A qualitative study of the perioperative exercise experience in elderly colorectal cancer patients with sarcopenia
Authors: Yang Jinmei , Fu Guifen , Zhang Xin , Wang Miao , Mo Ruizhi , Zhu Yuekai 
Published: December 2024

Objective: To understand the needs and characteristics of elderly colorectal cancer patients with sarcopenia for perioperative exercise rehabilitation, to develop an interview outline, and to analyze the facilitators and barriers to perioperative exercise, feasibility, acceptability, and implementability of perioperative exercise in elderly colorectal cancer patients with sarcopenia by means of qualitative interview, with the aim of providing theoretical basis for the guidance of perioperative exercise for elderly colorectal cancer patients with sarcopenia. Methods: A phenomenological research method was used to conduct semi-structured interviews with 15 perioperative exercisers of elderly colorectal cancer patients with sarcopenia, and the results of the interviews were analyzed using the Colaizzi seven-step analysis method. Results: The perioperative exercise experience of elderly colorectal cancer patients with sarcopenia encompasses 4 core elements:(1) the presence of intricate negative physical and psychological experiences. (2) Fear of limiting physical activity. (3) Anticipation of regaining health. (4) Desire for effective social support. Conclusion: The 4 core factors of perioperative exercise in elderly colorectal cancer patients with sarcopenia are expected to provide new insights into the development of perioperative exercise programs for elderly colorectal cancer patients with sarcopenia. The relationship between elderly patients with colorectal cancer muscle atrophy and biology is mainly reflected in the following aspects: (1) Inflammatory response and muscle atrophy: Colorectal cancer patients often experience systemic inflammatory response, which can trigger a series of changes in anorexia, metabolism, and neuroendocrine system, thereby activating muscle protein breakdown and leading to the occurrence of muscle atrophy. High levels of pro-inflammatory cytokines such as TNF - α and IL-1 β are significantly correlated with the occurrence of sarcopenia, while IL-6 levels show a positive correlation with the occurrence of sarcopenia. (2) Imbalance between protein synthesis and breakdown: In the tumor state, the protein breakdown system in skeletal muscle cells is activated and closely related to the ubiquitin proteasome system (UPS) and calpain. The muscle specific E3 ubiquitin ligase expression of UPS in cancer patients' muscles increases, leading to muscle protein breakdown and promoting muscle atrophy. (3) Autophagy: Autophagy is a normal physiological process in which cells break down unnecessary or dysfunctional organelles. In cancer patients, tumor cells can utilize autophagy to survive in nutrient deficient environments. Autophagy plays an important role in the dynamic balance of muscles. The FOXO transcription factor family participates in immune related regulation such as cell cycle arrest and apoptosis through various signaling pathways, inducing increased gene expression for muscle autophagy degradation, leading to the occurrence of sarcopenia. (4) Gut microbiota and its metabolites: High levels of Clostridium difficile, Escherichia coli, and Streptococcus pyogenes can be detected in the tumor tissues of colorectal cancer patients, while the number of protective bacteria, including Roche, Clostridium, and Bifidobacterium, is significantly reduced. The changes in gut microbiota may affect muscle quality by influencing the expression of genes related to muscle protein synthesis. (5) Individual differences and protein intake: The muscle mass changes of colorectal cancer patients show significant individual differences, indicating that the relationship between protein intake and muscle mass is not simply a linear correlation, but is influenced by multiple factors working together. The degree of inflammatory response plays a key role in this process, and CRC patients with high levels of chronic inflammatory markers (such as C-reactive protein, IL-6, etc.) have a poorer response to additional protein intake and are more prone to muscle atrophy. These biological factors work together to affect the muscle mass and function of elderly colorectal cancer patients, which is closely related to the occurrence and development of sarcopenia.