Promoting Physical Activity in Patients with Colon Adenomas: A Randomized Pilot Intervention Trial Kathleen Y. Wolin*, Casey Fagin, Aimee S. James, Dayna S. Early Washington University School of Medicine and Siteman Cancer Center, St Louis, Missouri, United States of America Abstract Background: Physical activity decreases risk of colon polyps and colon cancer and might reduce risk of colon cancer recurrence. Focusing on recent calls for translation of epidemiologic evidence into clinical care, our pilot study delivered an evidence-based physical activity intervention in adults with polyps, who are thus at elevated risk of developing colon cancer. The objective was to evaluate change in physical activity, measured by steps per day and minutes of moderate/ vigorous physical activity. Methods: Sixteen adults with adenomas detected and removed at screening colonoscopy were recruited to a 12-week physical activity intervention. Participants were randomized to receive a standard (30 minutes/day) or high (60 minutes/day) walking program. Physical activity was measured via blinded pedometer and accelerometer at baseline and follow-up. Intervention messages focused on self-monitoring using pedometers and overcoming barriers to engaging in physical activity. Results: Participants in both arms significantly increased objectively measured minutes of moderate/vigorous physical activity over the course of the intervention. Both arms exceeded the intervention goal, but there was not a significant difference between arms at follow-up. Results were similar for pedometer measured physical activity, with a significant overall increase in steps/day from baseline to follow-up, but no between arm difference in change. Conclusion: Simple interventions of minimal contact time focusing on walking can significantly increase physical activity in individuals at increased risk of developing colon cancer. Trial Registration: ClinicalTrials.gov NCT01476631 Citation: Wolin KY, Fagin C, James AS, Early DS (2012) Promoting Physical Activity in Patients with Colon Adenomas: A Randomized Pilot Intervention Trial. PLoS ONE 7(7): e39719. doi:10.1371/journal.pone.0039719 Editor: Jonatan R. Ruiz, University of Granada, Spain Received January 5, 2012; Accepted May 24, 2012; Published July 13, 2012 Copyright: 2012 Wolin et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This publication was made possible, in part, by Grant Number UL1 RR024992 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research and through support from the Barnes Jewish Hospital Foundation. The authors thank the Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri, for the use of the Tissue Procurement Core, which provided sample storage and processing. The Siteman Cancer Center is supported in part by NCI Cancer Center Support Grant #P30 CA91842. Study data were collected and managed using REDCap (Research Electronic Data Capture). The manuscript contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: wolink@wustl.edu Introduction Evidence linking regular physical activity with a reduced risk of colon cancer is consistent and convincing [1–3]. A recent meta- analysis of observational data found physical activity decreased risk of adenomatous polyps which are precursors to colon cancer [4]. There is no evidence of an association for physical activity with rectal cancer [2,5]. Despite the benefits of physical activity, nearly 75% of the population fails to meet recommended physical activity levels [6–8]. Previous studies have reported a reduced risk of colon cancer with engagement in moderate intensity activity [9,10]. Recent analyses in the Nurses’ Health Study, the largest prospective study to examine this association, found a significant risk reduction in colon cancer incidence among women walking at least two hours per week [11]. Observational data in colon cancer survivors shows a disease-free survival benefit for physical activity, but suggests that higher amounts of physical activity may be necessary to reduce risk of recurrence [12,13]. Together, these data suggest there is a favorable role for physical activity in terms of risk reduction, at multiple stages in colon cancer carcinogenesis. However, there is little data on the role of physical activity in individuals at elevated risk of colon cancer, particularly those who have previously had colon adenomatous polyps. We therefore interpreted a need for data on whether a physical activity intervention could be successfully implemented after removal of adenomatous polyps during screening colonoscopy. Designing such an intervention is challenging; the dose physical activity necessary to reduce risk of recurrent colon adenomas is unknown, as is whether increasing doses of physical activity would PLoS ONE | www.plosone.org 1 July 2012 | Volume 7 | Issue 7 | e39719