Multimodal digital health rehabilitation during acute survivorship following colorectal cancer surgery

Multimodal digital health rehabilitation during acute survivorship following colorectal cancer surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Multimodal digital health rehabilitation during acute survivorship following colorectal cancer surgery Seung Mi Yeo, Hee Cheol Kim, Yoon Ah Park, Yoon Suk Lee, Jung-Myun Kwak, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7913956/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract This multicenter randomized trial evaluated a 6-month digital health rehabilitation program for 321 colorectal cancer (CRC) survivors during the acute survivorship after surgery. The intervention, using a mobile application and activity tracker, provided individualized exercise and nutrition guidance. The primary outcome, skeletal muscle mass (SMM), was not significantly preserved compared to usual care. However, the intervention yielded significant improvements in key secondary outcomes, including nutritional status (Mini Nutritional Assessment) and overall quality of life (global health status), underscoring its broad clinical utility. A critical finding emerged from a subgroup analysis, where participants with high adherence to the program exhibited a significant increase in appendicular skeletal muscle index (aSMI). This highlights that the efficacy of digital interventions is contingent on patient engagement. These findings suggest that while not impacting total SMM, multimodal digital rehabilitation is a valuable tool for enhancing overall recovery, with adherence being a key determinant of its success. Biological sciences/Cancer Health sciences/Diseases Health sciences/Gastroenterology Health sciences/Health care Health sciences/Medical research Health sciences/Oncology Colorectal cancer Digital health intervention Acute survivorship Skeletal muscle mass Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 INTRODUCTION Colorectal cancer (CRC) is the third most diagnosed cancer worldwide and the second leading cause of cancer-related deaths 1 . In South Korea, it represents a significant public health burden as the third most common cancer in both incidence and mortality 2 . Advances in diagnosis and treatment have led to a growing population of CRC survivors, shifting the clinical focus toward optimizing postoperative recovery and long-term health. However, survivors often face substantial physical and psychological challenges, including fatigue 3 , diminished physical function 4 , changes in body weight 5 , and deteriorating quality of life (QoL) 6 . Foundational to survivorship care are lifestyle modifications, such as physical activity and nutritional management, which are crucial for preventing recurrence and improving overall prognosis 7 – 10 . Specifically, maintaining skeletal muscle mass is critical, as postoperative sarcopenia is linked to delayed recovery and increased complications 11 . Despite the clear benefits, adherence to lifestyle recommendations among CRC survivors remains strikingly low, with one study reporting that only 12% follow guidelines for diet, physical activity, and weight management 12 . This gap highlights the urgent need for structured, proactive strategies, particularly during the acute survivorship phase immediately following surgery. Digital health technologies, including mobile applications and wearable devices, offer a promising solution by providing scalable, individualized support for self-management, real-time health tracking, and patient-provider communication 13 . However, the evidence for the efficacy of these digital interventions in postoperative CRC survivors remains inconclusive, largely due to a fragmented research landscape. Existing studies have typically focused on two distinct and separate periods: the immediate postoperative phase, often limited to the first few weeks after discharge 14 , 15 , or the extended survivorship phase, long after active treatment has concluded 16 , 17 . This has left a significant gap in understanding how to best support patients during the metabolically vulnerable acute survivorship phase, which encompasses the entire recovery trajectory including the postoperative period and adjuvant radiotherapy or chemotherapy. A critical factor confounding outcomes in this field is the persistent challenge of patient adherence. A compelling example is the recent randomized controlled trial by Kim et al. published in npj Digital Medicine. In their study, a digital lifestyle intervention failed to significantly improve the primary outcome of QoL, a result potentially explained by low patient engagement, as the cohort averaged only 41 days of application use over six 18 . Nevertheless, a secondary analysis revealed potential benefits for skeletal muscle area, suggesting that while digital tools hold potential, their clinical impact is critically contingent on achieving sufficient patient adherence. Therefore, this study aimed to address these gaps by evaluating a multimodal digital health intervention specifically designed for CRC patients in the acute survivorship phase. We hypothesized that our intervention, which integrates individualized exercise and nutrition guidance along with provider feedback to enhance engagement, would preserve skeletal muscle mass (SMM) as the primary outcome. Furthermore, we sought to investigate the relationship between program adherence and clinical outcomes, building upon the findings of prior work to better understand the determinants of efficacy for digital health interventions in this population. Methods Study design This study was a prospective, multicenter, 2:1 randomized controlled trial conducted in accordance with the SPIRIT guidelines. Participants were recruited from three tertiary university hospitals in South Korea and randomly assigned to either a digital health intervention group or a control group that received usual care. All the study procedures were approved by the institutional review boards of the three hospitals (approval numbers: SMC-2021-01-090, 2021AN0104, and KC21FNSI0177). This clinical trial was registered at ClinicalTrials. gov (NCT05046756). The detailed protocol for this study has been published previously 19 . Participants Patients who had received CRC surgery within the previous week were recruited from three hospitals in a competitive manner between May 2021 and June 2022. The inclusion criteria were as follows: age between 19 and 85 years; diagnosis of CRC and CRC surgery within the previous week; use of an android or iOS smartphone; ability to use a mobile application; and willingness to participate in the follow-up assessments. The exclusion criteria were as follows: presence of comorbid conditions that make it impossible to follow exercise and diet recommendations based on the American Cancer Society guidelines; significant neuromusculoskeletal, cognitive, or visual impairments; inability to comprehend or follow the study protocol; and refusal to participate. Written informed consent was obtained from all participants who met the eligibility criteria prior to enrollment. The participants were assigned to either an intervention group that received multimodal digital health rehabilitation or a control group that received usual care (Fig. 1 ). Randomization, allocation, and blinding Participants were randomly assigned to either the intervention or control group in a 2:1 ratio using block randomization with randomly selected block sizes of three or six to ensure allocation balance. Owing to the nature of the intervention, this was an open-label study; thus, neither the participants nor outcome assessors were blinded to the group allocation. Baseline assessments were performed after randomization. Interventions Participants assigned to the intervention group received individualized healthcare service for 6 months using a health management application called Colon Cancer by Second Doctor (Medi Plus Solution, Seoul, South Korea) which was developed specifically for patients with CRC, and a wrist-worn activity tracker, DoFit (model NF-B20, Medi Plus Solution, Seoul, South Korea), which continuously measures step counts and heart rates using a built-in 6-axis accelerometer, gyroscope, and photoplethysmography sensor. The application was developed as an evidence-based tool by an expert team, including application developers, user interface and user experience (UI/UX) designers, service programmers, cancer rehabilitation specialists, and clinical researchers. The core domains of the application include exercise, diet, physical activity, and weight management (Fig. 2 ). 1) Exercise module Individualized aerobic exercise goals were provided in the exercise module, including target heart rate zones and the recommended exercise duration. The target heart rate was calculated by multiplying the patient's maximum heart rate by the target heart rate equation factor (THR EF), which gradually increased over the postoperative weeks. The exercise duration was also progressively extended. At 15 weeks postoperatively, a general exercise management algorithm was applied, in which exercise intensity was adjusted based on the patient's rating of perceived exertion (RPE). During chemotherapy, the THR EF was fixed at 0.60, and the exercise duration was limited to a target of either 15 or 20 min. The detailed THR EFs are presented in Appendix 1. From week 15 onward, after reaching 74% of the target heart rate corresponding to moderate-intensity exercise, exercise intensity was adjusted based on RPE and either increased or decreased, considering both the participant’s exercise capacity and safety in cases of low capacity. During the aerobic exercise, real-time activity data collected by a wrist-worn activity tracker were transmitted to the application via Bluetooth, enabling integrated monitoring and feedback. Video-guided programs for stretching and resistance exercises were offered according to the weekly phase of the rehabilitation process. In postoperative week 1, level 1 bed exercises were provided; in postoperative week 2, level 2 bed exercises; in postoperative weeks 3–6, level 1 strength recovery exercises; in postoperative weeks 7–10, level 2 strength recovery exercises; and in postoperative weeks 11–14, level 3 strength recovery exercises were provided. Levels 1 and 2 bed exercises differed only in the number of sets. Strength recovery exercises consisted of body weight and resistance band exercises of gradually increasing intensity. General strength training was initiated at week 15. As with aerobic training, if an RPE of 17 or higher was recorded, a downgraded strength exercise video (one level lower) was provided, and if an RPE of 9 or 11 was recorded on two or more occasions, an upgraded strength exercise video (one level higher) was provided. only two levels of low-intensity exercise videos specifically designed for patients undergoing chemotherapy were provided. For patients who underwent stoma reversal surgery, pelvic floor muscle exercises were performed in a stepwise manner according to the postoperative week. The exercise module is structured in a multi-depth format: depth-cancer type, depth-resection site, depth-presence of stoma, depth-recovery stage, and schedule of adjuvant treatment. Based on these classifications, individualized exercise programs were provided according to participants’ profiles. 2) Diet module The diet module allowed users to log their food intake, which was automatically analyzed for macronutrient distribution and calorie intake and provided feedback on whether the intake was excessive, appropriate, or insufficient. The criteria for setting individualized recommended caloric intakes and target nutrient levels included cancer type, body mass index (BMI), sex, age, weeks from the date of surgery, and presence of comorbid chronic diseases. The recommended caloric intake was calculated by multiplying the ideal body weight with the activity factor. Ideal body weight was defined as height(m) 2 × 22 for men and height(m) 2 × 21 for women. The activity factor was determined based on the BMI-defined obesity status, ranging from 26 to 35 kcal/kg ( Appendix 2). In patients with CRC, the algorithm incorporates hydration management and enhanced protein supplementation to support postoperative recovery. From week 13 onward, the recommendation system transitioned to a general dietary plan by applying nutrient management algorithms tailored for comorbid chronic diseases. Using a web-based administrative interface, healthcare professionals monitored participants’ application usage biweekly over a 6-month period and delivered encouraging feedback based on adherence to exercise (≥ 3 times/week) and meal logging (≥ 3 times/week). The control group received postoperative care for 6 months. This included a standard brochure provided after surgery, which outlines the general recommendations for exercise. Regardless of group allocation, all participants received nutritional education after surgery. In addition, all participants with colostomies were provided specific education regarding stoma care, and those who underwent low anterior resection received pelvic floor muscle training guidance. Outcome measures After eligibility screening, informed consent, group allocation, demographic characteristics, and medical data were collected from all the participants. Demographic information including sex, age, height, body weight, BMI, alcohol consumption, smoking history, comorbidities, and dominant hand were collected. Cancer-related data included cancer stage, tumor location, extent of resection, surgical method, administration of adjuvant chemotherapy or radiotherapy, and the presence of a stoma. Outcome measures were evaluated by a clinical research coordinator at baseline and at the 1-, 3-, and 6-month follow-ups (Table 1 ). Table 1 Summary of baseline screening, assessment, and follow-up during study visits TIMEPOINT Post op (± 1w) 1-month (± 2w) 3-month (± 1m) 6-month (± 2m) ENROLLMENT: 1. Eligibility screening X 2. Informed consent X 3. Allocation X 4. Demographic characteristic X 5. Medical history X ASSESSMENTS: 1. Hb and albumin X X 2. CT (visceral fat and muscle mass) X X 3. Muscle mass via BIA (SMM and aSMI) X X X X 4. Grip strength X X X X 5. 30-second chair stands test X X X 6. 2-minute walk test X X X 7. IPAQ-SF X X X X 8. Mini Nutritional Assessment X X X X 9. Average pain X X X X 10. Maximal pain X X X X 11. EORTC-QLQ-C30 X X X X 12. EORTC-QLQ-CR29 X X X X 13. Satisfaction questionnaire X Hb, hemoglobin; CT, computed tomography; BIA, bioelectrical impedance analysis; SMM, skeletal muscle mass; aSMI, appendicular skeletal muscle index; IPAQ-SF, International Physical Activity Questionnaire–Short Form; EORTC-QLQ, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Table 2 Baseline characteristics of the two groups Baseline demographics Control group (n = 106) Intervention group (n = 215) p-value Age (year), mean ± SD 58.7 ± 12.0 55.7 ± 9.8 0.030 Male sex, n (%) 69 (65.1) 128 (59.5) 0.336 Tumor stage, n (%) 0.484† I 22 (20.8) 59 (27.4) II 40 (37.7) 66 (30.7) III 40 (37.7) 79 (36.7) IV 3 (2.8) 10 (4.7) Tumor location, n (%) 0.997 Right colon 18 (17.0) 36 (16.7) Left colon 41 (38.7) 86 (40.0) Rectum 46(43.4) 91 (42.3) Surgery approach, n (%) 0.772† Laparoscopic 73 (68.9) 155 (72.1) Robotic 29 (27.4) 54 (25.1) Open 4 (3.8) 6 (2.8) With stoma, n (%) 23 (21.7) 39 (18.1) 0.717† With adjuvant chemotherapy, n (%) 57 (53.8) 98 (45.6) 0.167 With adjuvant radiotherapy, n (%) 7 (6.6) 14 (6.5) 0.975 With palliative chemotherapy, n (%) 6 (5.7) 13 (6.1) 0.890 BMI (kg/m 2 ), mean ± SD 23.1 ± 3.4 23.4 ± 3.1 0.141‡ Skeletal muscle mass (kg), mean ± SD 26.6 ± 5.5 26.5 ± 6.3 0.700‡ Hemoglobin (g/dL), mean ± SD 12.5 ± 1.6 12.5 ± 2.0 0.810 Albumin (g/dL), mean ± SD 4.2 ± 0.4 4.3 ± 0.4 0.039 ‡ Mini Nutritional Assessment, mean ± SD 23.1 ± 3.7 23.0 ± 3.6 0.763‡ BMI, body mass index; SD, standard deviation. †Analyzed using Fisher’s exact test. ‡Analyzed using the Mann–Whitney U test. Table 3 Changes in SMM, anthropometric measures, and physical performance over the study period in both groups Control group Intervention group Sources F p-value Baseline 1 month 3 months 6 months Baseline 1 month 3 months 6 months SMM (kg) 26.63 ± 5.50 25.63 ± 5.56 25.79 ± 5.16 26.19 ± 5.58 26.52 ± 6.31 26.98 ± 18.54 26.21 ± 6.12 26.52 ± 5.89 Group 0.14 0.706 Time 0.21 0.888 Group × time 0.45 0.718 Weight (kg) 63.06 ± 10.68 61.54 ± 10.43 61.96 ± 10.30 62.58 ± 10.51 63.78 ± 11.74 62.30 ± 11.55 63.32 ± 12.17 65.37 ± 12.47 Group 19.93 < 0.001 Time 39.14 < 0.001 Group × time 1.90 0.129 BMI (kg/m 2 ) 23.11 ± 3.38 22.69 ± 3.45 22.60 ± 3.41 22.88 ± 3.48 23.38 ± 3.12 22.81 ± 3.14 23.17 ± 3.29 23.93 ± 3.26 Group 8.10 0.004 Time 18.10 < 0.001 Group × time 2.78 0.041 Grip Strength (kg) 29.22 ± 10.01 28.33 ± 9.18 27.94 ± 8.86 28.74 ± 9.34 28.90 ± 10.71 28.42 ± 10.02 28.41 ± 10.16 29.78 ± 9.95 Group 1.49 0.223 Time 3.82 0.010 Group × time 0.35 0.788 30CST X 15.33 ± 5.27 16.92 ± 6.15 19.74 ± 6.78 X 16.41 ± 6.14 18.44 ± 6.32 20.54 ± 6.55 Group 0.61 0.434 Time 117.36 < 0.001 Group × time 1.10 0.332 2MWT (m) X 162.23 ± 32.83 173.54 ± 36.55 191.16 ± 30.94 X 169.90 ± 39.45 183.23 ± 36.60 194.17 ± 38.17 Group 1.52 0.219 Time 70.56 < 0.001 Group × time 2.63 0.074 SMM, skeletal muscle mass; BMI, body mass index; 30CST, 30-second chair stand test; 2MWT, 2-minute walk test Table 4 Changes in aSMI and computed tomography-derived muscle and fat measurements over the study period in both groups (n = 128) Control group Intervention group Sources F p-value Baseline 1 month 3 months 6 months Baseline 1 month 3 months 6 months aSMI (kg/m 2 ) 7.20 ± 1.15 7.08 ± 1.22 7.12 ± 0.98 7.20 ± 1.10 7.37 ± 1.32 7.21 ± 1.24 7.19 ± 1.18 7.23 ± 1.21 Group 8.70 0.004 Time 7.54 < 0.001 Group × time 0.83 0.476 SMA (cm 2 ) 127.39 ± 33.77 X X 124.11 ± 29.62 131.52 ± 46.33 X X 127.82 ± 30.19 Group 3.53 0.062 Time 1.22 0.272 Group × time 0.65 0.423 SMI (cm 2 /m 2 ) 46.59 ± 10.10 X X 44.99 ± 7.71 47.60 ± 14.75 X X 46.29 ± 8.61 Group 2.55 0.112 Time 1.09 0.300 Group × time 0.81 0.369 VFA (cm 2 ) 97.75 ± 72.60 X X 59.70 ± 44.46 98.29 ± 59.96 X X 82.44 ± 54.28 Group 1.00 0.318 Time 49.28 < 0.001 Group × time 5.63 0.019 aSMI, appendicular skeletal muscle index; SMA, skeletal muscle area; SMI, skeletal muscle index; VFA, visceral fat area. Table 5 Changes in physical activity, blood-based nutritional markers, and MNA scores over the study period in both groups PA, physical activity; MNA, Mini Nutritional Assessment Control group Intervention group Sources F p-value Baseline 1 month 3 months 6 months Baseline 1 month 3 months 6 months Total PA (MET·min/week) 2058.66 ± 2273.20 1707.11 ± 1274.06 2487.23 ± 2346.89 2748.30 ± 2340.43 2290.58 ± 2309.92 2110.81 ± 1534.29 2544.81 ± 2054.28 2856.73 ± 1976.95 Group 0.72 0.397 Time 10.13 < 0.001 Group × time 0.61 0.605 Hemoglobin (g/dL) 12.49 ± 1.62 X X 12.82 ± 1.64 12.54 ± 1.98 X X 13.07 ± 1.48 Group 0.15 0.703 Time 7.56 0.006 Group × time 0.64 0.423 Albumin (g/dL) 4.20 ± 0.38 X X 4.30 ± 0.36 4.29 ± 0.37 X X 4.32 ± 0.36 Group 0.29 0.588 Time 2.67 0.104 Group × time 0.98 0.325 MNA 23.07 ± 3.67 22.64 ± 3.31 24.59 ± 3.22 25.20 ± 3.26 23.00 ± 3.55 23.40 ± 3.37 25.58 ± 2.79 26.05 ± 2.15 Group 3.63 0.058 Time 65.71 < 0.001 Group × time 2.67 0.047 Table 6 Changes in quality of life over the study period in both groups Control group Intervention group Sources F p-value Baseline 1 month 3 months 6 months Baseline 1 month 3 months 6 months Physical function 79.11 ± 20.32 75.86 ± 17.94 82.48 ± 15.51 85.32 ± 15.41 82.82 ± 16.24 82.06 ± 14.99 88.82 ± 10.19 90.15 ± 10.94 Group 11.50 < 0.001 Time 25.18 < 0.001 Group × time 1.41 0.239 Role function 79.68 ± 26.04 71.05 ± 27.09 82.75 ± 22.79 83.12 ± 22.72 83.41 ± 24.36 77.14 ± 24.80 86.86 ± 17.78 89.03 ± 18.06 Group 6.74 0.010 Time 15.19 < 0.001 Group × time 0.17 0.915 Cognitive function 87.30 ± 14.71 88.42 ± 13.33 88.37 ± 12.80 88.40 ± 12.33 88.65 ± 13.56 90.92 ± 14.48 91.08 ± 12.71 91.51 ± 12.51 Group 3.53 0.061 Time 1.60 0.188 Group × time 0.33 0.806 Emotional function 80.71 ± 18.47 81.49 ± 19.72 86.63 ± 13.24 85.86 ± 15.41 80.59 ± 19.15 84.47 ± 17.73 87.25 ± 15.71 90.27 ± 11.62 Group 2.97 0.086 Time 15.47 < 0.001 Group × time 0.95 0.422 Social function 78.25 ± 26.67 75.44 ± 26.05 84.69 ± 19.00 86.08 ± 21.42 80.28 ± 24.60 82.02 ± 21.62 86.47 ± 20.19 90.86 ± 15.80 Group 4.48 0.035 Time 8.27 < 0.001 Group × time 1.17 0.321 Global health status 54.68 ± 24.04 53.77 ± 23.22 63.66 ± 18.70 63.40 ± 19.77 54.73 ± 24.50 61.47 ± 19.54 67.55 ± 18.78 71.02 ± 16.49 Group 5.92 0.016 Time 25.75 < 0.001 Group × time 3.25 0.021 Summary score 80.59 ± 13.70 80.43 ± 12.96 84.98 ± 10.77 86.74 ± 11.64 82.79 ± 12.54 83.52 ± 11.93 87.15 ± 9.85 89.51 ± 8.52 Group 6.28 0.013 Time 25.46 < 0.001 Group × time 0.24 0.868 Table 7 Function-specific log days, exercise time, and step count (n = 132) Month Exercise log days Exercise time (m) Step log days Step count (steps/d) Weight diary days Meal diary days Application log days 1 12.5 ± 12.1 40.2 ± 22.0 22.1 ± 10.0 8626.2 ± 4102.0 6.9 ± 9.3 18.9 ± 11.9 21.5 ± 10.1 2 12.8 ± 12.7 41.4 ± 19.7 20.3 ± 11.9 9018.5 ± 4271.8 7.6 ± 10.7 18.6 ± 12.5 20.8 ± 11.3 3 12.0 ± 12.4 50.8 ± 37.8 19.1 ± 12.5 9257.4 ± 4117.9 7.9 ± 11.1 17.5 ± 12.9 19.9 ± 12.0 4 11.8 ± 11.6 57.5 ± 30.8 19.1 ± 12.5 9176.6 ± 4176.8 7.3 ± 10.6 16.5 ± 12.7 19.2 ± 11.6 5 11.4 ± 11.8 58.5 ± 31.6 17.8 ± 13.0 9108.0 ± 4219.2 6.9 ± 10.5 15.4 ± 13.3 18.4 ± 12.1 6 10.9 ± 11.6 59.3 ± 28.8 16.5 ± 13.2 9219.8 ± 4174.5 6.3 ± 9.8 14.4 ± 13.2 17.5 ± 12.3 Mean ± SD 11.9 ± 11.0 49.8 ± 26.0 19.1 ± 10.9 8677.9 ± 3549.5 7.1 ± 9.8 16.9 ± 11.7 19.5 ± 10.8 SD, standard deviation Table 8 Satisfaction survey administered only to the intervention group after 6-month intervention Survey question Mean (SD) n = 142 Usability Sufficiency of in-service guidance and instruction 3.8 (0.9) Ease of understanding how to use the service* 3.8 (0.9) Accessibility of desired functions within the service 3.7 (0.8) Content adequacy Inclusion of necessary functions for health management 3.5 (0.8) Helpfulness and adequacy of information provided for managing health* 3.7 (0.7) Overall satisfaction Overall satisfaction with the healthcare service* 3.7 (0.8) Intention to continue using the healthcare service* 3.6 (0.9) Willingness to recommend the service to others* 3.7 (0.9) Effectiveness Increased regular monitoring of health status due to service participation 3.9 (0.8) Increased interest in personal health management after using the service 4.0 (0.7) Usefulness of the healthcare service in managing personal health 4.0 (0.7) Perceived appropriateness of the service for managing one’s condition 4.0 (0.7) *Participants who selected specific Likert-scale scores were instructed to provide further reasons. Skeletal muscle mass The primary outcome of this study was the change in skeletal muscle mass (SMM, kg) measured using bioelectrical impedance analysis (BIA, Inbody 770, Seoul, South Korea) from baseline to the 6-month assessment. Appendicular skeletal muscle index (aSMI) and computed tomography (CT)-derived muscle and fat measurements After the main study, exploratory outcomes were evaluated based on the investigators' judgment that more precise muscle mass measurements were warranted. Accordingly, a subgroup of patients (n = 128) from one participating center underwent additional assessments, including aSMI and CT-derived analyses of muscle and fat. These assessments were conducted at this site owing to the availability of appropriate imaging data. The aSMI was retrospectively calculated using data from BIA, whereas CT-derived measurements were obtained from abdominal and pelvic CT scans. aSMI was determined by summing the muscle mass of both the upper and lower limbs and dividing the total by the square of the participant’s height (m 2 ). CT-based assessments were conducted using a single-slice image at the mid-L3 vertebral level, which was analyzed using dedicated software developed by the Department of Radiology at Samsung Medical Center. Cross-sectional skeletal muscle area (SMA) and visceral fat area (VFA) were measured, and the skeletal muscle index (SMI) was calculated by dividing SMA by height squared (m 2 ) 20 . CT scans performed within 6 months prior to the baseline assessment were used as baseline data. Follow-up CT measurements were conducted only at 6 months, and no assessments were performed at 1 or 3 months. Physical performance Secondary outcomes included physical performance, physical activity level, nutritional status, pain, and quality of life. Physical performance was evaluated using the grip strength test, 30-second chair stand test (30CST), and 2-minute walk test (2MWT). Grip strength was assessed at all four time points. However, the 30CST and 2MWT were not conducted at baseline because the assessment was performed within 1 week postoperatively, and these tests were administered only at 1, 3, and 6 months postoperatively. Grip strength was measured using a handheld dynamometer (MicroFET Digital HandGRIP Dynamometer; Hoggan Scientific, LLC, USA). Participants completed three maximal grip strength trials using their dominant hand, and the mean value (kg) was used for the analysis 21 . The 30CST was used to assess lower extremity strength and muscular endurance. The participants were instructed to sit on a standard-height chair with a backrest without leaning against it, cross their arms over their chest, stand up, and sit down as many times as possible within 30 s. Only the fully completed repetitions were counted 22 . The 2MWT was used to assess cardiorespiratory endurance and ambulatory function. This is a validated and reliable measure, particularly for older adults and patients with cancer 23 . Participants were instructed to walk as far as possible for 2 min along a 15.2-m hallway, and the total distance covered was recorded 24 . Physical activity level Physical activity levels were evaluated using the International Physical Activity Questionnaire–Short Form (IPAQ-SF). In the IPAQ-SF, participants are made to recall their physical activity during the past 7 days, including walking, moderate-intensity activity, vigorous-intensity activity, and time spent sitting, to estimate total physical activity. The Korean version of the questionnaire demonstrated good reliability and validity across various populations 25 . Total physical activity was calculated by summing the MET minutes per week for each type of activity (walking: 3.3 METs, moderate-intensity activity: 4.0 METs, vigorous-intensity activity: 8.0 METs). Nutritional status Nutritional status was evaluated using blood-based nutritional markers and the Mini Nutritional Assessment (MNA). Blood samples were obtained preoperatively and at 6 months postoperatively. Among these markers, hemoglobin and albumin levels were used as indicators of nutritional status. The MNA consists of 18 items covering four domains: dietary intake, weight loss, anthropometric measurements, functional and psychological status, and overall health status 26 . Its reliability and validity have been demonstrated in several studies. Scores range from 0 to 30: <17 indicates malnutrition, 17–23.5 indicates risk of malnutrition, and 24–30 reflects normal nutritional status. Pain intensity Pain intensity over the past week was evaluated using a Numeric Rating Scale ranging from 0 ("no pain") to 10 ("worst possible pain"). The participants reported both their average and worst pain levels experienced during that period. Quality of life Quality of life was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ), which includes QLQ-C30 and QLQ-CR29. The of European Organization for Research and Treatment Cancer QLQ-C30 is a 30-item questionnaire comprising functional scales (physical, role, emotional, cognitive, and social), symptom scales, and a global health status scale. The Korean version of the EORTC QLQ-C30 has been translated and culturally adapted for use 27 . For the functional scales and global health status, higher scores indicated better functioning, whereas for the symptom scales, higher scores indicated greater symptom severity. The summary score is calculated by combining the functional and symptom scales, with higher scores indicating better health status. Disease-specific QoL was assessed using the EORTC QLQ-CR29, a validated 29-item module developed for patients with CRC 28 . It includes multiple symptom and functional scales, some of which are sex-specific. Higher scores indicated better functioning or greater symptom burden, depending on the scale. Satisfaction survey A self-developed satisfaction survey on mobile applications and Internet of Things (IoT) devices, developed through consensus among investigators from the three participating institutions, was administered only to the intervention group at the 6-month assessment point. The survey used a 5-point Likert scale, with higher scores indicating greater satisfaction. Adherence “Exercise log days” were defined as the number of days within a month during which the user performed any type of exercise for more than 5 min, based solely on exercise records entered into the application. “Exercise time” was calculated by dividing the total exercise duration by the number of exercise log days. To observe trends in the average exercise duration among users who recorded exercise using the application, values of zero were excluded from the calculation of the mean. “Step log days” refer to the total number of days on which step counts were recorded. The “step count” was calculated by dividing the total number of steps over a month by the number of step-log days. To ensure monthly representativeness, the step count was calculated only when step data were available for at least 7 days. For the trend analysis of step counts among users who logged their step data, values of zero were excluded when calculating the mean. “Weight diary days” and “meal diary days” indicate the number of days with at least one entry, and “application log days” denote the number of days the user accessed the application at least once. The means and standard deviations (SD) for all log-day variables included values of 0 in the calculation. Sample size calculation Based on a previous study 29 , the required sample size was calculated using an effect size of 0.35, with 80% power and 5% significance level. A 2:1 allocation ratio was used. The G*Power software (v3.1.9.2) estimated a minimum of 195 participants in the intervention group and 97 in the control group. Considering a 10% dropout rate, the total sample size was set at 324 (216 interventions and 108 controls). Participants were competitively enrolled across three institutions to achieve the target sample size. Statistical analysis Statistical analyses were conducted using the R software (version 4.3.1, R Foundation for Statistical Computing, Vienna, Austria). All the analyses followed the intention-to-treat principle. Descriptive statistics were used to summarize the baseline characteristics. Between-group differences in baseline data were assessed using the independent t-test for continuous variables with a normal distribution and the Mann–Whitney U test for those without. For categorical variables, the chi-square test or Fisher’s exact test was used, as appropriate. All the outcomes were evaluated using linear mixed-effects models (LMM). Variables that showed significant between-group differences at baseline and were considered potential confounders were included as covariates in the model (e.g., age). In cases where the group–time interaction was statistically significant, a post-hoc analysis was conducted with the Bonferroni correction. Results Baseline characteristics A total of 321 patients who underwent CRC surgery between May 2021 and June 2022 were enrolled in this study, which was slightly below the target sample size of 324. The patients were randomly assigned to either the intervention group (n = 215) or the control group (n = 106) in a 2:1 ratio. At the end of the 6-month study period, the retention rate was 74.9% (161/215) in the intervention group and 77.4% (82/106) in the control group (Fig. 1). This study was funded by a national grant within a predefined study period. However, owing to delays in participant enrollment caused by the coronavirus disease 2019 (COVID-19) pandemic, the study was terminated before some participants completed their 6-month follow-up. These participants are marked as “due to study closure” in Fig. 1. The baseline characteristics of the two groups are presented in Table 2. Except for age and serum albumin levels, no significant differences were observed between the groups. The mean ± SD of age was 58.7 ± 12.0 years in the control group and 55.7 ± 9.8 years in the intervention group. Age was included as a covariate in all LMM analyses except for albumin, for which both baseline albumin level and age were used as covariates. Primary outcome: Skeletal muscle mass The changes in the SMM at baseline and at 1, 3, and 6 months in both groups are presented in Table 3 and Fig. 4. In the LMM analysis of the SMM changes, no significant changes were observed within or between the groups. No significant change in SMM over time and difference in the pattern of SMM change were observed between the intervention and control groups. Exploratory outcomes: aSMI and CT-derived muscle and fat measurements Data from 128 patients enrolled at a single hospital were analyzed. The changes in the aSMI and CT-derived muscle and fat measurements are shown in Table 4. For aSMI, significant main effects of time (F = 7.54, p < 0.001), whereas the group × time interaction was not statistically significant. For SMA and SMI, no significant changes were detected within or between the groups. For VFA, significant main effects of both time (F = 49.28, p < 0.001) and group × time interactions (F = 5.63, p = 0.019) were noted. Thus, the VFA changed over time in both groups, and the pattern of VFA change over time differed significantly between the intervention and control groups. Post hoc analysis revealed that the control group showed a significantly greater reduction in VFA from baseline to 6 months than the intervention group (p = 0.031). The graphs (Fig. 3) illustrate the changes in aSMI and CT-derived muscle and fat measurements over time in both groups (means ± SD). Secondary outcomes Anthropometric measures The changes in anthropometric measures (body weight and BMI) are presented in Table 3. An LMM was used to assess the effects of group, time, and group × time interaction. Regarding body weight, significant effects of time (F = 39.14, p < 0.001) were observed, although the group × time interaction was not significant. For BMI, all three effects were statistically significant: time (F = 18.10, p < 0.001) and the group × time interaction (F = 2.78, p = 0.041). Thus, the BMI changed over time in both groups, and the pattern of BMI change over time differed significantly between the intervention and control groups. In the post hoc analysis using Bonferroni correction, no significant differences in BMI changes between the two groups were observed from baseline to 1 month (p = 0.856), 3 months (p = 0.176), and 6 months (p = 0.053). The graphs (Fig. 4) illustrate the changes in weight and BMI over time in both groups (means ± SD). Physical