Kenkhuis et al. (2022) found that increases in a lifestyle score was associated with better physical functioning and less fatigue. Furthermore, Kenkhuis et al. (2022) discovered that physical exercise had a significant impact on the lifestyle score in terms of quality of life. The MOX1 from Maastricht Instruments was utilized to track sedentary behavior in this investigation.


Advances in early detection and treatment, combined with the aging of the world population and an increase in the number of people living with colorectal cancer, have resulted in a significant increase in the number of people living with a prior diagnosis of colorectal cancer (CRC). For CRC survivors, the post-treatment phase is challenging, owing to the significant mental and physical health consequences that accompany cancer diagnosis and treatment recovery, affecting health-related quality of life (HRQoL)

The expanding number of CRC survivors emphasizes the necessity of addressing cancer treatment side effects and HRQoL. It’s also crucial to learn more about the links between these post-treatment health issues and lifestyle choices, including as dietary habits and physical activity, because healthy modifications in these behaviors could empower CRC survivors to enhance their health, function, and quality of life.

The World Cancer Research Fund (WCRF/AICR) and the American Institute for Cancer Research (WCRF/AICR) modified its lifestyle guidelines in 2018. Weight control, frequent physical activity, eating a balanced diet, and limiting alcohol use are all recommended in these suggestions to help cancer survivors attain and maintain a healthy lifestyle. These principles have been linked to fewer recurrences and longer longevity in cancer survivors, including those with CRC.

Individual lifestyle characteristics including as physical activity, dietary habits, body mass index (BMI), and alcohol use have been linked to HRQoL, fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) in CRC survivors in several studies. Their research team recently looked into the significance of individual WCRF/AICR recommendations in CRC survivors two years after therapy. They discovered that increases in adipose tissue and muscle mass, moderate-to-vigorous physical activity (MVPA), fruit, vegetable, and dietary fibre consumption, as well as decreases in sedentary behavior, sugar-sweetened drink consumption, ultra-processed food (UPF) intake, and energy density, were associated with improved HRQoL and decreased fatigue, but not with CIPN.

Goal of this study

Kenkhuis et al. (2022) aimed to investigate the role of overall adherence to the updated lifestyle recommendations from the 2018 WCRF/AICR guidelines in this paper. The individual WCRF/AICR lifestyle recommendations form a package that, when taken together, directs people towards healthy patterns of diet and physical activity. Kenkhuis et al. (2022) aimed to investigate how overall Cancers adherence in the form of a lifestyle score is longitudinally associated with HRQoL, fatigue, and CIPN in CRC survivors from 6 weeks to 2 years post-treatment using previously reported guidelines for operationalizing the level of adherence to the 2018 WCRF/AICR lifestyle recommendations.


Data from the Energy for Life after ColoRectal Cancer (EnCoRe) research was analyzed using longitudinal data obtained up through July 16, 2018. The EnCoRe project is a prospective cohort study that began enrolling patients in 2012 at three participating hospitals in the Netherlands’ south. Men and women over the age of 18 who had been diagnosed with stage I, II, or III CRC met the inclusion criteria. Stage IV CRC, inability to comprehend and speak Dutch, residence outside of the Netherlands, or the existence of comorbidities that could obstruct research participation, such as cognitive and visibility/hearing problems, were also exclusion factors.

Limiting body fatness is the first WCRF/AICR recommendation. To operationalize the body fatness advice, professional nutritionists took anthropometric measures at patients’ residences. Duplicate measurements of body height (cm) at diagnosis and body weight (kg) at each time point were used to calculate BMI (kg/m2) at each time point. At each time point, the waist circumference (cm) was measured in duplicate midway between the lowest rib and the iliac crest as another indicator of body fatness.

Physical activity as part of one’s daily existence is the second WCRF/AICR recommendation. The validated Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH) questionnaire was used to calculate MVPA hours per week. MVPA includes any activities with a metabolic equivalent (MET) value of less than three (walking, cycling, gardening, odd jobs, sports, domestic activities, and work). Accelerometers were used to collect objective data on time spent on sedentary behavior, which included activities with low to very low energy expenditure (1.5 MET values, e.g., sitting, lying) during waking hours. Participants wore thigh-mounted tri-axial MOX activity monitors (Maastricht Instruments B.V.) for 7 days, allowing for precise monitoring of activities at low intensities and in various postures. The scoring system used prolonged sedentary behavior (hours/day), which is sedentary time accrued in uninterrupted inactive bouts of at least 30 minutes. As previously stated, data was collected and processed.

Limiting the consumption of fast foods and sugary drinks; eating mostly plant-based foods by increasing fruit, vegetable, and dietary fibre intake; limiting animal-based food products by reducing red and processed meat intake; and limiting the consumption of alcoholic drinks are the three to seven WCRF/AICR recommendations focusing on diet. Participants completed structured dietary records for 7 consecutive days at each post-treatment time point in order to acquire quantitative data on food intake. Dietitians were in charge of coding these dietary records.

The well-validated, cancer-specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) was used to measure HRQoL outcomes at each post-treatment timepoint.


The findings demonstrate that there is still a lot of potential for CRC survivors to enhance their quality of life. Furthermore, we discovered that following more WCRF/AICR recommendations for a healthy lifestyle was linked to improved physical functioning and decreased activity-related weariness in this study. It’s difficult to study overall lifestyle behaviors and changes by operationalizing these behaviors in the form of a lifestyle score, especially in HRQoL research since competing associations for specific lifestyle suggestions might make interpreting an overall lifestyle score difficult. Nonetheless, the longitudinal relationships of the WCRF/AICR lifestyle score with HRQoL and fatigue found in our study suggest that lifestyle interventions for CRC survivors in the years following therapy could be beneficial. Such lifestyle interventions would ideally be multifaceted, focusing on increasing physical activity and improving nutrition quality to improve HRQoL and reduce fatigue symptoms.

Related products

MOX1 Activity logger for physical activity assessment.

The MOX1 is a validated accelerometer-based activity logger that seamlessly measures and records high resolution raw acceleration data up to 7 days. By using the IDEEQ software featuring our proprietary algorithms, objective measurements of human physical activity can be classified and quantified. The waterproof system design and biocompatible adhesive ensures easy application and comfortable wear by the subject.

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Kenkhuis M-F, Mols F, van Roekel EH, Breedveld-Peters JJL, Breukink SO, Janssen-Heijnen MLG, Keulen ETP, van Duijnhoven FJB, Weijenberg MP, Bours MJL. Longitudinal Associations of Adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Lifestyle Recommendations with Quality of Life and Symptoms in Colorectal Cancer Survivors up to 24 Months Post-Treatment. Cancers. 2022; 14(2):417.