Boston, MA.
Mayo Clinic, Rochester, MN.
University of California, San Francisco, San Francisco, CA.
Duke University, Durham, NC.
University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA.
University of North Carolina at Chapel Hill, Chapel Hill, NC.
Indiana University School of Medicine, Indianapolis, IN.
Medstar Washington Hospital Center, Washington, DC.
University of Chicago, Chicago, IL.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Southeast Clinical Oncology Research Consortium, National Cancer Institute Community Oncology Research Program, Winston-Salem, NC.
West Virginia University Cancer Institute, Morgantown, WV.
SWOG, Portland, OR.
Oregon Health & Science University, Portland, OR.
Memorial Sloan Kettering Cancer Center, New York, NY.
Yale School of Medicine, New Haven, CT.



Regular physical activity is associated with reduced risk of recurrence and mortality in patients with nonmetastatic colorectal cancer. Its influence on patients with advanced/metastatic colorectal cancer (mCRC) has been largely unexplored.


We conducted a prospective cohort study nested in Cancer and Leukemia Group B (Alliance)/SWOG 80405 ( identifier: NCT00265850), a National Cancer Institute-sponsored phase III trial of systemic therapy for mCRC. Within 1 month after therapy initiation, patients were invited to complete a validated questionnaire that reported average physical activity over the previous 2 months. On the basis of responses, we calculated metabolic equivalent task (MET) hours per week to quantify physical activity. The primary end point of the clinical trial and this companion study was overall survival (OS). Secondary end points included progression-free survival (PFS) and first grade 3 or greater treatment-related adverse events. To minimize confounding by poor and declining health, we excluded patients who experienced progression or died within 60 days of activity assessment and used Cox proportional hazards regression analysis to adjust for known prognostic factors, comorbidities, and weight loss.


The final cohort included 1,218 patients. Compared with patients engaged in less than 3 MET hours per week of physical activity, patients engaged in 18 or more MET hours per week experienced an adjusted hazard ratio for OS of 0.85 (95% CI, 0.71 to 1.02; PTrend = .06) and for PFS of 0.83 (95% CI, 0.70 to 0.99; PTrend = .01). Compared with patients engaging in less than 9 MET hours per week, patients engaging in 9 or more MET hours per week experienced an adjusted hazard ratio for grade 3 or greater treatment-related adverse events of 0.73 (95% CI, 0.62 to 0.86; PTrend < .001).


Among patients with mCRC in Cancer and Leukemia Group B (Alliance)/SWOG 80405, association of physical activity with OS was not statistically significant. Greater physical activity was associated with longer PFS and lower adjusted risk for first grade 3 or greater treatment-related adverse events.

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