performance Changes in physical performance, as assessed by grip strength (at baseline and at 1, 3, and 6 months), 30CST, and 2 MWT (at 1, 3, and 6 months) in both groups are presented in Table 3. For grip strength, the LMM analysis revealed statistically significant effects of time (F = 3.82, p = 0.010), whereas the group × time interaction was not significant. For the 30CST, LMM analysis revealed statistically significant effects of time (F = 117.36, p < 0.001), whereas the group × time interaction was not significant. For the 2 MWT, the LMM analysis revealed statistically significant effects of time (F = 70.56, p < 0.001), whereas the group × time interaction was not significant. The graphs (Fig. 4) illustrate the changes in physical performance over time in both groups (means ± SD). Physical activity level The changes in physical activity levels at baseline and at 1, 3, and 6 months in both groups are presented in Table 5. For physical activity, the LMM analysis revealed statistically significant effects of time (F = 10.13, p < 0.001), whereas the group × time interaction was not significant. The graphs (Fig. 5) illustrate the changes in physical activity level over time in both groups (means ± SD). Nutritional status Changes in nutritional status, as assessed by blood-based nutritional markers (at baseline and 6 months) and MNA (at baseline and 1, 3, and 6 months) in both groups are presented in Table 6. At baseline, no statistically significant differences in hemoglobin and MNA scores were observed, although a statistically significant difference in albumin levels were noted between the two groups. For hemoglobin, the LMM analysis revealed statistically significant effects of time (F = 7.56, p = 0.006), whereas the group × time interaction was not significant. For albumin, no significant changes were detected within or between the groups. For the MNA, significant main effects of both time (F = 65.71, p < 0.001) and group × time interaction (F = 2.67, p = 0.047) were observed. In the post hoc analysis using Bonferroni correction, no significant differences in MNA changes between the two groups were observed from baseline to 1 month (p = 0.035), 3 months (p = 0.032), and 6 months (p = 0.290). The graphs (Fig. 5) illustrate the changes in MNA scores, hemoglobin and albumin over time in both groups (means ± SD). Pain intensity and QoL For average and maximum pain, the LMM analysis revealed statistically significant effects of time, whereas the group and group × time interactions were not significant. Time effects were statistically significant for physical, role, emotional, and social functioning as well as the summary score. Group effects were significant for physical, role, and social functioning and the summary score. However, the group × time interaction effects were not statistically significant for any of the five functioning scales or summary scores. For global health status (GHS), all three effects were statistically significant: time (F =25.75, p < 0.001) and group × time interactions (F = 3.25, p = 0.021). In the post hoc analysis using Bonferroni correction, significant differences in GHS changes between the two groups were observed from baseline to 1 month (p = 0.013) and 6 months (p = 0.011), but not at 3 months (p = 0.071). Although a table and graph are not presented, no significant group × time interaction was identified for any item in the EORTC QLQ-CR29. The graphs (Fig. 6) illustrate the changes in pain and QoL, as assessed by the EORTC QLQ-C30, over time in both groups (means ± SD). Adherence outcomes Application usage metrics Of the 161 participants in the intervention group who completed the 6-month assessment, adherence was analyzed in 132 individuals. Participants who withdrew from the application or did not provide consent for data access at the time of retrieval were excluded from the study. The application usage trends over the 6-month period are presented in Table 7. The number of log days, such as exercise log days, step log days, weight diary days, meal diary days, and application log days gradually declined over time. This suggests a decrease in overall adherence to the mobile app as the intervention period progressed. By contrast, among users who continued to log data, both the average exercise time per exercise day and step count per day tended to increase over time. Clinical outcomes according to adherence level Following the adherence criteria used in previous multicomponent lifestyle intervention application studies 30 , 79 of 132 participants used applications for at least 4 out of 6 months. However, one participant met only the login day criterion and showed minimal usage across all the modules: weight, nutrition, exercise, and physical activity management. Among the 132 participants, 78 (59.1%) showed high adherence and 54 (40.9%) showed low adherence. To evaluate the impact of adherence on clinical outcomes, baseline characteristics were compared between the groups. A significant difference in age was observed, with the low adherence group having a mean age of 55.89 ± 9.06 years and the high adherence group 52.63 ± 8.79 years. No other significant differences were observed between groups. Therefore, age was included as a covariate in the LMM analysis. Among the outcomes assessed, a significant group × time interaction was identified only for the aSMI (F = 3.377, p = 0.022). As shown in Fig. 7, the aSMI declined over 6 months in the low-adherence group, whereas it remained stable or slightly increased in the high-adherence group (time effect, F = 6.891, p < 0.001). Post hoc analysis revealed that the intervention group showed a significantly greater increase in aSMI from baseline to 1 month than the control group (p = 0.016), but not at 3 months (p = 0.024) or 6 months (p = 0.033). Satisfaction survey A satisfaction survey was administered exclusively to participants in the intervention group after completion of the 6-month program (mean (SD), n = 142). Overall, the participants reported high satisfaction with digital healthcare services (Table 8). All survey items related to the effectiveness of the healthcare services used in this study received high scores, ranging from 3.9 4.0. The usability domain also scored favorably, with mean scores between 3.7 and 3.8. Participants who expressed dissatisfaction cited difficulties in connecting to smart bands and changing settings as the main reasons. Overall satisfaction was also relatively high, with scores ranging from 3.6 to 3.7, although two to three participants reported dissatisfaction because of the inconvenience in usage and malfunctioning of the device or application system. Many participants responded that the service was helpful for overall health management and indicated their intention to continue using it in the future as well as their willingness to recommend it to others. In the content adequacy domain, the item “inclusion of necessary functions for health management” received a relatively lower score of 3.5. The most helpful features were exercise and dietary management. Among the functions that required improvement, dietary management was the most frequently mentioned. Discussion This randomized controlled trial demonstrated that a 6-month multimodal digital health intervention for CRC survivors in the acute postoperative phase did not significantly preserve the primary outcome of total-body SMM. This finding, while not supporting our primary hypothesis, aligns with an emerging pattern of mixed results in the digital health literature for postoperative cancer survivors. For instance, a recent RCT by Kim et al. published in npj Digital Medicine similarly failed to meet its primary endpoint of QoL, yet observed secondary benefits in skeletal muscle area 18 . Our trial complements this finding by showing the inverse: while the primary muscle endpoint was not met, our intervention led to significant improvements in key secondary outcomes, including overall QoL (global health status) and nutritional status (MNA scores), when compared to the control group. Perhaps the most critical finding of this study is the profound impact of patient adherence on clinical outcomes. While the intention-to-treat analysis for muscle mass was negative, a subgroup analysis revealed that participants with high adherence to the program exhibited a significant increase in aSMI. This suggests a clear dose-response relationship, where the benefits of the digital intervention on muscle health are contingent on active and sustained patient engagement. This finding directly addresses a central challenge in digital therapeutics and highlights that intervention efficacy cannot be separated from user adherence. The lack of significant change in the primary SMM outcome can be attributed to several factors. First, as a measurement tool, BIA is less precise than imaging-based methods and may underestimate changes in appendicular muscle, which is more responsive to exercise 31,32 . Our exploratory aSMI analysis supports this, as the positive adherence-related effects were seen in limb muscle mass specifically. Second, the digital intervention was intentionally designed with conservative exercise prescriptions to ensure safety during the vulnerable early postoperative period. Most existing research has focused on exercise programs-initiated weeks or months after surgery, typically during or after adjuvant therapy 33-35 . Consequently, evidence regarding the role of rehabilitation in the immediate postoperative recovery phase remains limited. Although early postoperative mobilization is strongly recommended by the Enhanced Recovery After Surgery guidelines, structured rehabilitation programs have not yet been incorporated into the standard postoperative care for patients receiving CRC surgery. In the present study, patients in the acute survivorship phase were provided stepwise, individualized exercise guidelines tailored to their treatment context, including chemotherapy or radiotherapy, presence of a stoma, and underlying diseases. However, as the intervention was delivered through a digital health platform rather than under direct supervision, exercise intensity and duration were conservatively prescribed to ensure safety during the early postoperative period. This unsupervised, safety-first approach, while scalable, likely delivered a lower-intensity stimulus than structured, supervised rehabilitation programs, which have shown more robust effects on muscle mass The intervention group demonstrated a significantly greater recovery of BMI and a significant improvement in MNA scores. This indicates a key benefit of the program in mitigating postoperative weight loss and preventing nutritional decline. While a high BMI is a long-term risk factor, preventing excessive weight loss and sarcopenia during the acute recovery phase is a clinical priority 36 . Our program successfully addressed this, distinguishing itself from interventions that focus solely on exercise. Unlike many studies that target only malnourished patients, our trial included a broad postoperative population, providing important evidence that such interventions can confer nutritional benefits to a wider group of CRC 37-39 . While no between-group differences were seen in physical performance tests like the 30CST and 2MWT, likely reflecting a natural recovery trajectory supported by standard care, the intervention did show a potential early benefit. At the 1-month assessment, physical activity levels in the intervention group were significantly higher than in the control group. This suggests the digital program may play a crucial role in preventing the sharp decline in physical activity often observed in the immediate postoperative period, serving as a bridge to sustained activity in later recovery 40 , 41 . A major strength of our trial is the demonstration that sustained adherence is achievable in this population. Our high adherence rate of 59.1% —participants who used the program on more than 120 of 180 days (6 months)— is notably higher than the average of 41.0 usage days over a 6-month (180-day) period reported by Kim et al. in a similar setting without provider feedback 18 and surpasses the ~56% average seen across many mHealth interventions 42 . We attribute this success to the biweekly monitoring and feedback from healthcare providers integrated into our protocol. This underscores a critical implementation insight: for digital health interventions to be effective, a "human-in-the-loop" approach that fosters accountability and support may be essential. The positive aSMI outcome in the high-adherence group solidifies this conclusion, providing strong evidence that when digital tools are used consistently, they can produce tangible physiological benefits. Taken together, our findings contribute a crucial piece to the digital survivorship puzzle. We demonstrate that while a single primary endpoint like total SMM may not be achieved, a multimodal digital intervention provides significant and clinically meaningful benefits in improving nutritional status and QoL for postoperative CRC patients. Critically, our work highlights that adherence is the key mediator of physiological success, particularly for muscle health. Future research should therefore focus not just on if digital tools work, but on how to optimize engagement through strategies like personalized feedback and provider oversight. Evaluating long-term effects on recurrence and survival remains a vital next step. Limitations This study had some limitations. First, the primary outcome, SMM, was assessed using BIA, which may be less sensitive than imaging-based methods. Recognizing this, we attempted to mitigate this limitation by conducting an exploratory analysis using CT-based measurements and aSMI in a large subgroup, which ultimately revealed the adherence-dependent effects on limb muscle. However, these more precise assessments were limited to a single center. Second, owing to the open-label design, both participants and outcome assessors were aware of group assignments, which may have introduced performance and reporting bias, particularly in subjective measures such as physical activity and quality of life. Third, owing to delays caused by the COVID-19 pandemic, follow-up assessments could not be completed for some participants, resulting in a smaller sample size than originally intended. Fourth, the sample was limited to Korean patients recruited from tertiary hospitals, which may reduce the external validity of the findings across different ethnic, cultural, and healthcare settings. Fifth, although the participants were randomized, age significantly differed between the groups, which is a critical demographic factor that may have influenced the study outcomes. Although age was included as a covariate in the LMM analysis, this imbalance remained a fundamental limitation that could have affected the internal validity of the results. Lastly, long-term outcomes beyond the 6-month intervention period were not assessed. Future studies with extended follow-up periods are warranted to determine the sustained impact of digital health interventions on the survival outcomes of patients with CRC. Conclusion In patients with CRC during acute survivorship following surgery, multimodal digital health rehabilitation, including exercise, dietary management, and weight management, proved to be both feasible and well accepted. Compared with standard care, this intervention led to faster recovery of postoperative weight and nutritional status, as well as greater improvements in quality of life. Participants with high adherence to the intervention demonstrated a significant increase in limb muscle mass during cancer treatment. These findings provide further evidence supporting the role of multimodal digital health interventions in promoting functional recovery and enhancing postoperative outcomes in patients with CRC. Declarations Ethics Approval declaration and clinical trial registration All the study procedures were approved by the institutional review boards of the three hospitals (SMC-2021-01-090 from Samsung Medical Center, 2021AN0104 from Korea University Anam Hospital, and KC21FNSI0177 from Seoul St. Mary’s Hospital). This clinical trial was registered at ClinicalTrials.gov (identifier: NCT05046756) on May 11, 2021. All the participants provided written informed consent prior to study enrollment. Acknowledgement Available from corresponding author upon reasonable request. Funding This research, which was reviewed by external peers during the funding process, was financially supported by the National IT Industry Promotion Agency, funded by the Ministry of Science and ICT of Korea (project numbers S2001-20-1006 and S2401-21-1001, Project Healthcare big data showcase utilization service support: Cancer patient treatment and prognosis management service development). Acknowledgement We would like to thank Medi Plus Solution for technical support and all hospital members who devoted their efforts to the study. Author contributions S. M. Y.: Writing— original draft, review & editing, formal analysis, conceptualization. H. C. K, Y. A. P, Y. S. L, J. K, S. H. K and I. K.: Resources, data curation, and methodology. J. Y. L. and S. W. K.: investigation, data curation, resources, and methodology. J. Y. L. and J. H. 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J Med Internet Res 24, e35371 (2022). Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 11 Dec, 2025 Reviews received at journal 11 Dec, 2025 Reviews received at journal 23 Nov, 2025 Reviewers agreed at journal 21 Nov, 2025 Reviewers agreed at journal 14 Nov, 2025 Reviewers invited by journal 29 Oct, 2025 Editor assigned by journal 27 Oct, 2025 Submission checks completed at journal 27 Oct, 2025 First submitted to journal 21 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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19:24:37","extension":"xml","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":201976,"visible":true,"origin":"","legend":"","description":"","filename":"083ce9d9c3b04875a8dc74e9df78ca3c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/5dc1a29b31be1baffe9f1b33.xml"},{"id":96117543,"identity":"64d6672f-81fb-480c-bef3-048bcc49132e","added_by":"auto","created_at":"2025-11-17 19:24:37","extension":"html","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":220253,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/593425fd17c560b53adfbf61.html"},{"id":96247253,"identity":"aa53ded3-1dda-46c5-aa71-7bff87988abe","added_by":"auto","created_at":"2025-11-19 07:27:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":157737,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of the study.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/126dd06576f2aa504ca98f8e.png"},{"id":96117521,"identity":"52ada68d-ab44-43a8-8ad0-eee5b657759e","added_by":"auto","created_at":"2025-11-17 19:24:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":370898,"visible":true,"origin":"","legend":"\u003cp\u003eScreenshots of the application categorized by function: (A) home screen displaying user points, ranking, and to-do list; (B) exercise management; (C) diet management; (D) weight management; (E) exercise video; and (F) appearance of the \u003cem\u003eDoFit\u003c/em\u003e and recorded data.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/ae1292029e3ff50c51bcf9a5.png"},{"id":96249505,"identity":"37ff4042-efbc-4a73-a6e3-345d3eed6bd9","added_by":"auto","created_at":"2025-11-19 07:33:47","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":84160,"visible":true,"origin":"","legend":"\u003cp\u003eChanges of aSMI and CT-derived muscle and fat measurements (SMA, SMI, and VFA); Asterisk indicates the statistically significant changes between intervention and control group. aSMI, appendicular skeletal muscle index; SMA, skeletal muscle area; SMI, skeletal muscle index; VFA, visceral fat area.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/fcee3f7f284d6120a0295255.png"},{"id":96117519,"identity":"a1a7e0c0-1fa0-4575-8645-e6773d204513","added_by":"auto","created_at":"2025-11-17 19:24:37","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":118173,"visible":true,"origin":"","legend":"\u003cp\u003eChanges of SMM, weight, BMI, and physical performance. SMM, skeletal muscle mass; BMI, body mass index; 30CST, 30-second chair stand test; 2MWT, 2-minute walk test.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/f08f83ecbf6c01d5011f0538.png"},{"id":96247371,"identity":"39511f08-5d87-40e5-8633-f2b167419626","added_by":"auto","created_at":"2025-11-19 07:27:25","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":99561,"visible":true,"origin":"","legend":"\u003cp\u003eChanges of physical activity and nutritional status. MNA, Mini Nutritional Assessment\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/132e358b8f64f2587838ace1.png"},{"id":96250621,"identity":"d386231a-d310-4231-b6b9-01e1949d2ee1","added_by":"auto","created_at":"2025-11-19 07:38:48","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":156543,"visible":true,"origin":"","legend":"\u003cp\u003eChanges of pain intensity and QoL. Asterisk indicates the statistically significant changes between intervention and control group after bonferroni correction. GHS/QoL, global health status/quality of life.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/1fefbab8f0409a9b1b33b153.png"},{"id":96117523,"identity":"9975fb12-bbc5-48fd-8977-8238f736c870","added_by":"auto","created_at":"2025-11-17 19:24:37","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":80568,"visible":true,"origin":"","legend":"\u003cp\u003eChanges of aSMI according to adherence. Asterisk indicates the statistically significant changes between intervention and control group after bonferroni correction. aSMI, appendicular skeletal muscle index.\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/f891fbe00cf0cff27e65cf91.png"},{"id":96256954,"identity":"934b033b-a101-40ef-a2cb-80ba1314d53c","added_by":"auto","created_at":"2025-11-19 07:51:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2469278,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/2b5e87fd-559f-4ba7-8457-8146fea7398d.pdf"},{"id":96117515,"identity":"178bd06c-b1fc-4087-bd07-79e9c038fa97","added_by":"auto","created_at":"2025-11-17 19:24:37","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18632,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-7913956/v1/8a0372c024fda5efea6b163a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Multimodal digital health rehabilitation during acute survivorship following colorectal cancer surgery","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eColorectal cancer (CRC) is the third most diagnosed cancer worldwide and the second leading cause of cancer-related deaths \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In South Korea, it represents a significant public health burden as the third most common cancer in both incidence and mortality \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Advances in diagnosis and treatment have led to a growing population of CRC survivors, shifting the clinical focus toward optimizing postoperative recovery and long-term health. However, survivors often face substantial physical and psychological challenges, including fatigue \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e, diminished physical function \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, changes in body weight \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, and deteriorating quality of life (QoL) \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Foundational to survivorship care are lifestyle modifications, such as physical activity and nutritional management, which are crucial for preventing recurrence and improving overall prognosis \u003csup\u003e\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Specifically, maintaining skeletal muscle mass is critical, as postoperative sarcopenia is linked to delayed recovery and increased complications \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDespite the clear benefits, adherence to lifestyle recommendations among CRC survivors remains strikingly low, with one study reporting that only 12% follow guidelines for diet, physical activity, and weight management \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This gap highlights the urgent need for structured, proactive strategies, particularly during the acute survivorship phase immediately following surgery. Digital health technologies, including mobile applications and wearable devices, offer a promising solution by providing scalable, individualized support for self-management, real-time health tracking, and patient-provider communication \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, the evidence for the efficacy of these digital interventions in postoperative CRC survivors remains inconclusive, largely due to a fragmented research landscape. Existing studies have typically focused on two distinct and separate periods: the immediate postoperative phase, often limited to the first few weeks after discharge \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, or the extended survivorship phase, long after active treatment has concluded \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. This has left a significant gap in understanding how to best support patients during the metabolically vulnerable acute survivorship phase, which encompasses the entire recovery trajectory including the postoperative period and adjuvant radiotherapy or chemotherapy. A critical factor confounding outcomes in this field is the persistent challenge of patient adherence. A compelling example is the recent randomized controlled trial by Kim et al. published in npj Digital Medicine. In their study, a digital lifestyle intervention failed to significantly improve the primary outcome of QoL, a result potentially explained by low patient engagement, as the cohort averaged only 41 days of application use over six \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Nevertheless, a secondary analysis revealed potential benefits for skeletal muscle area, suggesting that while digital tools hold potential, their clinical impact is critically contingent on achieving sufficient patient adherence.\u003c/p\u003e\u003cp\u003eTherefore, this study aimed to address these gaps by evaluating a multimodal digital health intervention specifically designed for CRC patients in the acute survivorship phase. We hypothesized that our intervention, which integrates individualized exercise and nutrition guidance along with provider feedback to enhance engagement, would preserve skeletal muscle mass (SMM) as the primary outcome. Furthermore, we sought to investigate the relationship between program adherence and clinical outcomes, building upon the findings of prior work to better understand the determinants of efficacy for digital health interventions in this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003e This study was a prospective, multicenter, 2:1 randomized controlled trial conducted in accordance with the SPIRIT guidelines. Participants were recruited from three tertiary university hospitals in South Korea and randomly assigned to either a digital health intervention group or a control group that received usual care. All the study procedures were approved by the institutional review boards of the three hospitals (approval numbers: SMC-2021-01-090, 2021AN0104, and KC21FNSI0177). This clinical trial was registered at ClinicalTrials. gov (NCT05046756). The detailed protocol for this study has been published previously \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003ePatients who had received CRC surgery within the previous week were recruited from three hospitals in a competitive manner between May 2021 and June 2022. The inclusion criteria were as follows: age between 19 and 85 years; diagnosis of CRC and CRC surgery within the previous week; use of an android or iOS smartphone; ability to use a mobile application; and willingness to participate in the follow-up assessments. The exclusion criteria were as follows: presence of comorbid conditions that make it impossible to follow exercise and diet recommendations based on the American Cancer Society guidelines; significant neuromusculoskeletal, cognitive, or visual impairments; inability to comprehend or follow the study protocol; and refusal to participate. Written informed consent was obtained from all participants who met the eligibility criteria prior to enrollment. The participants were assigned to either an intervention group that received multimodal digital health rehabilitation or a control group that received usual care (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eRandomization, allocation, and blinding\u003c/h3\u003e\n\u003cp\u003eParticipants were randomly assigned to either the intervention or control group in a 2:1 ratio using block randomization with randomly selected block sizes of three or six to ensure allocation balance. Owing to the nature of the intervention, this was an open-label study; thus, neither the participants nor outcome assessors were blinded to the group allocation. Baseline assessments were performed after randomization.\u003c/p\u003e\n\u003ch3\u003eInterventions\u003c/h3\u003e\n\u003cp\u003eParticipants assigned to the intervention group received individualized healthcare service for 6 months using a health management application called \u003cem\u003eColon Cancer by Second Doctor\u003c/em\u003e (Medi Plus Solution, Seoul, South Korea) which was developed specifically for patients with CRC, and a wrist-worn activity tracker, \u003cem\u003eDoFit\u003c/em\u003e (model NF-B20, Medi Plus Solution, Seoul, South Korea), which continuously measures step counts and heart rates using a built-in 6-axis accelerometer, gyroscope, and photoplethysmography sensor. The application was developed as an evidence-based tool by an expert team, including application developers, user interface and user experience (UI/UX) designers, service programmers, cancer rehabilitation specialists, and clinical researchers. The core domains of the application include exercise, diet, physical activity, and weight management (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e1) Exercise module\u003c/p\u003e\u003cp\u003eIndividualized aerobic exercise goals were provided in the exercise module, including target heart rate zones and the recommended exercise duration. The target heart rate was calculated by multiplying the patient's maximum heart rate by the target heart rate equation factor (THR EF), which gradually increased over the postoperative weeks. The exercise duration was also progressively extended. At 15 weeks postoperatively, a general exercise management algorithm was applied, in which exercise intensity was adjusted based on the patient's rating of perceived exertion (RPE). During chemotherapy, the THR EF was fixed at 0.60, and the exercise duration was limited to a target of either 15 or 20 min. The detailed THR EFs are presented in \u003cspan refid=\"Sec19\" class=\"InternalRef\"\u003eAppendix\u003c/span\u003e 1. From week 15 onward, after reaching 74% of the target heart rate corresponding to moderate-intensity exercise, exercise intensity was adjusted based on RPE and either increased or decreased, considering both the participant\u0026rsquo;s exercise capacity and safety in cases of low capacity. During the aerobic exercise, real-time activity data collected by a wrist-worn activity tracker were transmitted to the application via Bluetooth, enabling integrated monitoring and feedback.\u003c/p\u003e\u003cp\u003eVideo-guided programs for stretching and resistance exercises were offered according to the weekly phase of the rehabilitation process. In postoperative week 1, level 1 bed exercises were provided; in postoperative week 2, level 2 bed exercises; in postoperative weeks 3\u0026ndash;6, level 1 strength recovery exercises; in postoperative weeks 7\u0026ndash;10, level 2 strength recovery exercises; and in postoperative weeks 11\u0026ndash;14, level 3 strength recovery exercises were provided. Levels 1 and 2 bed exercises differed only in the number of sets. Strength recovery exercises consisted of body weight and resistance band exercises of gradually increasing intensity. General strength training was initiated at week 15. As with aerobic training, if an RPE of 17 or higher was recorded, a downgraded strength exercise video (one level lower) was provided, and if an RPE of 9 or 11 was recorded on two or more occasions, an upgraded strength exercise video (one level higher) was provided. only two levels of low-intensity exercise videos specifically designed for patients undergoing chemotherapy were provided. For patients who underwent stoma reversal surgery, pelvic floor muscle exercises were performed in a stepwise manner according to the postoperative week. The exercise module is structured in a multi-depth format: depth-cancer type, depth-resection site, depth-presence of stoma, depth-recovery stage, and schedule of adjuvant treatment. Based on these classifications, individualized exercise programs were provided according to participants\u0026rsquo; profiles.\u003c/p\u003e\u003cp\u003e2) Diet module\u003c/p\u003e\u003cp\u003eThe diet module allowed users to log their food intake, which was automatically analyzed for macronutrient distribution and calorie intake and provided feedback on whether the intake was excessive, appropriate, or insufficient. The criteria for setting individualized recommended caloric intakes and target nutrient levels included cancer type, body mass index (BMI), sex, age, weeks from the date of surgery, and presence of comorbid chronic diseases. The recommended caloric intake was calculated by multiplying the ideal body weight with the activity factor. Ideal body weight was defined as height(m)\u003csup\u003e2\u003c/sup\u003e \u0026times; 22 for men and height(m)\u003csup\u003e2\u003c/sup\u003e \u0026times; 21 for women. The activity factor was determined based on the BMI-defined obesity status, ranging from 26 to 35 kcal/kg (\u003cspan refid=\"Sec19\" class=\"InternalRef\"\u003eAppendix\u003c/span\u003e 2). In patients with CRC, the algorithm incorporates hydration management and enhanced protein supplementation to support postoperative recovery. From week 13 onward, the recommendation system transitioned to a general dietary plan by applying nutrient management algorithms tailored for comorbid chronic diseases.\u003c/p\u003e\u003cp\u003eUsing a web-based administrative interface, healthcare professionals monitored participants\u0026rsquo; application usage biweekly over a 6-month period and delivered encouraging feedback based on adherence to exercise (\u0026ge;\u0026thinsp;3 times/week) and meal logging (\u0026ge;\u0026thinsp;3 times/week).\u003c/p\u003e\u003cp\u003eThe control group received postoperative care for 6 months. This included a standard brochure provided after surgery, which outlines the general recommendations for exercise. Regardless of group allocation, all participants received nutritional education after surgery. In addition, all participants with colostomies were provided specific education regarding stoma care, and those who underwent low anterior resection received pelvic floor muscle training guidance.