Physical Activity and Cancer (Fact Sheet)

Breast cancer: Consistent evidence from epidemiologic studies links physical activity after diagnosis with better breast cancer outcomes.^35,36 For example, a large cohort study found that women who exercised moderately (the equivalent of walking 3 to 5 hours per week at an average pace) after a breast cancer diagnosis had approximately 40% to 50% lower risks of breast cancer recurrence, death from breast cancer, and death from any cause compared with more sedentary women.³⁷ The potential physical activity benefit with regard to death from breast cancer was most apparent in women with hormone receptor–positive tumors.³⁷

Another prospective cohort study found that women who had breast cancer and who engaged in recreational physical activity roughly equivalent to walking at an average pace of 2 to 2.9 mph for 1 hour per week had a 35% to 49% lower risk of death from breast cancer compared with women who engaged in less physical activity.³⁸

Colorectal cancer: Evidence from multiple epidemiologic studies suggests that physical activity after a colorectal cancer diagnosis is associated with reduced risks of dying from colorectal cancer.³⁹ In a large prospective cohort of patients with colorectal cancer, those who engaged in leisure-time physical activity had a 31% lower risk of death than those who did not, independent of their leisure-time physical activity before diagnosis.⁴⁰

Prostate cancer: Limited evidence from a few epidemiologic studies has suggested a possible link between physical activity and better outcomes among men diagnosed with prostate cancer. In one study, men with nonmetastatic prostate cancer who engaged in vigorous activity for at least 3 hours per week had a 61% lower risk of death from prostate cancer compared with men who engaged in vigorous activity for less than 1 hour per week.⁴¹ Another study of men with localized prostate cancer found that higher levels of physical activity were associated with reduced overall and prostate cancer–specific mortality.⁴²

Findings from epidemiologic studies cannot completely exclude reverse causation as a possible explanation of the link between physical activity and better cancer outcomes. That is, people who feel good are more likely to exercise and be physically active than people who do not feel good.

What additional research is under way on the relationship between physical activity and cancer?

Many questions remain to be answered in several broad areas of research on physical activity and cancer:

• Although the evidence for causal link is strong for a few cancers, for others it is not, and the question of causality remains an important one. That is, does being physically inactive cause cancer and/or does being physically active prevent cancer?
• If the association is causal, what is the optimal time in life, intensity, duration, and/or frequency of physical activity needed to reduce the risk of cancer, both overall and for specific sites?
• Do biomarkers of cancer risk or progression that are affected by physical activity exist?
• Does the association between physical activity and cancer differ in populations that have higher proportions of inactive and/or obese individuals compared with the general population?
• Does physical activity benefit people with a genetic susceptibility to cancer?

Selected References

1. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer–Viewpoint of the IARC Working Group. New England Journal of Medicine 2016; 375(8):794-798. doi: 10.1056/NEJMsr1606602

2. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.

3. Kruk J, Czerniak U. Physical activity and its relation to cancer risk: updating the evidence. Asian Pacific Journal of Cancer Prevention 2013; 14(7):3993-4003.

4. Wolin KY, Yan Y, Colditz GA, Lee IM. Physical activity and colon cancer prevention: a meta-analysis. British Journal of Cancer 2009; 100(4):611-616.

5. Moore SC, Lee IM, Weiderpass E, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Internal Medicine 2016; 176(6):816-825.

6. Boyle T, Keegel T, Bull F, Heyworth J, Fritschi L. Physical activity and risks of proximal and distal colon cancers: a systematic review and meta-analysis. Journal of the National Cancer Institute 2012; 104(20):1548-1561.

7. Robsahm TE, Aagnes B, Hjartåker A, et al. Body mass index, physical activity, and colorectal cancer by anatomical subsites: a systematic review and meta-analysis of cohort studies. European Journal of Cancer Prevention 2013; 22(6):492-505.

8. Wolin KY, Yan Y, Colditz GA. Physical activity and risk of colon adenoma: a meta-analysis. British Journal of Cancer 2011; 104(5):882-885.

9. Slattery ML. Physical activity and colorectal cancer. Sports Medicine 2004; 34(4):239-252.10. Wolin KY, Tuchman H. Physical activity and gastrointestinal cancer prevention. Recent Results in Cancer Research 2011; 186:73-100.

10. Wolin KY, Tuchman H. Physical activity and gastrointestinal cancer prevention. Recent Results in Cancer Research 2011; 186:73-100. [PubMed Abstract]

11. Colbert LH, Lanza E, Ballard-Barbash R, et al. Adenomatous polyp recurrence and physical activity in the Polyp Prevention Trial (United States). Cancer Causes and Control 2002; 13(5):445-453.

12. Wu Y, Zhang D, Kang S. Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Research and Treatment 2013; 137(3):869-882.

13. Eliassen AH, Hankinson SE, Rosner B, Holmes MD, Willett WC. Physical activity and risk of breast cancer among postmenopausal women. Archives of Internal Medicine 2010; 170(19):1758-1764.

