Vigorous Intermittent Lifestyle Physical Activity and Cancer Incidence Among Nonexercising Adults

Key Points Question Does vigorous intermittent lifestyle physical activity (VILPA) in short bouts (≤1 and ≤2 minutes) have a dose-response association with incident cancer among nonexercising adults? Findings In this prospective cohort study of 22 398 self-reported nonexercising adults, a minimum dose of 3.4 to 3.6 minutes of VILPA per day was associated with a 17% to 18% reduction in total incident cancer risk compared with no VILPA. A median daily VILPA of 4.5 minutes was associated with a 31% to 32% reduction in physical activity–related cancer incidence. Meaning The findings of this large cohort study suggest that 3 to 4 minutes of VILPA per day may be associated with decreased cancer incidence risk; thus, VILPA may be a promising intervention for cancer prevention among individuals unable or unmotivated to exercise in leisure time.

Adjusted absolute risk dose-response of VILPA with total incident cancer eFigure 3. Dose-response of up to one-minute VILPA duration with exclusion for poor health, underweight, and cancer events occurring during the first 2 years of follow up eFigure 4. Dose-response of up to one-minute VILPA duration with further adjustment for body mass index eFigure 5. Dose-response of up to one-minute VILPA duration with adjustment for VILPA energy expenditure (KJ/kg per day) eFigure 6. Sequential dose-response of up to 1-minute VILPA duration eFigure 7. Categorical analysis of VILPA with total cancer and PA-related cancer eFigure 8. Dose-response association of Vigorous Intermittent Lifestyle Physical Activity (VILPA) daily duration from bouts lasting up to one and two minutes with total cancer incidence; adjustment for smoking pack-years (n=19,103; events=1,962).For direct comparisons with the main analyses we also present results in the same sample of the analyses adjusted for the existing smoking status variable eFigure 9. Dose-response association of Vigorous Intermittent Lifestyle Physical Activity (VILPA) daily duration from bouts lasting up to one and two minutes with PA-related cancer incidence; adjustment for smoking pack-years (n=19,103; events=913).For a direct comparisons with the main analyses we also present results of the analyses adjusted for the existing smoking status variable in the same sample eFigure 10.Dose-response association of Vigorous Intermittent Lifestyle Physical Activity (VILPA) daily duration from bouts lasting up to one and two minutes with total cancer incidence; adjustment for units per day of alcohol (See eTable 4) eFigure 11.Dose-response association of Vigorous Intermittent Lifestyle Physical Activity (VILPA) daily duration from bouts lasting up to one and two minutes with PA-related incidence; adjustment for units per day of alcohol eFigure 12. Dose-response association of Vigorous Intermittent Lifestyle Physical Activity (VILPA) daily duration from bouts lasting up to one and two minutes with total cancer incidence; with adjustment for prevalent diabetes eFigure 13.Dose-response association of Vigorous Intermittent Lifestyle Physical Activity (VILPA) daily duration from bouts lasting up to one and two minutes with PA-related incidence; adjustment for prevalent diabetes eFigure 14.Dose-response association of Vigorous Intermittent Lifestyle Physical Activity (VILPA) daily duration from bouts lasting up to one and two minutes with total cancer incidence; stratified by sex (women n=12,276 ; men n= 10,122 ) eAppendix.Follow up ascertainment descriptives, unabridged sampling, design, and physical activity-related methods This supplemental material has been provided by the authors to give readers additional information about their work.Values represent: point estimate (and lower limit of the confidence interval in brackets) that an unmeasured confounder would need to have with both the exposure and outcome, conditional on the measured covariates to explain away the exposure-outcome association  Wearable device-based physical activity classification eMethods 1 Display Item B below summarises how activity intensity was classified using a previously validated Random Forest (RF) activity classifier 4 .RF is an ensemble of multiple decision trees.Each tree is learned on a bootstrap sample of training data and each node in the tree is split using the best among a randomly selected set of acceleration features.The decisions from each tree are aggregated and a final model prediction is based on majority vote.The RF model requires very little pre-processing of the data, as the features do not need to be normalized.Additionally, the model is resistant to over fitting the training data because each tree within the forest is independently grown to maximum depth using a randomly selected subset of features.
Display Item B: Physical activity type and intensity diagram This 2-stage classifier which first categorized physical activity in 10 second windows into one of ,four activity classes: sedentary, standing utilitarian movements (e.g., ironing a shirt, washing dishes), walking activities (e.g.gardening, active commuting, mopping floors), running/high energetic activities (e.g.active playing with children).These activity classes were then assigned to one of four activity intensities: sedentary, light, moderate, and vigorous.Walking activities were classified as light (an acceleration value of <100mg), moderate (≥=100mg) and vigorous (≥=400mg) intensity 5 .For example, a VILPA bout lasting up to 2 minutes, 12 consecutive 10-second windows needed to be classified as vigorous.When there were more than 12 vigorous consecutive activity windows these bouts counted as long vigorous physical activity sessions in the corresponding analyses (2.3% of all vigorous physical activity bouts).Differentiation between sleep 6 and nonwear 7 was identified using the change in tilt angle and acceleration standard deviation.Monitors were calibrated 8 and corrected for orientation 9 using previously published methods, although residual signal and alignment uncertainties may persist.https://ora.ox.ac.uk/objects/uuid:99d7c092-d865-4a19-b096-cc16440cd001).Participants in this dataset wore body cameras that provided pictures every 20 seconds to annotate ground-truth free-living activity labels.The picture-based activity coding scheme has been previously described 9 .A total of 172,360 activity samples (28,727 minutes) were provided by participants.
Display Item E: Participant-level specific recall and precision of activity classification in 151 UK adults

