Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases
Open accessAbstract
Objective: To provide an overview of the breadth and validity of claimed associations between physical activity and risk of developing or dying from cancer. Design: Umbrella review. Data sources: We searched Medline, Embase, Cochrane Database and Web of Science. Eligibility criteria for selecting studies: Systematic reviews about physical activity and cancer incidence and cancer mortality in different body sites among general population. Results: We included 19 reviews covering 22 cancer sites, 26 exposure-outcome pairs meta-analyses and 541 original studies. Physical activity was associated with lower risk of seven cancer sites (colon, breast, endometrial, lung, oesophageal, pancreas and meningioma). Only colon (a protective association with recreational physical activity) and breast cancer (a protective association with overall physical activity) were supported by strong evidence and highly suggestive evidence, respectively. Evidence from endometrial, lung, oesophageal, pancreas and meningioma presented hints of uncertainty and bias in the literature (eg,not reaching P values<10-6) showing large between-study heterogeneity and/or not demonstrating a definite direction for the effect when 95% prediction intervals were considered. Four of the 26 meta-analyses showed small study effects and 4 showed excess significance. Conclusion: Physical activity is associated with a lower risk of several cancers, but only colon and breast cancer associations were supported by strong or highly suggestive evidence, respectively. Evidence from other cancer sites was less consistent, presenting hints of uncertainty and/or bias.
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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 [2]
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Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2008) · BMJ · doi:10.1136/bmj.39489.470347.ad · Cited by 23,305 · see citing works
Why Most Published Research Findings Are False
Ioannidis, J. P. A. (2005) · PLoS Medicine · doi:10.1371/journal.pmed.0020124 · Cited by 10,505 · see citing works
Self-citationInternational Agency for Research on Cancer
National Cancer Institute (2020) · Definitions · doi:10.32388/pfg7jq · Cited by 9,493 · see citing works
Sterne, J. A. C., Sutton, A. J., Ioannidis, J. P. A., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rucker, G., Harbord, R. M., Schmid, C. H., et al. (2011) · BMJ · doi:10.1136/bmj.d4002 · Cited by 7,709 · see citing works
Self-citationThe environment and disease: association or causation?
Hill, A. B. (2015) · Journal of the Royal Society of Medicine · doi:10.1177/0141076814562718 · Cited by 7,302 · see citing works
The Environment and Disease: Association or Causation?
Hill, A. B. (1965) · Proceedings of the Royal Society of Medicine · doi:10.1177/003591576505800503 · Cited by 6,974 · see citing works
Global physical activity levels: surveillance progress, pitfalls, and prospects
Hallal, P. C., Andersen, L. B., Bull, F. C., Guthold, R., Haskell, W., & Ekelund, U. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60646-1 · Cited by 5,711 · see citing works
Food, nutrition, physical activity, and the prevention of cancer: a global perspective
Marmot, M. G., Atinmo, T., Byers, T., Chen, J., Hirohata, T., Jackson, A., James, W., Kolonel, L. N., Kumanyika, S., Leitzmann, C., et al. (2008) · Choice Reviews Online · doi:10.5860/choice.45-5024 · Cited by 5,365 · see citing works
Why Most Published Research Findings Are False
Ioannidis, J. P. A. (2005) · CHANCE · doi:10.1080/09332480.2005.10722754 · Cited by 4,702 · see citing works
Self-citationDevelopment of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews
Shea, B. J., Grimshaw, J. M., Wells, G. A., Boers, M., Andersson, N., Hamel, C., Porter, A. C., Tugwell, P., Moher, D., & Bouter, L. M. (2007) · BMC Medical Research Methodology · doi:10.1186/1471-2288-7-10 · Cited by 4,374 · see citing works
Body Fatness and Cancer — Viewpoint of the IARC Working Group
Lauby-Secretan, B., Scoccianti, C., Loomis, D., Grosse, Y., Bianchini, F., & Straif, K. (2016) · New England Journal of Medicine · doi:10.1056/nejmsr1606602 · Cited by 3,596 · see citing works
Interpretation of random effects meta-analyses
Riley, R. D., Higgins, J. P. T., & Deeks, J. J. (2011) · BMJ · doi:10.1136/bmj.d549 · Cited by 2,884 · see citing works
Giovannucci, E., Harlan, D. M., Archer, M. C., Bergenstal, R. M., Gapstur, S. M., Habel, L. A., Pollak, M., Regensteiner, J. G., & Yee, D. (2010) · Diabetes Care · doi:10.2337/dc10-0666 · Cited by 2,366 · see citing works