14. Hildebrand JS, Gapstur SM, Campbell PT, Gaudet MM, Patel AV. Recreational physical activity and leisure-time sitting in relation to postmenopausal breast cancer risk. Cancer Epidemiology, Biomarkers & Prevention 2013; 22(10):1906-1912.

15. Fournier A, Dos Santos G, Guillas G, et al. Recent recreational physical activity and breast cancer risk in postmenopausal women in the E3N cohort. Cancer Epidemiology, Biomarkers & Prevention 2014; 23(9):1893-1902.

16. Schmid D, Behrens G, Keimling M, et al. A systematic review and meta-analysis of physical activity and endometrial cancer risk. European Journal of Epidemiology 2015; 30(5):397-412.

17. Du M, Kraft P, Eliassen AH, et al. Physical activity and risk of endometrial adenocarcinoma in the Nurses’ Health Study. International Journal of Cancer 2014; 134(11):2707-2716.

18. Friedenreich C, Cust A, Lahmann PH, et al. Physical activity and risk of endometrial cancer: The European prospective investigation into cancer and nutrition. International Journal of Cancer 2007; 121(2):347-355.

19. Behrens G, Matthews CE, Moore SC, et al. The association between frequency of vigorous physical activity and hepatobiliary cancers in the NIH-AARP Diet and Health Study. European Journal of Epidemiology 2013; 28(1):55-66.

20. Behrens G, Jochem C, Keimling M, et al. The association between physical activity and gastroesophageal cancer: systematic review and meta-analysis. European Journal of Epidemiology 2014; 29(3):151-170.

21. Behrens G, Leitzmann MF. The association between physical activity and renal cancer: systematic review and meta-analysis. British Journal of Cancer 2013; 108(4):798-811.

22. Keimling M, Behrens G, Schmid D, Jochem C, Leitzmann MF. The association between physical activity and bladder cancer: systematic review and meta-analysis. British Journal of Cancer 2014; 110(7):1862-1870.

23. Winzer BM, Whiteman DC, Reeves MM, Paratz JD. Physical activity and cancer prevention: a systematic review of clinical trials. Cancer Causes and Control 2011; 22(6):811-826.

24. Wertheim BC, Martinez ME, Ashbeck EL, et al. Physical activity as a determinant of fecal bile acid levels. Cancer Epidemiology, Biomarkers & Prevention 2009; 18(5):1591-1598.

25. Bernstein H, Bernstein C, Payne CM, Dvorakova K, Garewal H. Bile acids as carcinogens in human gastrointestinal cancers. Mutation Research 2005; 589(1):47-65.

26. Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Annals of Oncology 2014; 25(7):1293-311.

27. 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. Annals of Internal Medicine 2015; 162(2):123-132.

28. Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet 2016; 388(10051):1302-1310.

29. Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH.  An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship 2010; 4(2):87-100.

30. Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians 2012; 62(4):243-274.

31. Bradshaw PT, Ibrahim JG, Stevens J, et al. Postdiagnosis change in bodyweight and survival after breast cancer diagnosis. Epidemiology 2012; 23(2):320-327.

32. Fong DY, Ho JW, Hui BP, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. British Medical Journal 2012; 344:e70.

33. Mishra SI, Scherer RW, Geigle PM, et al. Exercise interventions on health-related quality of life for cancer survivors. The Cochrane Database of Systematic Reviews 2012; 8:Cd007566.

34. Arem H, Moore SC, Park Y, et al. Physical activity and cancer-specific mortality in the NIH-AARP Diet and Health Study cohort. International Journal of Cancer 2014; 135(2):423-431.

35. Chlebowski RT. Nutrition and physical activity influence on breast cancer incidence and outcome. Breast 2013; 22 Suppl 2:S30-37.

36. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Medical Oncology 2011; 28(3):753-765.

37. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA 2005; 293(20):2479-2486.

38. Holick CN, Newcomb PA, Trentham-Dietz A, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiology, Biomarkers & Prevention 2008; 17(2):379-386.

39. Ballard-Barbash R, Friedenreich CM, Courneya KS, et al. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. Journal of the National Cancer Institute 2012; 104(11):815-840.

40. Arem H, Pfeiffer RM, Engels EA, et al. Pre- and postdiagnosis physical activity, television viewing, and mortality among patients with colorectal cancer in the National Institutes of Health-AARP Diet and Health Study. Journal of Clinical Oncology 2015; 33(2):180-188. 

41. Kenfield SA, Stampfer MJ, Giovannucci E, Chan JM. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. Journal of Clinical Oncology 2011; 29(6):726-732. 

42. Bonn SE, Sjölander A, Lagerros YT, et al. Physical activity and survival among men diagnosed with prostate cancer. Cancer Epidemiology, Biomarkers & Prevention 2015; 24(1):57-64. 

Source: National Cancer Institute.