\u003c/p\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cp\u003eAfter eligibility screening, informed consent, group allocation, demographic characteristics, and medical data were collected from all the participants. Demographic information including sex, age, height, body weight, BMI, alcohol consumption, smoking history, comorbidities, and dominant hand were collected. Cancer-related data included cancer stage, tumor location, extent of resection, surgical method, administration of adjuvant chemotherapy or radiotherapy, and the presence of a stoma. Outcome measures were evaluated by a clinical research coordinator at baseline and at the 1-, 3-, and 6-month follow-ups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of baseline screening, assessment, and follow-up during study visits\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTIMEPOINT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost op\u003c/p\u003e\u003cp\u003e(\u0026plusmn;\u0026thinsp;1w)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1-month\u003c/p\u003e\u003cp\u003e(\u0026plusmn;\u0026thinsp;2w)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3-month\u003c/p\u003e\u003cp\u003e(\u0026plusmn;\u0026thinsp;1m)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6-month\u003c/p\u003e\u003cp\u003e(\u0026plusmn;\u0026thinsp;2m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eENROLLMENT:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Eligibility screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Informed consent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Allocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Demographic characteristic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Medical history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASSESSMENTS:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Hb and albumin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. CT (visceral fat and muscle mass)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Muscle mass via BIA (SMM and aSMI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Grip strength\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. 30-second chair stands test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. 2-minute walk test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. IPAQ-SF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. Mini Nutritional Assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. Average pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10. Maximal pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11. EORTC-QLQ-C30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12. EORTC-QLQ-CR29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13. Satisfaction questionnaire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eHb, hemoglobin; CT, computed tomography; BIA, bioelectrical impedance analysis; SMM, skeletal muscle mass; aSMI, appendicular skeletal muscle index; IPAQ-SF, International Physical Activity Questionnaire\u0026ndash;Short Form; EORTC-QLQ, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of the two groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaseline demographics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;106)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;215)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.030\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale sex, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (65.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e128 (59.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.336\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor stage, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.484\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (27.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (37.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (30.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (37.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79 (36.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor location, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.997\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight colon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (17.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft colon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (38.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRectum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46(43.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91 (42.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery approach, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.772\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaparoscopic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (68.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e155 (72.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRobotic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (27.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54 (25.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith stoma, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (21.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (18.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.717\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith adjuvant chemotherapy, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57 (53.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98 (45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.167\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith adjuvant radiotherapy, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (6.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.975\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith palliative chemotherapy, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.890\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.141\u0026Dagger;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkeletal muscle mass (kg), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.700\u0026Dagger;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin (g/dL), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.810\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlbumin (g/dL), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u0026Dagger;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMini Nutritional Assessment, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.763\u0026Dagger;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eBMI, body mass index; SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u0026dagger;Analyzed using Fisher\u0026rsquo;s exact test.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u0026Dagger;Analyzed using the Mann\u0026ndash;Whitney U test.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in SMM, anthropometric measures, and physical performance over the study period in both groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eIntervention group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSMM (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e26.63\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e25.63\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;5.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e25.79\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e26.19\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;5.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e26.52\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;6.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e26.98\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;18.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e26.21\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;6.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e26.52\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;5.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.706\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.888\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.718\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e63.06\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e61.54\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e61.96\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e62.58\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e63.78\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;11.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e62.30\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;11.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e63.32\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;12.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e65.37\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;12.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e19.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e39.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.129\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e23.11\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e22.69\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e22.60\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e22.88\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e23.38\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e22.81\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e23.17\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e23.93\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e8.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e18.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGrip\u003c/p\u003e\u003cp\u003eStrength (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e29.22\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e28.33\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;9.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e27.94\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;8.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e28.74\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;9.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e28.90\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e28.42\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e28.41\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e29.78\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;9.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.223\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.788\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e30CST\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e15.33\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;5.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e16.92\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;6.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e19.74\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;6.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e16.41\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;6.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e18.44\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;6.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e20.54\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;6.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.434\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e117.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.332\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2MWT (m)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e162.23\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;32.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e173.54\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;36.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e191.16\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;30.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e169.90\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;39.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e183.23\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;36.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e194.17\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;38.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.219\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e70.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"12\"\u003eSMM, skeletal muscle mass; BMI, body mass index; 30CST, 30-second chair stand test; 2MWT, 2-minute walk test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in aSMI and computed tomography-derived muscle and fat measurements over the study period in both groups (n\u0026thinsp;=\u0026thinsp;128)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eIntervention group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eaSMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e7.20\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e7.08\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e7.12\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e7.20\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e7.37\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e7.21\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e7.19\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e7.23\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e8.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e7.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.476\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSMA (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e127.39\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;33.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e124.11\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;29.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e131.52\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;46.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e127.82\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;30.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.272\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.423\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSMI (cm\u003csup\u003e2\u003c/sup\u003e/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e46.59\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e44.99\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;7.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e47.60\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;14.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e46.29\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;8.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.112\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.300\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.369\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVFA (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e97.75\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;72.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e59.70\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;44.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e98.29\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;59.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e82.44\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;54.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.318\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e49.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"12\"\u003eaSMI, appendicular skeletal muscle index; SMA, skeletal muscle area; SMI, skeletal muscle index; VFA, visceral fat area.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in physical activity, blood-based nutritional markers, and MNA scores over the study period in both groups PA, physical activity; MNA, Mini Nutritional Assessment\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eIntervention group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTotal PA (MET\u0026middot;min/week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2058.66\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;2273.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1707.11\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1274.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2487.23\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;2346.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2748.30\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;2340.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2290.58\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;2309.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2110.81\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1534.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2544.81\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;2054.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2856.73\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1976.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.397\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e10.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.605\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e12.49\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e12.82\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e12.54\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e13.07\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.703\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e7.