The case of the misleading funnel plot
Lau, J., Ioannidis, J. P. A., Terrin, N., Schmid, C. H., & Olkin, I. (2006) · BMJ · doi:10.1136/bmj.333.7568.597 · Cited by 1,766 · see citing works
Self-citationAssociation of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults
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., et al. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.1548 · Cited by 1,487 · see citing works
Self-citationUncertainty in heterogeneity estimates in meta-analyses
Ioannidis, J. P. A., Patsopoulos, N. A., & Evangelou, E. (2007) · BMJ · doi:10.1136/bmj.39343.408449.80 · Cited by 1,254 · see citing works
Self-citationTriangulation in aetiological epidemiology
Lawlor, D. A., Tilling, K., & Davey Smith, G. (2017) · International Journal of Epidemiology · doi:10.1093/ije/dyw314 · Cited by 1,129 · see citing works
Dwan, K., Gamble, C., Williamson, P. R., Kirkham, J. J., & the Reporting Bias Group (2013) · PLoS ONE · doi:10.1371/journal.pone.0066844 · Cited by 1,127 · see citing works
Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies
Tsilidis, K. K., Kasimis, J. C., López, D. S., Ntzani, E., & Ioannidis, J. P. A. (2015) · BMJ · doi:10.1136/bmj.g7607 · Cited by 861 · see citing works
Self-citationAdiposity and cancer at major anatomical sites: umbrella review of the literature
Kyrgiou, M., Kalliala, I., Markozannes, G., Gunter, M. J., Paraskevaidis, E., Gabra, H., Martin-Hirsch, P., & Tsilidis, K. K. (2017) · BMJ · doi:10.1136/bmj.j477 · Cited by 803 · see citing works
Self-citationAn exploratory test for an excess of significant findings
Ioannidis, J. P., & Trikalinos, T. A. (2007) · Clinical Trials · doi:10.1177/1740774507079441 · Cited by 751 · see citing works
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(2018) · Palgrave Macmillan UK eBooks · doi:10.1007/978-1-349-95810-8_1325 · Cited by 746 · see citing works
Physical activity and colon cancer prevention: a meta-analysis
Wolin, K. Y., Yan, Y., Colditz, G. A., & Lee, I.-M. M. (2009) · British Journal of Cancer · doi:10.1038/sj.bjc.6604917 · Cited by 647 · see citing works
Self-citationNaci, H., & Ioannidis, J. P. A. (2013) · BMJ · doi:10.1136/bmj.f5577 · Cited by 630 · see citing works
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Young, N., Ioannidis, J., & Al-Ubaydli, O. (2008) · PLoS Medicine · doi:10.1371/journal.pmed.0050201 · Cited by 478 · see citing works
Self-citationBoyle, T., Keegel, T. G., Bull, F., Heyworth, J. S., & Fritschi, L. (2012) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djs354 · Cited by 333 · see citing works
Bellou, V., Belbasis, L., Tzoulaki, I., Middleton, L. T., Ioannidis, J. P. A., & Εvangelou, Ε. (2016) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2016.07.152 · Cited by 287 · see citing works
Self-citationDoes Physical Activity Reduce the Risk of Prostate Cancer? A Systematic Review and Meta-analysis
Liu, Y., Hu, F., Li, D., Wang, F., Zhu, L., Chen, W., Ge, J., An, R., & Zhao, Y. (2011) · European Urology · doi:10.1016/j.eururo.2011.07.007 · Cited by 231 · see citing works
Almost all articles on cancer prognostic markers report statistically significant results
Kyzas, P., Denaxa-Kyza, D., & Ioannidis, J. P. A. (2007) · European Journal of Cancer · doi:10.1016/j.ejca.2007.08.030 · Cited by 231 · see citing works
Self-citationFalse-Positive Results in Cancer Epidemiology: A Plea for Epistemological Modesty
Boffetta, P., McLaughlin, J. K., Vecchia, C. L., Tarone, R. E., Lipworth, L., & Blot, W. J. (2008) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djn191 · Cited by 199 · see citing works
Is everything we eat associated with cancer? A systematic cookbook review
Schoenfeld, J. D., & Ioannidis, J. P. A. (2012) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.112.047142 · Cited by 199 · see citing works
Self-citationPizot, C., Boniol, M., Mullie, P., Koechlin, A., Boniol, M., Boyle, P., & Autier, P. (2015) · European Journal of Cancer · doi:10.1016/j.ejca.2015.10.063 · Cited by 193 · see citing works
A systematic review and meta-analysis of physical activity and endometrial cancer risk
Schmid, D., Behrens, G., Keimling, M., Jochem, C., Ricci, C., & Leitzmann, M. F. (2015) · European Journal of Epidemiology · doi:10.1007/s10654-015-0017-6 · Cited by 171 · see citing works
The association between physical activity and bladder cancer: systematic review and meta-analysis
Keimling, M., Behrens, G., Schmid, D., Jochem, C., & Leitzmann, M. F. (2014) · British Journal of Cancer · doi:10.1038/bjc.2014.77 · Cited by 151 · see citing works
