The Effect Of Exercise On Anorectal Manometry Of Colorectal Cancer Patients With Low Anterior Resection

PURPOSE: Although a majority of colorectal cancer patients (CRC) suffer from defecation-related symptoms (DRS), there are very few treatment options to improve DRS. We recently demonstrated that tailored exercise for CRC significantly improved bowel function (BF). However, how tailored exercise improved BF is still not known. Therefore, we investigate the efficacy of exercise on DRS by using anorectal manometry (AM) in CRC who underwent low anterior resection (LAR). METHODS: A total of 42 stage 1-3 CRC patients who completed LAR were randomly 1:1 ratio assigned to either the exercise group (n = 20, EG) or the usual care group (n = 22, UG). The exercise intervention included a 6-week twice weekly, where 1-hour exercise session combined supervised and home-based exercise program (150 min per week of leisure physical activity). Bodyweight exercises include 12 movements aimed to increase whole-body muscle strength, core strength including pelvic floor muscles. The primary outcome was the AM-assessed anal squeezing pressure (ASP). Secondary outcomes were bowel-related questionnaire for CRC assessed DRS score (constipation, diarrhea, blood and mucus in stool, abdominal pain, buttock pain, bloating, flatulence, fecal incontinence, sore skin, embarrassment in EORTC-QLQ-C30, CR29) and low anterior resection syndrome (LARS). A two-way ANOVA repeated measures were used to determine group and time interaction. UG did not receive any exercise education or intervention. ClinicalTrials. Gov ID is NCT05420870. This study was funded by Yonsei Signature Research Cluster Program of 2023-22-0017. RESULTS: A total of 40 participants completed the trial (age: 56.5 ± 8.0 yr, men: 60.0% in EG, age 58.0 ± 7.5 yr, men: 72.7% in UG). There was a 96.3% adherence rate in EG. EG showed a significant improvement in ASP compared to UG (post-pre: EG = 38.0 ± 29.2 mmHg vs. UG = 1.6 ± 38.1 mmHg, p for time and group interaction <0.001). A similar trend was observed in DRS score (Post-Pre: EG = -241.7 ± 168.1 vs. UG = -81.8 ± 159.9, p for time and group interaction <0.001), and LARS [the proportion of major LARS from pre = 15 (75%) to post = 5 (25%) in EG and pre = 16 (72.7%) to post = 16 (72.7%) in UG, χ2 = 10.49, p = 0.005]. CONCLUSION: Combined supervised and home-based exercise significantly improved ASP which may lead to improvement in DRS and LARS in CRC.