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.423\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAlbumin (g/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4.20\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4.30\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4.29\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4.32\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.588\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.104\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.325\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e23.07\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e22.64\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e24.59\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e25.20\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e23.00\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e23.40\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e25.58\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e26.05\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e65.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in quality of life over the study period in both groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eIntervention group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePhysical\u003c/p\u003e\u003cp\u003efunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e79.11\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;20.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e75.86\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;17.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e82.48\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;15.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e85.32\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;15.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e82.82\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;16.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e82.06\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;14.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e88.82\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e90.15\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e11.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e25.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.239\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eRole\u003c/p\u003e\u003cp\u003efunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e79.68\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;26.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e71.05\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;27.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e82.75\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;22.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e83.12\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;22.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e83.41\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;24.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e77.14\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;24.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e86.86\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;17.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e89.03\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;18.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e6.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e15.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.915\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCognitive\u003c/p\u003e\u003cp\u003efunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e87.30\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;14.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e88.42\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;13.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e88.37\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;12.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e88.40\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;12.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e88.65\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;13.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e90.92\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;14.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e91.08\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;12.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e91.51\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;12.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.188\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.806\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eEmotional\u003c/p\u003e\u003cp\u003efunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e80.71\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;18.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e81.49\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;19.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e86.63\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;13.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e85.86\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;15.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e80.59\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;19.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e84.47\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;17.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e87.25\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;15.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e90.27\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;11.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e15.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.422\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSocial\u003c/p\u003e\u003cp\u003efunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e78.25\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;26.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e75.44\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;26.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e84.69\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;19.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e86.08\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;21.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e80.28\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;24.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e82.02\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;21.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e86.47\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;20.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e90.86\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;15.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e4.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.035\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e8.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.321\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGlobal health status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e54.68\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;24.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e53.77\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;23.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e63.66\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;18.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e63.40\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;19.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e54.73\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;24.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e61.47\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;19.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e67.55\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;18.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e71.02\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;16.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e25.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSummary score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e80.59\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;13.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e80.43\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;12.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e84.98\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;10.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e86.74\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;11.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e82.79\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;12.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e83.52\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;11.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e87.15\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;9.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e89.51\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;8.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e6.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e25.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eGroup \u0026times; time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.868\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFunction-specific log days, exercise time, and step count (n\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonth\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExercise log days\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercise time (m)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStep log days\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStep count (steps/d)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eWeight diary days\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMeal diary days\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eApplication log days\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e40.2\u0026thinsp;\u0026plusmn;\u0026thinsp;22.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e22.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e8626.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4102.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e\u003cp\u003e18.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e\u003cp\u003e21.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e41.4\u0026thinsp;\u0026plusmn;\u0026thinsp;19.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e20.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e9018.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4271.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e\u003cp\u003e18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e\u003cp\u003e20.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e50.8\u0026thinsp;\u0026plusmn;\u0026thinsp;37.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e9257.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4117.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e\u003cp\u003e17.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e\u003cp\u003e19.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e11.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e57.5\u0026thinsp;\u0026plusmn;\u0026thinsp;30.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e9176.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4176.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e7.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e\u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e\u003cp\u003e19.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e58.5\u0026thinsp;\u0026plusmn;\u0026thinsp;31.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e17.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e9108.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4219.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e\u003cp\u003e15.4\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e\u003cp\u003e18.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e59.3\u0026thinsp;\u0026plusmn;\u0026thinsp;28.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e9219.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4174.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e\u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e\u003cp\u003e17.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e11.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e49.8\u0026thinsp;\u0026plusmn;\u0026thinsp;26.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e8677.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3549.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e\u003cp\u003e16.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e\u003cp\u003e19.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eSD, standard deviation\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSatisfaction survey administered only to the intervention group after 6-month intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSurvey question\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean (SD) n\u0026thinsp;=\u0026thinsp;142\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eUsability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSufficiency of in-service guidance and instruction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.8 (0.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEase of understanding how to use the service*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.8 (0.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAccessibility of desired functions within the service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.7 (0.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eContent adequacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInclusion of necessary functions for health management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.5 (0.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHelpfulness and adequacy of information provided for managing health*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.7 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eOverall satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall satisfaction with the healthcare service*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.7 (0.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntention to continue using the healthcare service*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.6 (0.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWillingness to recommend the service to others*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.7 (0.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eEffectiveness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncreased regular monitoring of health status due to service participation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.9 (0.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncreased interest in personal health management after using the service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.0 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUsefulness of the healthcare service in managing personal health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.0 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived appropriateness of the service for managing one\u0026rsquo;s condition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.0 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Participants who selected specific Likert-scale scores were instructed to provide further reasons.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSkeletal muscle mass\u003c/h2\u003e\u003cp\u003eThe primary outcome of this study was the change in skeletal muscle mass (SMM, kg) measured using bioelectrical impedance analysis (BIA, Inbody 770, Seoul, South Korea) from baseline to the 6-month assessment.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAppendicular skeletal muscle index (aSMI) and computed tomography (CT)-derived muscle and fat measurements\u003c/h3\u003e\n\u003cp\u003eAfter the main study, exploratory outcomes were evaluated based on the investigators' judgment that more precise muscle mass measurements were warranted. Accordingly, a subgroup of patients (n\u0026thinsp;=\u0026thinsp;128) from one participating center underwent additional assessments, including aSMI and CT-derived analyses of muscle and fat. These assessments were conducted at this site owing to the availability of appropriate imaging data.\u003c/p\u003e\u003cp\u003eThe aSMI was retrospectively calculated using data from BIA, whereas CT-derived measurements were obtained from abdominal and pelvic CT scans. aSMI was determined by summing the muscle mass of both the upper and lower limbs and dividing the total by the square of the participant\u0026rsquo;s height (m\u003csup\u003e2\u003c/sup\u003e). CT-based assessments were conducted using a single-slice image at the mid-L3 vertebral level, which was analyzed using dedicated software developed by the Department of Radiology at Samsung Medical Center. Cross-sectional skeletal muscle area (SMA) and visceral fat area (VFA) were measured, and the skeletal muscle index (SMI) was calculated by dividing SMA by height squared (m\u003csup\u003e2\u003c/sup\u003e)\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. CT scans performed within 6 months prior to the baseline assessment were used as baseline data. Follow-up CT measurements were conducted only at 6 months, and no assessments were performed at 1 or 3 months.