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Original Investigation
June 18, 2020

Association of Sedentary Behavior With Cancer Mortality in Middle-aged and Older US Adults

Author Affiliations
  • 1Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston
  • 2Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston
  • 3Department of Epidemiology, University of Alabama School of Public Health, Birmingham
  • 4Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
  • 5Department of Biostatistics, University of Alabama School of Public Health, Birmingham
  • 6Vermont Cancer Center, Department of Medicine, Larner College of Medicine, University of Vermont, Burlington
  • 7College of Health and Human Services, San Diego State University, San Diego, California
  • 8Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York
JAMA Oncol. 2020;6(8):1210-1217. doi:10.1001/jamaoncol.2020.2045
Key Points

Question  Is sedentary behavior as determined by accelerometry associated with future risk of cancer mortality in middle-aged and older US adults?

Findings  In this cohort study of 8002 adults, a greater amount of sedentary time was associated with a higher risk of cancer mortality. Replacing sedentary time with light- or moderate- to vigorous-intensity physical activity was associated with reduced cancer mortality risk.

Meaning  The findings of this cohort study suggest that less time in sedentary behavior and more time in physical activity may help to reduce the risk of cancer death.

Abstract

Importance  Sedentary behavior is associated with several health outcomes, including diabetes, cardiovascular disease, and all-cause mortality. Less is known about the association between objectively measured sedentary behavior and cancer mortality, as well as the association with physical activity.

Objective  To examine the association between accelerometer-measured sedentary behavior (total volume and accrual in prolonged, uninterrupted bouts) and cancer mortality.

Design, Setting, and Participants  A prospective cohort study conducted in the contiguous US included 8002 black and white adults aged 45 years or older enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The present analysis was performed from April 18, 2019, to April 21, 2020.

Exposures  Sedentary time, light-intensity physical activity (LIPA), and moderate- to vigorous-intensity physical activity (MVPA) were measured using a hip-mounted accelerometer worn for 7 consecutive days.

Main Outcomes and Measures  Cancer mortality.

Results  Of the 8002 study participants, 3668 were men (45.8%); mean (SD) age was 69.8 (8.5) years. Over a mean (SD) follow-up of 5.3 (1.5) years, 268 participants (3.3%) died of cancer. In multivariable-adjusted models, including MVPA, greater total sedentary time was associated with a greater risk of cancer mortality (tertile 2 vs tertile 1: hazard ratio [HR], 1.45; 95% CI, 1.00-2.11; tertile 3 vs tertile 1: HR, 1.52; 95% CI, 1.01-2.27). Longer sedentary bout duration was not significantly associated with greater cancer mortality risk: after adjustment for MVPA (tertile 2 vs tertile 1: HR, 1.26; 95% CI, 0.90-1.78; tertile 3 vs tertile 1: HR, 1.36; 95% CI, 0.96-1.93). Replacing 30 minutes of sedentary time with LIPA was significantly associated with an 8% (per 30 minutes: HR, 0.92; 95% CI, 0.86-0.97) lower risk of cancer mortality; MVPA was significantly associated with a 31% (per 30 minutes: HR, 0.69; 95% CI, 0.48-0.97) lower risk of cancer mortality.

Conclusions and Relevance  In this cohort study, greater sedentary time, as measured with accelerometry, appeared to be independently associated with cancer mortality risk. Replacing sedentary time with either LIPA or MVPA may be associated with a lower risk of cancer mortality. These findings suggest that the total volume of sedentary behavior is a potential cancer mortality risk factor and support the public health message that adults should sit less and move more to promote longevity.

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    2 Comments for this article
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    Sedentary Behaviour and Cancer Mortality of Aged Males
    Michael McAleer, PhD(Econometrics),Queen's | Asia University, Taiwan
    In an invaluable original investigation of sedentary behaviour and future risk of cancer mortality of aged males, several experts have used accelerometers to determine movement patterns in a cohort of 8002 middle-aged and older US adults, of which 3668 were males with a mean age of 69.8 years.

    The key finding for public health is that decreasing sedentary behaviour and increasing physical activity is associated with reducing the risk of cancer death in a cohort of adults aged 45+ years, in a study for a one-year period from 18 April 2019 to 21 April 2020.

    It would be
    invaluable to cancer patients, oncologists, and health care providers to extend the analysis to examine the effects of accelerometry on:

    (1) sedentary females;

    (2) younger cohorts of males and females;

    (3) different health categories of males and females;

    (4) extending the accelerometry period beyond 7 days;

    (5) varying intensity levels of accelerometry;

    (6) an alternative set of healthy lifestyle choices;

    (7) different types of cancer;

    (8) duration of diagnosed cancer;

    (9) different comorbidities;

    (10) different treatments for cancer, including radio and chemo therapies;

    (11) examining genetic associations;

    (12) analysing the effects of stress induced by COVID-19.

    Certain types of cancer are seen as immutable, but it is striking that the quality of life of cancer patients can be enhanced through even mild forms of exercise.
    CONFLICT OF INTEREST: None Reported
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    RE: Association of sedentary behavior with cancer mortality in middle-aged and older US adults
    Tomoyuki Kawada, MD | Nippon Medical School
    Gilchrist et al. conducted a prospective study to examine the association between accelerometer-measured sedentary behavior and cancer mortality (1). Sedentary time, light-intensity physical activity (LIPA), and moderate- to vigorous-intensity physical activity (MVPA) were measured using a hip-mounted accelerometer worn for 7 consecutive days. Adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) of the second and the third tertile against the first tertile of total sedentary time for cancer mortality were 1.45 (1.00-2.11) and 1.52 (1.01-2.27), respectively. In addition, adjusted HRs (95% CIs) of replacing 30 minutes of sedentary time with LIPA or MVPA for cancer mortality were 0.92 (0.86-0.97) and 0.69 (0.48-0.97), respectively. The authors concluded that adults should sit less and move more for lowering cancer mortality. I have a query about their study.

    Recent meta-analysis presented the risk of sedentary behavior and lack of physical activity for all-cause and cardiovascular mortalities (2), but increased risk of cancer mortality was not observed (3). In contrast, there was a significant risk of prolonged sedentary time for cancer mortality by adjusting physical activity (4). By compiling more prospective data, risk assessment of sedentary behavior for cancer mortality should be conducted. In addition, risk of major types of cancer should also be specified, although the mechanism of the association would be complexed.


    References
    1. Gilchrist SC, Howard VJ, Akinyemiju T, et al. Association of sedentary behavior with cancer mortality in middle-aged and older US adults. JAMA Oncol 2020 doi:10.1001/jamaoncol.2020.2045
    2. Ekelund U, Tarp J, Steene-Johannessen J, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ 2019;366:l4570.
    3. Patterson R, McNamara E, Tainio M, et al. Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol 2018;33(9):811-829.
    4. Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med 2015;162(2):123-132.
    CONFLICT OF INTEREST: None Reported
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