The acceptability and feasibility of a diet and physical activity intervention to prevent recurrence in colorectal cancer survivors

Judy Ho’s study identified that there is only a limited service in Hong Kong that offers specific dietary and activity advice to prevent relapse.

  • Topic: Colorectal cancer
  • Institution: University of Hong Kong
  • Country: Hong Kong
  • Status: Completed
Researcher: Judy Ho
Scientific abstract

(View the plain language abstract)


In Hong Kong, increasing colorectal cancer (CRC) incidence and advances in treatment have resulted in an increasing number of CRC survivors. Many CRC survivors are motivated to make lifestyle changes to improve their cancer outcome. However, insufficient scientific evidence has prevented conclusive dietary and physical activity (PA) recommendations from being made.


The objective of our project was to establish a feasible and acceptable dietary and PA intervention programme to reduce CRC recurrence through lowering red meat and eliminating processed meat consumption and increasing PA.


Phase 0 consisted of qualitative studies based on interviews with healthcare professionals and interviews, focus groups and a questionnaire survey with CRC survivors and caregivers in two hospitals in Hong Kong. A literature review was also undertaken. Information obtained from Phase 0 was used to design the intervention packages in Phase 1. The project followed the Medical Research Council’s framework for the design and evaluation of complex healthcare interventions.


The literature review identified no published randomised controlled trial that involved a dietary and PA intervention aimed at improving outcomes in CRC survivors. The study also identified that there is only a limited service in Hong Kong that offers specific dietary and PA advice to prevent CRC relapse. While most CRC survivors are receptive to lifestyle modifications, they have only a limited knowledge of the influence of these factors on CRC recurrence. Perceived barriers and facilitators to lifestyle modification and intervention participation were identified. An intervention programme consisting of assessment packages and dietary and physical activity intervention components was designed and pilot-tested in Phase 1. Improving knowledge and instilling beliefs regarding the association of specific lifestyle factors with CRC outcome are essential components of this intervention programme.


A Phase 2 trial is recommended to test the feasibility of this programme.

Plain language abstract


  1. There is an outstanding need for a useful lifestyle-changing programme targeting diet and physical activity for bowel cancer survivors.
  2. Bowel cancer survivors are motivated to make lifestyle changes to improve their cancer outlook and overall health.


Bowel cancer is the second most common cancer and the second cancer killer in Hong Kong. Increasing bowel cancer incidence in recent years and the improvement in its treatment have resulted in an ever-increasing number of survivors from the disease.

Many of these individuals are motivated to make lifestyle changes to improve their cancer outlook. Yet, insufficient scientific evidence has hampered authoritative dietary and physical activity recommendations from being made.


The first part of the study (carried out from April 2010 to March 2011 in two public hospitals in Hong Kong), involved:

a. Interviews of healthcare professionals.
b. Group discussion and individual interviews with bowel cancer patients and/or their caregivers.
c. Questionnaire survey of patients.
d. Review of published medical literature.

Our research group gathered information regarding:

a. The existing practice on lifestyle advice delivery.
b. Patient’s attitudes, beliefs and preferences relating to lifestyle changes and participation in research on lifestyle changes.
c. Effectiveness of previously reported dietary and physical activity programmes in improving bowel cancer outlook.

In the second part of the study (carried out from April to July 2011), the research team designed a lifestyle-changing programme for bowel cancer survivors aimed at:

a. Reducing red meat intake and eliminating processed meat.
b. Increasing physical activity level.

Key findings

  1. A medical literature review failed to identify any previously published paper involving dietary and physical activity programme that aimed to reduce bowel cancer recurrence.
  2. There is a minimal existing service offering specific dietary and physical activity advice aimed at reducing bowel cancer relapse.
  3. Bowel cancer survivors are willing to undergo lifestyle changes. However, they only have a limited knowledge regarding the influence of various lifestyle factors on their cancer outlook. In particular, many of our patients were unaware of the influence of physical activity on bowel cancer outlook.
  4. Possible factors to encourage or discourage patients to change their dietary and physical activity habits and to participate in the relevant lifestyle-changing programmes were identified.
  5. Based on the above findings, the research team devised and field-tested the planned programme comprising of both dietary and physical activity components so that the programme could be tested on a wider scale in a future (third part) of the study.
  6. Improving the knowledge and instilling the belief about the important roles of appropriate dietary and physical activity habits in improving cancer outlook are essential for the success of this lifestyle-changing programme.

Grant publications

> Physical activity for cancer survivors: meta-analysis of randomised controlled trials