\u003c/p\u003e\n\u003ch3\u003ePhysical performance\u003c/h3\u003e\n\u003cp\u003eSecondary outcomes included physical performance, physical activity level, nutritional status, pain, and quality of life. Physical performance was evaluated using the grip strength test, 30-second chair stand test (30CST), and 2-minute walk test (2MWT). Grip strength was assessed at all four time points. However, the 30CST and 2MWT were not conducted at baseline because the assessment was performed within 1 week postoperatively, and these tests were administered only at 1, 3, and 6 months postoperatively. Grip strength was measured using a handheld dynamometer (MicroFET Digital HandGRIP Dynamometer; Hoggan Scientific, LLC, USA). Participants completed three maximal grip strength trials using their dominant hand, and the mean value (kg) was used for the analysis \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. The 30CST was used to assess lower extremity strength and muscular endurance. The participants were instructed to sit on a standard-height chair with a backrest without leaning against it, cross their arms over their chest, stand up, and sit down as many times as possible within 30 s. Only the fully completed repetitions were counted \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. The 2MWT was used to assess cardiorespiratory endurance and ambulatory function. This is a validated and reliable measure, particularly for older adults and patients with cancer \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Participants were instructed to walk as far as possible for 2 min along a 15.2-m hallway, and the total distance covered was recorded \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePhysical activity level\u003c/h2\u003e\u003cp\u003ePhysical activity levels were evaluated using the International Physical Activity Questionnaire\u0026ndash;Short Form (IPAQ-SF). In the IPAQ-SF, participants are made to recall their physical activity during the past 7 days, including walking, moderate-intensity activity, vigorous-intensity activity, and time spent sitting, to estimate total physical activity. The Korean version of the questionnaire demonstrated good reliability and validity across various populations \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Total physical activity was calculated by summing the MET minutes per week for each type of activity (walking: 3.3 METs, moderate-intensity activity: 4.0 METs, vigorous-intensity activity: 8.0 METs).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eNutritional status\u003c/h2\u003e\u003cp\u003eNutritional status was evaluated using blood-based nutritional markers and the Mini Nutritional Assessment (MNA). Blood samples were obtained preoperatively and at 6 months postoperatively. Among these markers, hemoglobin and albumin levels were used as indicators of nutritional status. The MNA consists of 18 items covering four domains: dietary intake, weight loss, anthropometric measurements, functional and psychological status, and overall health status \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Its reliability and validity have been demonstrated in several studies. Scores range from 0 to 30: \u0026lt;17 indicates malnutrition, 17\u0026ndash;23.5 indicates risk of malnutrition, and 24\u0026ndash;30 reflects normal nutritional status.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePain intensity\u003c/h2\u003e\u003cp\u003ePain intensity over the past week was evaluated using a Numeric Rating Scale ranging from 0 (\"no pain\") to 10 (\"worst possible pain\"). The participants reported both their average and worst pain levels experienced during that period.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eQuality of life\u003c/h2\u003e\u003cp\u003eQuality of life was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ), which includes QLQ-C30 and QLQ-CR29. The of European Organization for Research and Treatment Cancer QLQ-C30 is a 30-item questionnaire comprising functional scales (physical, role, emotional, cognitive, and social), symptom scales, and a global health status scale. The Korean version of the EORTC QLQ-C30 has been translated and culturally adapted for use \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. For the functional scales and global health status, higher scores indicated better functioning, whereas for the symptom scales, higher scores indicated greater symptom severity. The summary score is calculated by combining the functional and symptom scales, with higher scores indicating better health status. Disease-specific QoL was assessed using the EORTC QLQ-CR29, a validated 29-item module developed for patients with CRC \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. It includes multiple symptom and functional scales, some of which are sex-specific. Higher scores indicated better functioning or greater symptom burden, depending on the scale.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eSatisfaction survey\u003c/h2\u003e\u003cp\u003eA self-developed satisfaction survey on mobile applications and Internet of Things (IoT) devices, developed through consensus among investigators from the three participating institutions, was administered only to the intervention group at the 6-month assessment point. The survey used a 5-point Likert scale, with higher scores indicating greater satisfaction.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eAdherence\u003c/h2\u003e\u003cp\u003e\u0026ldquo;Exercise log days\u0026rdquo; were defined as the number of days within a month during which the user performed any type of exercise for more than 5 min, based solely on exercise records entered into the application. \u0026ldquo;Exercise time\u0026rdquo; was calculated by dividing the total exercise duration by the number of exercise log days. To observe trends in the average exercise duration among users who recorded exercise using the application, values of zero were excluded from the calculation of the mean. \u0026ldquo;Step log days\u0026rdquo; refer to the total number of days on which step counts were recorded. The \u0026ldquo;step count\u0026rdquo; was calculated by dividing the total number of steps over a month by the number of step-log days. To ensure monthly representativeness, the step count was calculated only when step data were available for at least 7 days. For the trend analysis of step counts among users who logged their step data, values of zero were excluded when calculating the mean. \u0026ldquo;Weight diary days\u0026rdquo; and \u0026ldquo;meal diary days\u0026rdquo; indicate the number of days with at least one entry, and \u0026ldquo;application log days\u0026rdquo; denote the number of days the user accessed the application at least once. The means and standard deviations (SD) for all log-day variables included values of 0 in the calculation.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eSample size calculation\u003c/h2\u003e\u003cp\u003eBased on a previous study \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, the required sample size was calculated using an effect size of 0.35, with 80% power and 5% significance level. A 2:1 allocation ratio was used. The G*Power software (v3.1.9.2) estimated a minimum of 195 participants in the intervention group and 97 in the control group. Considering a 10% dropout rate, the total sample size was set at 324 (216 interventions and 108 controls). Participants were competitively enrolled across three institutions to achieve the target sample size.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were conducted using the R software (version 4.3.1, R Foundation for Statistical Computing, Vienna, Austria). All the analyses followed the intention-to-treat principle. Descriptive statistics were used to summarize the baseline characteristics. Between-group differences in baseline data were assessed using the independent t-test for continuous variables with a normal distribution and the Mann\u0026ndash;Whitney U test for those without. For categorical variables, the chi-square test or Fisher\u0026rsquo;s exact test was used, as appropriate. All the outcomes were evaluated using linear mixed-effects models (LMM). Variables that showed significant between-group differences at baseline and were considered potential confounders were included as covariates in the model (e.g., age). In cases where the group\u0026ndash;time interaction was statistically significant, a post-hoc analysis was conducted with the Bonferroni correction.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 321 patients who underwent CRC surgery between May 2021 and June 2022 were enrolled in this study, which was slightly below the target sample size of 324. The patients were randomly assigned to either the intervention group (n = 215) or the control group (n = 106) in a 2:1 ratio. At the end of the 6-month study period, the retention rate was 74.9% (161/215) in the intervention group and 77.4% (82/106) in the control group (Fig. 1). This study was funded by a national grant within a predefined study period. However, owing to delays in participant enrollment caused by the coronavirus disease 2019 (COVID-19) pandemic, the study was terminated before some participants completed their 6-month follow-up. These participants are marked as “due to study closure” in Fig. 1.\u003c/p\u003e\n\u003cp\u003eThe baseline characteristics of the two groups are presented in Table 2. Except for age and serum albumin levels, no significant differences were observed between the groups. The mean ± SD of age was 58.7 ± 12.0 years in the control group and 55.7 ± 9.8 years in the intervention group. Age was included as a covariate in all LMM analyses except for albumin, for which both baseline albumin level and age were used as covariates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary outcome: Skeletal muscle mass\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe changes in the SMM at baseline and at 1, 3, and 6 months in both groups are presented in Table 3 and Fig. 4. In the LMM analysis of the SMM changes, no significant changes were observed within or between the groups. No significant change in SMM over time and difference in the pattern of SMM change were observed between the intervention and control groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExploratory outcomes: aSMI and CT-derived muscle and fat measurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from 128 patients enrolled at a single hospital were analyzed. The changes in the aSMI and CT-derived muscle and fat measurements are shown in Table 4. For aSMI, significant main effects of time (F = 7.54, p \u0026lt; 0.001), whereas the group × time interaction was not statistically significant. For SMA and SMI, no significant changes were detected within or between the groups. For VFA, significant main effects of both time (F = 49.28, p \u0026lt; 0.001) and group × time interactions (F = 5.63, p = 0.019) were noted. Thus, the VFA changed over time in both groups, and the pattern of VFA change over time differed significantly between the intervention and control groups.\u0026nbsp;Post hoc analysis revealed that the control group showed a significantly greater reduction in VFA from baseline to 6 months than the intervention group (p = 0.031). The graphs (Fig. 3) illustrate the changes in aSMI and CT-derived muscle and fat measurements over time in both groups (means ± SD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnthropometric measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe changes in anthropometric measures (body weight and BMI) are presented in Table 3. An LMM was used to assess the effects of group, time, and group × time interaction. Regarding body weight, significant effects of time (F = 39.14, p \u0026lt; 0.001) were observed, although the group × time interaction was not significant. For BMI, all three effects were statistically significant: time (F = 18.10, p \u0026lt; 0.001) and the group × time interaction (F = 2.78, p = 0.041). Thus, the BMI changed over time in both groups, and the pattern of BMI change over time differed significantly between the intervention and control groups. In the post hoc analysis using Bonferroni correction, no significant differences in BMI changes between the two groups were observed from baseline to 1 month (p = 0.856), 3 months (p = 0.176), and 6 months (p = 0.053). The graphs (Fig. 4) illustrate the changes in weight and BMI over time in both groups (means ± SD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical performance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChanges in physical performance, as assessed by grip strength (at baseline and at 1, 3, and 6 months), 30CST, and 2 MWT (at 1, 3, and 6 months) in both groups are presented in Table 3. For grip strength, the LMM analysis revealed statistically significant effects of time (F = 3.82, p = 0.010), whereas the group × time interaction was not significant. For the 30CST, LMM analysis revealed statistically significant effects of time (F = 117.36, p \u0026lt; 0.001), whereas the group × time interaction was not significant. For the 2 MWT, the LMM analysis revealed statistically significant effects of time (F = 70.56, p \u0026lt; 0.001), whereas the group × time interaction was not significant. The graphs (Fig. 4) illustrate the changes in physical performance over time in both groups (means ± SD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical activity level\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe changes in physical activity levels at baseline and at 1, 3, and 6 months in both groups are presented in Table 5. For physical activity, the LMM analysis revealed statistically significant effects of time (F = 10.13, p \u0026lt; 0.001), whereas the group × time interaction was not significant. The graphs (Fig. 5) illustrate the changes in physical activity level over time in both groups (means ± SD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNutritional status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChanges in nutritional status, as assessed by blood-based nutritional markers (at baseline and 6 months) and MNA (at baseline and 1, 3, and 6 months) in both groups are presented in Table 6. At baseline, no statistically significant differences in hemoglobin and MNA scores were observed, although a statistically significant difference in albumin levels were noted between the two groups. For hemoglobin, the LMM analysis revealed statistically significant effects of time (F = 7.56, p = 0.006), whereas the group × time interaction was not significant. For albumin, no significant changes were detected within or between the groups. For the MNA, significant main effects of both time (F = 65.71, p \u0026lt; 0.001) and group × time interaction (F = 2.67, p = 0.047) were observed. In the post hoc analysis using Bonferroni correction, no significant differences in MNA changes between the two groups were observed from baseline to 1 month (p = 0.035), 3 months (p = 0.032), and 6 months (p = 0.290). The graphs (Fig. 5) illustrate the changes in MNA scores, hemoglobin and albumin over time in both groups (means ± SD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePain intensity and QoL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor average and maximum pain, the LMM analysis revealed statistically significant effects of time, whereas the group and group × time interactions were not significant. Time effects were statistically significant for physical, role, emotional, and social functioning as well as the summary score. Group effects were significant for physical, role, and social functioning and the summary score. However, the group × time interaction effects were not statistically significant for any of the five functioning scales or summary scores. For global health status (GHS), all three effects were statistically significant: time (F =25.75, p \u0026lt; 0.001) and group × time interactions (F = 3.25, p = 0.021). In the post hoc analysis using Bonferroni correction, significant differences in GHS changes between the two groups were observed from baseline to 1 month (p = 0.013) and 6 months (p = 0.011), but not at 3 months (p = 0.071). Although a table and graph are not presented, no significant group × time interaction was identified for any item in the EORTC QLQ-CR29. The graphs (Fig. 6) illustrate the changes in pain and QoL, as assessed by the EORTC QLQ-C30, over time in both groups (means ± SD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdherence outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApplication usage metrics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 161 participants in the intervention group who completed the 6-month assessment, adherence was analyzed in 132 individuals. Participants who withdrew from the application or did not provide consent for data access at the time of retrieval were excluded from the study. The application usage trends over the 6-month period are presented in Table 7. The number of log days, such as exercise log days, step log days, weight diary days, meal diary days, and application log days gradually declined over time. This suggests a decrease in overall adherence to the mobile app as the intervention period progressed. By contrast, among users who continued to log data, both the average exercise time per exercise day and step count per day tended to increase over time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical outcomes according to adherence level\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the adherence criteria used in previous multicomponent lifestyle intervention application studies \u003csup\u003e30\u003c/sup\u003e, 79 of 132 participants used applications for at least 4 out of 6 months. However, one participant met only the login day criterion and showed minimal usage across all the modules: weight, nutrition, exercise, and physical activity management. Among the 132 participants, 78 (59.1%) showed high adherence and 54 (40.9%) showed low adherence. To evaluate the impact of adherence on clinical outcomes, baseline characteristics were compared between the groups. A significant difference in age was observed, with the low adherence group having a mean age of 55.89 ± 9.06 years and the high adherence group 52.63 ± 8.79 years. No other significant differences were observed between groups. Therefore, age was included as a covariate in the LMM analysis. Among the outcomes assessed, a significant group × time interaction was identified only for the aSMI (F = 3.377, p = 0.022). As shown in Fig. 7, the aSMI declined over 6 months in the low-adherence group, whereas it remained stable or slightly increased in the high-adherence group (time effect, F = 6.891, p \u0026lt; 0.001). Post hoc analysis revealed that the intervention group showed a significantly greater increase in aSMI from baseline to 1 month than the control group (p = 0.016), but not at 3 months (p = 0.024) or 6 months (p = 0.033).