Leisure time physical activity and cancer risk: evaluation of the WHO's recommendation based on 126 high-quality epidemiological studies

Physical Performance and Telomere Length in Older Adults

BACKGROUND

The aging population prompts studying risk factors and markers to predict healthy aging. Telomere length is a promising candidate for assessing various age-related traits.

AIM OF THE STUDY

To investigate the association between physical performance and telomere length.

METHODS

We enrolled 323 older Mexican adults from the "Cohort of Obesity, Sarcopenia, and Frailty of Older Mexican Adults" affiliated with the Instituto Mexicano del Seguro Social and assessed their physical performance using the Short Physical Performance Battery, dividing participants into low (≤7) and high (>7) groups. Absolute telomere length was determined by qPCR, and individuals were classified into short (≤4.22 kb) and long (>4.22 kb) groups. We calculated the mean and adjusted mean, considering sex and age, among others, with 95% CI. We estimated the effect size between physical performance and telomere length using Cohen's d for unequal group sizes and calculated the odds ratio for physical performance based on telomere length.

RESULTS

Participants with low physical performance had significantly shorter telomeres (mean 4.14.44.7 kb, adjusted mean 3.54.04.5 kb, p <0.001), while those with high physical performance exhibited longer telomeres (mean 5.55.75.9 kb, adjusted mean 4.75.35.8 kb, p <0.001), with a medium-to-high telomere length effect size (d = 0.762). The odds of low physical activity increased 2.13.66.1-fold per kb of telomere attrition (adjOR 1.73.36.3, p <0.001).

CONCLUSION

Decreased physical function is associated with shorter telomere length. Absolute telomere length presents a promising biomarker for distinguishing between healthy and unhealthy aging, warranting further investigation.

The Role of Adipocytes Recruited as Part of Tumor Microenvironment in Promoting Colorectal Cancer Metastases

Adipose tissue dysfunction, which is associated with an increased risk of colorectal cancer (CRC), is a significant factor in the pathophysiology of obesity. Obesity-related inflammation and extracellular matrix (ECM) remodeling promote colorectal cancer metastasis (CRCM) by shaping the tumor microenvironment (TME). When CRC occurs, the metabolic symbiosis of tumor cells recruits adjacent adipocytes into the TME to supply energy. Meanwhile, abundant immune cells, from adipose tissue and blood, are recruited into the TME, which is stimulated by pro-inflammatory factors and triggers a chronic local pro-inflammatory TME. Dysregulated ECM proteins and cell surface adhesion molecules enhance ECM remodeling and further increase contractibility between tumor and stromal cells, which promotes epithelial-mesenchymal transition (EMT). EMT increases tumor migration and invasion into surrounding tissues or vessels and accelerates CRCM. Colorectal symbiotic microbiota also plays an important role in the promotion of CRCM. In this review, we provide adipose tissue and its contributions to CRC, with a special emphasis on the role of adipocytes, macrophages, neutrophils, T cells, ECM, and symbiotic gut microbiota in the progression of CRC and their contributions to the CRC microenvironment. We highlight the interactions between adipocytes and tumor cells, and potential therapeutic approaches to target these interactions.

Eating Behaviors and Physical Activity versus the Big Five Personality Traits in Women with a Hereditary Predisposition to Breast or Ovarian Cancer

The Big Five personality traits-neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness-represent continuous, individual features that affect a number of vital health aspects, including morbidity, self-reported health status, or lifestyle. The aim of this study was to analyze the relationship between the eating behaviors and engagement in physical activity of women with a hereditary predisposition to breast or ovarian cancer and the Big Five personality traits. A total of 357 women, participants of 'The National Program for Families With Genetic/Familial High Risk for Cancer', were included in the study. In the healthy group, the following statistically significant predictors were found in variables: agreeableness-meal frequency (β = 0.151; p = 0.030); neuroticism-consumption of fruits and vegetables (β = -0.177; p = 0.016) and cereal products (β = -0.223; p = 0.002); openness to experience-consumption of plant-based fats (β = 0.141; p = 0.034) and physical activity (β = 0.153; p = 0.021). In the cancer group, the frequency of dairy consumption (β = 0.286; p = 0.003) and physical activity (β = 0.370; p = 0.000) were found to be statistically significant predictors for the openness to experience variable. Neuroticism is associated with less frequent consumption of fresh fruits and vegetables as well as cereal products. Openness to experience was more often linked with a higher frequency of dairy consumption, plant-based fats, and physical activity. Women with breast or ovarian cancer and a higher openness to experience consumed dairy and engaged in physical activity more often than their peers with the remaining personality traits.

