PHYSICAL ACTIVITY AND THE PRIMARY PREVENTION OF CANCER

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The American Cancer Society Advisory Committee on Diet, Nutrition, and Cancer concluded in their 1996 report that physical activity is an important factor in the prevention of cancer and cancer death;2 however, the scientific literature investigating the relationship between physical activity and cancer is fraught with methodological inconsistencies and contradictory findings. This review summarizes the literature in an attempt to answer the following questions:

  • 1

    What is the evidence that regular physical activity reduces the risk of developing and dying from all cancers and site-specific cancers?

  • 2

    How much physical activity needs to be done to reduce cancer risk?

  • 3

    What are the mechanisms by which regular physical activity may reduce all cancers and site-specific cancer mortality?

Section snippets

METHODOLOGIC PROBLEMS

“Physical activity,” “physical fitness,” and “exercise” are terms used often together, but need to be distinguished. Physical activity is a behavior consisting of any bodily movement produced by skeletal muscles resulting in energy expenditure. Epidemiologists often divide daily “physical activity” into the energy used during work activities and the energy used during leisure (or recreational) activities. “Physical fitness” is a set of attributes that determine the ability of a person to

Epidemiology

Several studies that have evaluated the relationship between physical activity or physical fitness and cancer are summarized in Table 1. Physical activity was estimated by a variety of methods. The subjects in all the studies were predominantly white.

Two early studies of men used participation in college athletics as an indicator of physical activity or fitness.68, 74 Neither of these studies found a relationship between college sports participation and cancer mortality; however, participation

Epidemiology

Colon cancer has been the most extensively studied, site-specific cancer with regard to the impact of physical activity on the risk of development. Tables 3, 4,

. PHYSICAL ACTIVITY AND COLON CANCER IN WOMEN

StudyPhysical ActivityAssessmentDesignControlled VariablesResults
Slattery et al87Self-report totalCase controlAge, BMI, fiber consumptionOR 0.5*, High:Low activity
Wu et al104Leisure-time 4.5AgeRR 0.89 (NS), Most:Least active
Slattery et al90TotalCase-controlAge, BMI, dietOR 0.48*,

Epidemiology

An association of decreased breast cancer risk with regular physical activity was first suggested by Frisch et al in 198523 when they reported a significantly greater prevalence of breast cancer in women who were not involved with athletics in college compared with athletes 1 to 56 years after graduation. Since that time, several studies have investigated the relationship between breast cancer and physical activity (Table 7). Of the 13 studies summarized in Table 7, 8 showed a significant

Epidemiology

Eleven studies that evaluated the effect of physical activity levels and prostate cancer are summarized in Table 8. Of the studies that measured occupational physical activity, three found a significant decreased risk of prostate cancer with increased activity,10, 58, 97 one reported a nonsignificant trend toward decreased risk,1 and one study did not find a relationship between physical activity and prostate cancer risk.77 All of the studies that assessed leisure-time physical activity found

CONCLUSION

There is a growing body of epidemiological evidence that physical activity may decrease the risk cancer mortality. The evidence for a protective effect of regular physical activity against colon cancer is particularly strong. Data are accumulating that suggest an inverse relationship between physical activity and breast and prostate cancer. Several mechanisms by which exercise may decrease cancer development have been proposed, including immunologic enhancement, increased antioxidant defense,

ACKNOWLEDGMENT

The author would like to thank Tanya Emch for her help in the preparation of this manuscript.

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    Address reprint requests to Robert Kiningham, MD, Department of Family Medicine, University of Michigan Medical School, 1018 Fuller Street, Ann Arbor, MI 48109-0707

    *

    Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan

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