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSatisfaction survey\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA satisfaction survey was administered exclusively to participants in the intervention group after completion of the 6-month program (mean (SD), n = 142). Overall, the participants reported high satisfaction with digital healthcare services (Table 8).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll survey items related to the effectiveness of the healthcare services used in this study received high scores, ranging from 3.9 4.0. The usability domain also scored favorably, with mean scores between 3.7 and 3.8. Participants who expressed dissatisfaction cited difficulties in connecting to smart bands and changing settings as the main reasons. Overall satisfaction was also relatively high, with scores ranging from 3.6 to 3.7, although two to three participants reported dissatisfaction because of the inconvenience in usage and malfunctioning of the device or application system. Many participants responded that the service was helpful for overall health management and indicated their intention to continue using it in the future as well as their willingness to recommend it to others. In the content adequacy domain, the item “inclusion of necessary functions for health management” received a relatively lower score of 3.5. The most helpful features were exercise and dietary management. Among the functions that required improvement, dietary management was the most frequently mentioned.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis randomized controlled trial demonstrated that a 6-month multimodal digital health intervention for CRC survivors in the acute postoperative phase did not significantly preserve the primary outcome of total-body SMM. This finding, while not supporting our primary hypothesis, aligns with an emerging pattern of mixed results in the digital health literature for postoperative cancer survivors. For instance, a recent RCT by Kim et al. published in npj Digital Medicine similarly failed to meet its primary endpoint of QoL, yet observed secondary benefits in skeletal muscle area \u003csup\u003e18\u003c/sup\u003e. Our trial complements this finding by showing the inverse: while the primary muscle endpoint was not met, our intervention led to significant improvements in key secondary outcomes, including overall QoL (global health status) and nutritional status (MNA scores), when compared to the control group.\u003c/p\u003e\n\u003cp\u003ePerhaps the most critical finding of this study is the profound impact of patient adherence on clinical outcomes. While the intention-to-treat analysis for muscle mass was negative, a subgroup analysis revealed that participants with high adherence to the program exhibited a significant increase in aSMI. This suggests a clear dose-response relationship, where the benefits of the digital intervention on muscle health are contingent on active and sustained patient engagement. This finding directly addresses a central challenge in digital therapeutics and highlights that intervention efficacy cannot be separated from user adherence.\u003c/p\u003e\n\u003cp\u003eThe lack of significant change in the primary SMM outcome can be attributed to several factors. First, as a measurement tool, BIA is less precise than imaging-based methods and may underestimate changes in appendicular muscle, which is more responsive to exercise \u003csup\u003e31,32\u003c/sup\u003e. Our exploratory aSMI analysis supports this, as the positive adherence-related effects were seen in limb muscle mass specifically. Second, the digital intervention was intentionally designed with conservative exercise prescriptions to ensure safety during the vulnerable early postoperative period. Most existing research has focused on exercise programs-initiated weeks or months after surgery, typically during or after adjuvant therapy \u003csup\u003e33-35\u003c/sup\u003e. Consequently, evidence regarding the role of rehabilitation in the immediate postoperative recovery phase remains limited. Although early postoperative mobilization is strongly recommended by the Enhanced Recovery After Surgery guidelines, structured rehabilitation programs have not yet been incorporated into the standard postoperative care for patients receiving CRC surgery. In the present study, patients in the acute survivorship phase were provided stepwise, individualized exercise guidelines tailored to their treatment context, including chemotherapy or radiotherapy, presence of a stoma, and underlying diseases. However, as the intervention was delivered through a digital health platform rather than under direct supervision, exercise intensity and duration were conservatively prescribed to ensure safety during the early postoperative period. This unsupervised, safety-first approach, while scalable, likely delivered a lower-intensity stimulus than structured, supervised rehabilitation programs, which have shown more robust effects on muscle mass\u003c/p\u003e\n\u003cp\u003eThe intervention group demonstrated a significantly greater recovery of BMI and a significant improvement in MNA scores. This indicates a key benefit of the program in mitigating postoperative weight loss and preventing nutritional decline. While a high BMI is a long-term risk factor, preventing excessive weight loss and sarcopenia during the acute recovery phase is a clinical priority\u0026nbsp;\u003csup\u003e36\u003c/sup\u003e. Our program successfully addressed this, distinguishing itself from interventions that focus solely on exercise. Unlike many studies that target only malnourished patients, our trial included a broad postoperative population, providing important evidence that such interventions can confer nutritional benefits to a wider group of CRC \u003csup\u003e37-39\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile no between-group differences were seen in physical performance tests like the 30CST and 2MWT, likely reflecting a natural recovery trajectory supported by standard care, the intervention did show a potential early benefit. At the 1-month assessment, physical activity levels in the intervention group were significantly higher than in the control group. This suggests the digital program may play a crucial role in preventing the sharp decline in physical activity often observed in the immediate postoperative period, serving as a bridge to sustained activity in later recovery \u003csup\u003e40\u003c/sup\u003e,\u0026nbsp;\u003csup\u003e41\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA major strength of our trial is the demonstration that sustained adherence is achievable in this population. Our high adherence rate of 59.1% —participants who used the program on more than 120 of 180 days (6 months)— is notably higher than the average of 41.0 usage days over a 6-month (180-day) period reported by Kim et al. in a similar setting without provider feedback \u003csup\u003e18\u003c/sup\u003e and surpasses the ~56% average seen across many mHealth interventions\u0026nbsp;\u003csup\u003e42\u003c/sup\u003e. We attribute this success to the biweekly monitoring and feedback from healthcare providers integrated into our protocol. This underscores a critical implementation insight: for digital health interventions to be effective, a \"human-in-the-loop\" approach that fosters accountability and support may be essential. The positive aSMI outcome in the high-adherence group solidifies this conclusion, providing strong evidence that when digital tools are used consistently, they can produce tangible physiological benefits.\u003c/p\u003e\n\u003cp\u003eTaken together, our findings contribute a crucial piece to the digital survivorship puzzle. We demonstrate that while a single primary endpoint like total SMM may not be achieved, a multimodal digital intervention provides significant and clinically meaningful benefits in improving nutritional status and QoL for postoperative CRC patients. Critically, our work highlights that adherence is the key mediator of physiological success, particularly for muscle health. Future research should therefore focus not just on if digital tools work, but on how to optimize engagement through strategies like personalized feedback and provider oversight. Evaluating long-term effects on recurrence and survival remains a vital next step.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study had some limitations. First, the primary outcome, SMM, was assessed using BIA, which may be less sensitive than imaging-based methods. Recognizing this, we attempted to mitigate this limitation by conducting an exploratory analysis using CT-based measurements and aSMI in a large subgroup, which ultimately revealed the adherence-dependent effects on limb muscle. However, these more precise assessments were limited to a single center.\u003c/p\u003e\n\u003cp\u003eSecond, owing to the open-label design, both participants and outcome assessors were aware of group assignments, which may have introduced performance and reporting bias, particularly in subjective measures such as physical activity and quality of life.\u003c/p\u003e\n\u003cp\u003eThird, owing to delays caused by the COVID-19 pandemic, follow-up assessments could not be completed for some participants, resulting in a smaller sample size than originally intended.\u003c/p\u003e\n\u003cp\u003eFourth, the sample was limited to Korean patients recruited from tertiary hospitals, which may reduce the external validity of the findings across different ethnic, cultural, and healthcare settings.\u003c/p\u003e\n\u003cp\u003eFifth, although the participants were randomized, age significantly differed between the groups, which is a critical demographic factor that may have influenced the study outcomes. Although age was included as a covariate in the LMM analysis, this imbalance remained a fundamental limitation that could have affected the internal validity of the results.\u003c/p\u003e\n\u003cp\u003eLastly, long-term outcomes beyond the 6-month intervention period were not assessed. Future studies with extended follow-up periods are warranted to determine the sustained impact of digital health interventions on the survival outcomes of patients with CRC.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn patients with CRC during acute survivorship following surgery, multimodal digital health rehabilitation, including exercise, dietary management, and weight management, proved to be both feasible and well accepted. Compared with standard care, this intervention led to faster recovery of postoperative weight and nutritional status, as well as greater improvements in quality of life. Participants with high adherence to the intervention demonstrated a significant increase in limb muscle mass during cancer treatment. These findings provide further evidence supporting the role of multimodal digital health interventions in promoting functional recovery and enhancing postoperative outcomes in patients with CRC.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval declaration and clinical trial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the study procedures were approved by the institutional review boards of the three hospitals (SMC-2021-01-090 from Samsung Medical Center, 2021AN0104 from Korea University Anam Hospital, and KC21FNSI0177 from Seoul St. Mary’s Hospital). This clinical trial was registered at ClinicalTrials.gov (identifier: NCT05046756) on May 11, 2021. All the participants provided written informed consent prior to study enrollment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAvailable from corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research, which was reviewed by external peers during the funding process, was financially supported by the National IT Industry Promotion Agency, funded by the Ministry of Science and ICT of Korea (project numbers S2001-20-1006 and S2401-21-1001, Project Healthcare big data showcase utilization service support: Cancer patient treatment and prognosis management service development).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Medi Plus Solution for technical support and all hospital members who devoted their efforts to the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS. M. Y.: Writing— original draft, review \u0026amp; editing, formal analysis, conceptualization. H. C. K, Y. A. P, Y. S. L, J. K, S. H. K and I. K.: Resources, data curation, and methodology. J. Y. L. and S. W. K.: investigation, data curation, resources, and methodology. J. Y. L. and J. H. H.: Conceptualization, methodology, supervision, project administration, review \u0026amp; editing, and funding acquisition\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no financial or non-financial competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray, F. et al. 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Factors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review. \u003cem\u003eJ Med Internet Res\u003c/em\u003e 24, e35371 (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"npj-digital-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"npjdigitalmed","sideBox":"Learn more about [npj Digital Medicine](http://www.nature.com/npjdigitalmed/)","snPcode":"41746","submissionUrl":"https://submission.springernature.com/new-submission/41746/3","title":"npj Digital Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Colorectal cancer, Digital health intervention, Acute survivorship, Skeletal muscle mass","lastPublishedDoi":"10.21203/rs.3.rs-7913956/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7913956/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis multicenter randomized trial evaluated a 6-month digital health rehabilitation program for 321 colorectal cancer (CRC) survivors during the acute survivorship after surgery. The intervention, using a mobile application and activity tracker, provided individualized exercise and nutrition guidance. The primary outcome, skeletal muscle mass (SMM), was not significantly preserved compared to usual care. However, the intervention yielded significant improvements in key secondary outcomes, including nutritional status (Mini Nutritional Assessment) and overall quality of life (global health status), underscoring its broad clinical utility. A critical finding emerged from a subgroup analysis, where participants with high adherence to the program exhibited a significant increase in appendicular skeletal muscle index (aSMI). This highlights that the efficacy of digital interventions is contingent on patient engagement. These findings suggest that while not impacting total SMM, multimodal digital rehabilitation is a valuable tool for enhancing overall recovery, with adherence being a key determinant of its success.\u003c/p\u003e","manuscriptTitle":"Multimodal digital health rehabilitation during acute survivorship following colorectal cancer surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-17 19:24:32","doi":"10.21203/rs.3.rs-7913956/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-11T18:30:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-11T13:02:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-24T02:54:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287892067262365788676597744547108066961","date":"2025-11-21T06:24:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1974188233184206006512613324625301501","date":"2025-11-14T20:07:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-29T08:06:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-27T18:53:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-27T06:07:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"npj Digital Medicine","date":"2025-10-21T11:22:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"npj-digital-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"npjdigitalmed","sideBox":"Learn more about [npj Digital Medicine](http://www.nature.com/npjdigitalmed/)","snPcode":"41746","submissionUrl":"https://submission.springernature.com/new-submission/41746/3","title":"npj Digital Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ee7c5522-4297-4aec-a5d7-1fce7c43d29e","owner":[],"postedDate":"November 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":57679602,"name":"Biological sciences/Cancer"},{"id":57679603,"name":"Health sciences/Diseases"},{"id":57679604,"name":"Health sciences/Gastroenterology"},{"id":57679605,"name":"Health sciences/Health care"},{"id":57679606,"name":"Health sciences/Medical research"},{"id":57679607,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2026-05-14T20:39:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-17 19:24:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7913956","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7913956","identity":"rs-7913956","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}