eTable 1 . 7 .
Questions to assess participation in leisure time physical activity eTable 2. Characteristics of excluded non-exercisers eTable 3. Number of events per physical activity-related cancer site eTable 4. Covariate definitions eTable 5. STROBE Statement eTable 6. Sample characteristics by tertiles of average daily duration of up to 1 minute bouts of vigorous intermittent lifestyle physical activity (VILPA) in a sample of UK Biobank participants reporting no exercise or sports (N=22,398) eTable Hazard ratios associated with the minimum dose1 and median and maximum VILPA values eTable 8. E-values for minimum dose, and median/maximum VILPA values for incident cancer eFigure 1. Flow diagram of participants in the study eFigure 2.

eFigure 2 :
Adjusted absolute risk dose-response of VILPA with total incident cancer VILPA: vigorous intermittent lifestyle physical activity.Absolute risk adjusted for age, sex, body mass index, duration of light intensity physical activity, duration of moderate intensity physical activity, smoking history, alcohol consumption, accelerometer estimated sleep duration, fruit and vegetable consumption, education, medication use, self-reported parental history of cancer, and prevalent CVD.All analyses were additionally adjusted for vigorous physical activity duration lasting more than two minutes.© 2023 Stamatakis E et al.JAMA OncoleFigure 3: Dose-response of up to 1-minute VILPA duration with exclusion for poor health, underweight, and cancer events occurring during the first 2 years of follow up (n=21,011) Diamond: ED50 value, the minimal dose, defined as the duration of VILPA associated with 50% of the optimal risk reduction; Circle: Median VILPA value.Analyses adjusted for age, sex, body mass index, duration of light intensity physical activity, duration of moderate intensity physical activity, smoking history, alcohol consumption, accelerometer estimated sleep duration, fruit and vegetable consumption, education, medication use, self-reported parental history of cancer, and prevalent CVD.All analyses were additionally adjusted for vigorous physical activity duration lasting more than two minutes.Hazard ratios calculated from Fine-Gray models © 2023 Stamatakis E et al.JAMA OncoleFigure 4: Dose-response of up to 1-minute VILPA duration with no adjustment for body mass index (n= 22,507)Diamond: ED50 value, the minimal dose, defined as the duration of VILPA associated with 50% of the optimal risk reduction; Circle: Median VILPA value.Analyses adjusted for age, sex, duration of light intensity physical activity, duration of moderate intensity physical activity, smoking history, alcohol consumption, accelerometer estimated sleep duration, fruit and vegetable consumption, education, medication use, self-reported parental history of cancer, and prevalent CVD.All analyses were additionally adjusted for vigorous physical activity duration lasting more than two minutes.Hazard ratios calculated from Fine-Gray models Analyses adjusted for age, sex, body mass index, duration of light intensity physical activity, duration of moderate intensity physical activity, smoking history, alcohol consumption, prevalent diabetes, accelerometer estimated sleep duration, fruit and vegetable consumption, education, medication use, self-reported parental history of cancer, and prevalent CVD.All analyses were additionally adjusted for vigorous physical activity duration lasting more than one (bouts up to 1 minute exposure) or more than two (bouts up to 2 minutes exposure) minutes.Hazard ratios calculated from Fine-Gray models

eTable 1 :
Questions to assess participation in leisure time physical activity Colon and rectal cancer have been collapsed into colorectal in accordance with UKBB linkage (https://biobank.ndph.ox.ac.uk/~bbdatan/DeathSummaryReport.html)eTable 4: Covariate definitions Sample characteristics by rounded tertiles of average daily duration of up to 1 minute bouts of vigorous intermittent lifestyle physical activity (VILPA) in a sample of UK Biobank participants reporting no exercise or sports (N=22,398), and comparisons with full sample with valid data (including exercisers).Hazard ratios associated with the minimum dose 1 and median VILPA values A. Total incident cancer Minimal dose (ED50 value): defined as the duration/frequency of VILPA associated with 50% of the optimal risk reduction.The VILPA duration median values were calculated in the sample excluding participants with zero VILPA.Analyses adjusted for age, sex, duration of light intensity physical activity, duration of moderate intensity physical activity, smoking history, alcohol consumption, accelerometer estimated sleep duration, fruit and vegetable consumption, education, self-reported parental history cancer, and prevalent CVD.All analyses were additionally adjusted for vigorous physical activity duration lasting more than one/two minute as appropriate.