The association between physical activity and renal cancer: systematic review and meta-analysis
Behrens, G., & Leitzmann, M. F. (2013) · British Journal of Cancer · doi:10.1038/bjc.2013.37 · Cited by 138 · see citing works
Body mass index, physical activity, and risk of adult meningioma and glioma
Niedermaier, T., Behrens, G., Schmid, D., Schlecht, I., Fischer, B., & Leitzmann, M. F. (2015) · Neurology · doi:10.1212/wnl.0000000000002020 · Cited by 137 · see citing works
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Ioannidis, J. P. A. (2015) · Statistics in Medicine · doi:10.1002/sim.6825 · Cited by 122 · see citing works
Self-citationAssociation of Physical Activity by Type and Intensity With Digestive System Cancer Risk
Keum, N., Bao, Y., Smith‐Warner, S. A., Orav, E. J., Wu, K., Fuchs, C. S., & Giovannucci, E. L. (2016) · JAMA Oncology · doi:10.1001/jamaoncol.2016.0740 · Cited by 116 · see citing works
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Behrens, G., Jochem, C., Keimling, M., Ricci, C., Schmid, D., & Leitzmann, M. F. (2014) · European Journal of Epidemiology · doi:10.1007/s10654-014-9895-2 · Cited by 94 · see citing works
Physical activity and risk of pancreatic cancer: a systematic review and meta-analysis
Behrens, G., Jochem, C., Schmid, D., Keimling, M., Ricci, C., & Leitzmann, M. F. (2015) · European Journal of Epidemiology · doi:10.1007/s10654-015-0014-9 · Cited by 94 · see citing works
Tsilidis, K. K., Papatheodorou, S., Εvangelou, Ε., & Ioannidis, J. P. A. (2012) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djs437 · Cited by 93 · see citing works
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Brenner, D. R., Yannitsos, D., Farris, M. S., Johansson, M., & Friedenreich, C. M. (2016) · Lung Cancer · doi:10.1016/j.lungcan.2016.01.021 · Cited by 81 · see citing works
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Ψαλτοπούλου, Θ., Ntanasis‐Stathopoulos, I., Tzanninis, I., Καντζάνου, Μ., Georgiadou, D., & Sergentanis, T. Ν. (2016) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000000316 · Cited by 60 · see citing works
Call to improve transparency of trials of non-regulated interventions
Dal‐Ré, R., Bracken, M. B., & Ioannidis, J. P. A. (2015) · BMJ · doi:10.1136/bmj.h1323 · Cited by 54 · see citing works
Self-citationIoannidis, J. P. A., Zhou, Y., Chang, C. Q., Schully, S. D., Khoury, M. J., & Freedman, A. N. (2013) · Annals of Oncology · doi:10.1093/annonc/mdt372 · Cited by 46 · see citing works
Self-citationPhysical activity and gastric cancer risk: a case-control study in the Amazon region of Brazil
Fagundes, M. A., Peres, S. V., de Assumpção, P. P., & Curado, M. P. (2020) · European Journal of Cancer Prevention · doi:10.1097/cej.0000000000000654 · Cited by 34 · see citing works
Nonoccupational physical activity and risk of ovarian cancer: a meta-analysis
Zhong, S., Chen, L., Lv, M., Ma, T., Zhang, X., & Zhao, J. (2014) · Tumor Biology · doi:10.1007/s13277-014-2385-z · Cited by 32 · see citing works
Detecting and describing heterogeneity in meta-analysis
Hardy, R. J., & Thompson, S. G. (1998) · Statistics in Medicine · doi:10.1002/(sici)1097-0258(19980430)17:8
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- Authors
- Rezende, L. F. M. D., Sá, T. H. D., Markozannes, G., Rey-López, J. P., Lee, I.-M., Tsilidis, K. K., Ioannidis, J. P. A., & Eluf-Neto, J.
- Affiliations
- Universidade de São Paulo (BR)
- University of Ioannina (GR)
- The University of Sydney (AU)
- Brigham and Women's Hospital (US)
- Stanford Medicine (US)
- Corresponding author
- Rezende, Leandro Fórnias Machado de
- ORCID
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2017-11-16
- Volume
- 52
- Issue
- 13
- Pages
- 826-833
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W2769893580
- Cited by
- 276
- References
- 53
- Citations by year
- 2026: 15 · 2025: 32 · 2024: 28 · 2023: 38 · 2022: 35 · 2021: 44 · 2020: 41 · 2019: 32 · 2018: 11
- FWCI
- 2.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- University of Sydney
- World Cancer Research Fund International Regular Grant Programme
- São Paulo Research Foundation
- 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
- physical activity, cancer risk, cancer incidence, cancer mortality, colon cancer, breast cancer, endometrial cancer, lung cancer, esophageal cancer, pancreatic cancer, meningioma, tumor location, quality of evidence, prediction intervals, small-study effects
- MeSH terms
- Breast Neoplasms, Colonic Neoplasms, Humans, Neoplasms, Risk Factors, Exercise, Incidence
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