Supplementary Material for: Step by Step: A Meta-Analysis and Systematic Review on the Impact of Walking on Colonoscopy Outcomes

Introduction
Colorectal cancer screening relies on effective bowel preparation before a colonoscopy. Walking has emerged as a potential adjunct strategy to achieve bowel cleansing prior to colonoscopy. We investigated the efficacy of walking as a potential adjunct strategy to bowel preparation methods.
Methods
Our search encompassed Embase, Medline, Cochrane, and Scopus databases. Search results underwent screening utilizing Covidence based on predefined criteria. Data extraction performed by independent reviewers involved general characteristics, baseline patient characteristics, and outcome measures. Risk of Bias evaluation employed the RoB 2 tool for RCTs. Statistical analysis utilized RevMan v5.3, employing mean differences and random-effects models. Statistical significance was indicated by p-value < 0.05. Heterogeneity was assessed with I-square tests.
Results
Our meta-analysis included four RCTs with a total of 1218 patients. We found that walking did not yield a significant difference in total BPPS score compared to control groups. Walking led to statistically significant improvements in ascending, transverse, and descending colon BPPS scores. Walking did not significantly affect cecal intubation time or total procedure time. While there was no significant difference in the time to first diarrhea, the total number of diarrheal episodes was significantly impacted.
Conclusion
While walking did not significantly affect total BPPS scores, procedural timelines, or cecal intubation, it demonstrated significant improvements in ascending, transverse, and descending colon BPPS scores and diarrheal instances. These findings suggest that walking may have a beneficial effect on specific aspects of bowel preparation for colonoscopy, highlighting its potential as an adjunctive strategy in enhancing colonoscopy outcomes.