Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults
Open accessAbstract
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.
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Data from 1.44 million participants across prospective cohort studies showed that physically inactive individuals had more than 20% greater risk of several cancers, including esophageal adenocarcinoma, liver, lung, kidney, gastric cardia, and endometrial cancers and myeloid leukemia, after adjusting for adiposity and smoking except for lung cancer.
“data from 1.44 million participants across several prospective cohort studies revealed that, as compared to individuals exhibiting high levels of leisure-time physical activity (≥90th percentile), those who were physically inactive (≤10th percentile) had a greater risk (>20%) of developing several cancers, including esophageal adenocarcinoma; liver, lung, kidney, gastric cardia and endometrial”
From Chronic inflammation in the etiology of disease across the life span (2019) · cites this paper as [102]
Physical activity and exercise benefits apply to conditions characterized by very distinct pathophysiology, such as Alzheimer's disease, cancer, heart disease, and pneumonia/other infections.
“Physical activity and exercise benefits apply to conditions characterized by very distinct pathophysiology, such as Alzheimer’s disease [629], cancer [628], heart disease [630], and pneumonia/other infections [631,632].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [628]
Physical activity and exercise benefits apply to conditions with very distinct pathophysiology, such as Alzheimer's disease, cancer, heart disease, and pneumonia/other infections.
“Physical activity and exercise benefits apply to conditions characterized by very distinct pathophysiology, such as Alzheimer’s disease [629], cancer [628], heart disease [630], and pneumonia/other infections [631,632].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [628]
Observational evidence shows that PA levels lower than recommended threshold are already associated with reduced mortality, and benefits exhibit a curvilinear dose-dependency.
“Indeed, observational evidence shows that PA levels lower than recommended threshold are already associated with reduced mortality [65,628,668], and benefits exhibit a curvilinear dose-dependency [628,668].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [628]
Physical activity is associated with reduced mortality risk, reduced risk of cardiovascular disease and certain cancers.
“Physical activity is associated with reduced mortality risk1, and reduced risk of CVD1 and certain cancers2–4.”
From Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality (2022) · cites this paper as [3]
Epidemiological studies suggest that physical activity in leisure time reduces the risk of at least 13 different cancer types.
“Epidemiological studies suggest that physical activity in leisure time reduces the risk of at least 13 different cancer types (41, 42, 222, 223).”
From Muscle–Organ Crosstalk: The Emerging Roles of Myokines (2020) · cites this paper as [222]
The effects of exercise on cancer growth were mediated via a direct regulation of natural killer cells by a mechanism that involved epinephrine-dependent mobilization of natural killer cells to the circulation and an IL-6-dependent redistribution to tumors.
“The effects of exercise on cancer growth were mediated via a direct regulation of natural killer cells by a mechanism that involved epinephrine-dependent mobilization of natural killer cells to the circulation and an IL-6-dependent redistribution to tumors.”
From Muscle–Organ Crosstalk: The Emerging Roles of Myokines (2020) · cites this paper as [222]
Running mice demonstrated a marked reduction in tumor volume and incidence across 6 different tumor models.
“Running mice demonstrated a marked reduction in tumor volume and incidence across 6 different tumor models.”
From Muscle–Organ Crosstalk: The Emerging Roles of Myokines (2020) · cites this paper as [222]
Blocking IL-6 signaling during exercise abolished the exercise-induced inhibition of tumor growth.
“Blocking IL-6 signaling during exercise abolished the exercise-induced inhibition of tumor growth.”
From Muscle–Organ Crosstalk: The Emerging Roles of Myokines (2020) · cites this paper as [222]
A meta-analysis of 12 prospective cohorts using self-reported physical activity found that higher activity levels are associated with lower risk of incident cancer across multiple cancer types, with many associations persisting after BMI adjustment.
“A meta-analysis pooled data from 12 prospective cohorts with self-reported physical activity and found that increased physical activity levels are associated with decreased risk of incident cancer across multiple types; many of these associations remained even after adjusting for BMI129.”
From Exerkines in health, resilience and disease (2022) · cites this paper as [129]
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- Authors
- Moore, S. C., Lee, I.-M., Weiderpass, E., Campbell, P. T., Sampson, J. N., Kitahara, C. M., Keadle, S. K., Arem, H., Berrington de Gonzalez, A., Hartge, P., Adami, H.-O., Blair, C. K., Borch, K. B., Boyd, E., Check, D. P., Fournier, A., Freedman, N. D., Gunter, M., Johannson, M., Khaw, K.-T., Linet, M. S., Orsini, N., Park, Y., Riboli, E., Robien, K., Schairer, C., Sesso, H., Spriggs, M., Van Dusen, R., Wolk, A., Matthews, C. E., & Patel, A. V.
- Affiliations
- National Cancer Institute (US)
- Brigham and Women's Hospital (US)
- Karolinska Institutet (SE)
- American Cancer Society (US)
- United States Agency for International Development (US)
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Harvard University (US)
- University of New Mexico (US)
- UiT The Arctic University of Norway (NO)
- Information Management Services (US)
- Centre for Research in Epidemiology and Population Health, Institut Gustave Roussy, Villejuif, France
- Centre international de recherche sur le cancer (FR)
- University of Cambridge (GB)
- Washington University in St. Louis (US)
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, England
- George Washington University (US)
- Information Management Services, Inc, Rockville, Maryland
- Corresponding author
- Moore, Steven C.
- ORCID
- Moore, Steven C.
- Lee, I-Min
- Weiderpass, Elisabete
- Campbell, Peter T.
- Sampson, Joshua N.
- Kitahara, Cari M.
- Keadle, Sarah K.
- Arem, Hannah
- Adami, Hans-Olov
- Blair, Cindy K.
- Borch, Kristin B.
- Check, David P.
- Freedman, Neal D.
- Gunter, Marc
- Khaw, Kay-Tee
- Linet, Martha S.
- Orsini, Nicola
- Park, Yikyung
- Robien, Kim
- Schairer, Catherine
- Sesso, Howard
- Wolk, Alicja
- Matthews, Charles E.
- Patel, Alpa V.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2016-06-01
- Volume
- 176
- Issue
- 6
- Pages
- 816
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC5812009
- OpenAlex
- W2402756356
- Cited by
- 1,487
- References
- 48
- Citations by year
- 2026: 113 · 2025: 139 · 2024: 144 · 2023: 163 · 2022: 154 · 2021: 155 · 2020: 175 · 2019: 184 · 2018: 134 · 2017: 107 · 2016: 18
- FWCI
- 79.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- World Health Organization
- Cancer Research UK (14136)
- National Institute for Health and Care Research (NF-SI-0512-10114)
- National Institutes of Health (Z99 CA999999)
- Medical Research Council (MR/N003284/1)
- National Cancer Institute (R01CA039742)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- leisure-time physical activity, cancer incidence, cancer risk, moderate-to-vigorous physical activity, body size, smoking, esophageal adenocarcinoma, liver cancer, lung cancer, kidney cancer, gastric cardia cancer, endometrial cancer, myeloid leukemia, breast cancer, colorectal cancer, colorectal adenoma, colorectal polyps, recurrent colorectal cancer, colorectal cancer mortality
- MeSH terms
- Adult, European Union, Female, Follow-Up Studies, Humans, Leisure Activities, Male, Middle Aged, Neoplasms, Retrospective Studies, Risk Factors, United States, Meta-Analysis as Topic, Exercise, Body Mass Index, Incidence, Risk Assessment, Evidence-Based Medicine
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