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Original Investigation
June 2016

Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults

Author Affiliations
  • 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
  • 2Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 3Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
  • 4Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Arctic University of Norway, Tromsø, Norway
  • 5Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
  • 6Department of Research, Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
  • 7Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
  • 8now with USAID Bureau for Global Health, Washington, DC
  • 9Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 10Division of Epidemiology, Biostatistics, and Preventive Medicine, University of New Mexico, Albuquerque
  • 11Information Management Services, Inc, Rockville, Maryland
  • 12Centre for Research in Epidemiology and Population Health, Institut Gustave Roussy, Villejuif, France
  • 13Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, England
  • 14now with Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
  • 15Genetic Epidemiology Group, International Agency for Research on Cancer (IARC), Lyon, France
  • 16Department of Biobank Research, Umeå University, Umeå, Sweden
  • 17Cambridge Institute of Public Health, University of Cambridge, Cambridge, England
  • 18Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
  • 19Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri
  • 20Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC
JAMA Intern Med. 2016;176(6):816-825. doi:10.1001/jamainternmed.2016.1548

Importance  Leisure-time physical activity has been associated with lower risk of heart-disease and all-cause mortality, but its association with risk of cancer is not well understood.

Objective  To determine the association of leisure-time physical activity with incidence of common types of cancer and whether associations vary by body size and/or smoking.

Design, Setting, and Participants  We pooled data from 12 prospective US and European cohorts with self-reported physical activity (baseline, 1987-2004). We used multivariable Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals for associations of leisure-time physical activity with incidence of 26 types of cancer. Leisure-time physical activity levels were modeled as cohort-specific percentiles on a continuous basis and cohort-specific results were synthesized by random-effects meta-analysis. Hazard ratios for high vs low levels of activity are based on a comparison of risk at the 90th vs 10th percentiles of activity. The data analysis was performed from January 1, 2014, to June 1, 2015.

Exposures  Leisure-time physical activity of a moderate to vigorous intensity.

Main Outcomes and Measures  Incident cancer during follow-up.

Results  A total of 1.44 million participants (median [range] age, 59 [19-98] years; 57% female) and 186 932 cancers were included. High vs low levels of leisure-time physical activity were associated with lower risks of 13 cancers: esophageal adenocarcinoma (HR, 0.58; 95% CI, 0.37-0.89), liver (HR, 0.73; 95% CI, 0.55-0.98), lung (HR, 0.74; 95% CI, 0.71-0.77), kidney (HR, 0.77; 95% CI, 0.70-0.85), gastric cardia (HR, 0.78; 95% CI, 0.64-0.95), endometrial (HR, 0.79; 95% CI, 0.68-0.92), myeloid leukemia (HR, 0.80; 95% CI, 0.70-0.92), myeloma (HR, 0.83; 95% CI, 0.72-0.95), colon (HR, 0.84; 95% CI, 0.77-0.91), head and neck (HR, 0.85; 95% CI, 0.78-0.93), rectal (HR, 0.87; 95% CI, 0.80-0.95), bladder (HR, 0.87; 95% CI, 0.82-0.92), and breast (HR, 0.90; 95% CI, 0.87-0.93). Body mass index adjustment modestly attenuated associations for several cancers, but 10 of 13 inverse associations remained statistically significant after this adjustment. Leisure-time physical activity was associated with higher risks of malignant melanoma (HR, 1.27; 95% CI, 1.16-1.40) and prostate cancer (HR, 1.05; 95% CI, 1.03-1.08). Associations were generally similar between overweight/obese and normal-weight individuals. Smoking status modified the association for lung cancer but not other smoking-related cancers.

Conclusions and Relevance  Leisure-time physical activity was associated with lower risks of many cancer types. Health care professionals counseling inactive adults should emphasize that most of these associations were evident regardless of body size or smoking history, supporting broad generalizability of findings.