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Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases
  1. Leandro Fórnias Machado de Rezende1,
  2. Thiago Hérick de Sá2,
  3. Georgios Markozannes3,
  4. Juan Pablo Rey-López4,
  5. I-Min Lee5,6,
  6. Konstantinos K Tsilidis3,7,
  7. John P A Ioannidis8,9,10,11,
  8. José Eluf-Neto1
  1. 1Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
  2. 2Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, São Paulo, Brazil
  3. 3Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
  4. 4Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia
  5. 5Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  6. 6Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
  7. 7Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, London, UK
  8. 8Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
  9. 9Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
  10. 10Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA
  11. 11Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California, USA
  1. Correspondence to Mr Leandro Fórnias Machado de Rezende, Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidadede São Paulo, São Paulo, Brasil; lerezende{at}usp.br

Abstract

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.

  • physical activity
  • cancer
  • epidemiology
  • meta-analysis
  • oncology
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Footnotes

  • Contributors All authors conceived and designed the study. LFMR, JPRL and THS acquired and collated the data. LFMR and GM analysed the data. All authors drafted and critically revised the manuscript for important intellectual content and gave final approval of the version to be published.

  • Funding This work was supported by São Paulo Research Foundation (FAPESP), grant#2014/25614-4 (funding was obtained from FAPESP as part of LFMR doctoral scholarship); World Cancer Research Fund International Regular Grant Programme (2014/1180 to KKT; funding was obtained from World Cancer Research Fund (WCRF UK), as part of the World Cancer Research Fund International grant programme). JPRL is postdoctoral fellowship from the University of Sydney (Australia) (Project Code: U2334).

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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