Breast Cancer and Lifestyle Factors: Umbrella Review

Lifestyle factors play a major role in the risk of breast cancer. This review aimed to examine the size of the effect of select lifestyle factors on risk for breast cancer and assess the quality of existing evidence. The authors performed an umbrella review of systematic reviews. The authors found an increased risk for breast cancer associated with obesity, alcohol intake, and smoking and a decreased risk due to physical activity. The evidence for sleep disruption and duration indicates risk for breast cancer, but it is limited in size, statistical significance, and quality of evidence.

"That's like therapy"-A qualitative study on socially disadvantaged women's views on the effects of a community-based participatory research project on their health and health behavior

Background

Regular physical activity has positive effects on both physical and mental health. Nevertheless, socially disadvantaged women are often insufficiently physically active. Through needs-based physical activity offers, community-based participatory research (CBPR) projects have the potential to reach these women and increase the effectiveness of physical activity interventions by supporting women's empowerment, health, and health behaviors. This study aimed to examine socially disadvantaged women's views on the effects of long-term participation in Bewegung als Investition in Gesundheit (BIG, i.e., movement as an investment in health), a long-standing German CBPR project, on their health and health behavior.

Methods

Semi-structured qualitative interviews were conducted with 30 participating women at five BIG sites across Germany between April and August 2022. The interviews were recorded, transcribed verbatim, and analyzed using framework analysis.

Results

Women reported that participation in BIG classes contributed to their physical, mental, and social health. For many women, the positive effects on their mental and social wellbeing were most important. In addition to increased fitness and improved physical endurance, many participating women were able to expand their social networks, thus receiving further social support, and improve their self-esteem, self-confidence, and self-efficacy. Furthermore, participation in BIG physical activity classes positively influenced the health awareness of many women helping them to improve their activity level and diet over time.

Conclusion

Our results suggest that CBPR projects, such as the BIG project, can increase physical activity among socially disadvantaged groups and contribute to their overall health and wellbeing. CBPR projects could thus be considered a key element of health promotion for this target group. Future interventional research is required to confirm and further explore the effects of CBPR interventions and to examine whether the effects can be replicated in other settings.

Cancer Prevention and Treatment Based on Lifestyles

Cancer morbidity and mortality incidence are rapidly increasing over the period of time. Cancer prevention, alongside innovative therapies and earlier detection, is considered a key strategy for reducing the overall cancer burden. Substantial evidence indicates a clear correlation between lifestyle factors and changes in nutrient metabolism. Approximately 5-10% of all cancer cases are attributed to genetic factors, whereas 90-95% are due to environmental and lifestyle factors, suggesting that lifestyle interventions have significant prospects for preventing various cancers. Healthy lifestyle changes, in particular healthy diets, physical activity, staying at a healthy weight, reduction or elimination of tobacco/alcohol consumption, and avoiding exposure to radiation and other carcinogens, are significant factors to be considered to tackle the challenges associated with cancer in modern society. This chapter aims to provide lifestyle intervention strategies to improve cancer prevention and risk reduction while promoting the health of cancer patients. The therapeutic role of some dietary regimens and supplements, as well as complementary and alternative health approaches, in cancer treatment is also discussed.

Comparative effectiveness of interventions on promoting physical activity in older adults: A systematic review and network meta-analysis

Background

Despite the well-established health benefits of physical activity, a large population of older adults still maintain sedentary life style or physical inactivity. This network meta-analysis (NMA) aimed to compare the effectiveness of wearable activity tracker-based intervention (WAT), electronic and mobile health intervention (E&MH), structured exercise program intervention (SEP), financial incentive intervention (FI) on promoting physical activity and reducing sedentary time in older adults.

Methods

The systematic review based on PRISMA guidelines, a systematic literature search of PubMed, Web of Science, Google Scholar, EMbase, Cochrane Library, Scopus were searched from inception to December 10th 2022. The randomized controlled trials (RCT) were included. Two reviewers independently conducted study selection, data extraction, risk of bias and certainty of evidence assessment. The effect measures were standard mean differences (SMD) and 95% confidence interval (CI) in daily steps, moderate-to-vigorous physical activity (MVPA) and sedentary time.

Results

A total of 69 studies with 14,120 participants were included in the NMA. Among these included studies, the results of daily steps, MVPA and sedentary time was reported by 55, 25 and 15 studies, respectively. The NMA consistency model analysis suggested that the following interventions had the highest probability (surface under the cumulative ranking, SUCRA) of being the best when compared with control: FI + WAT for daily steps (SUCRA = 96.6%; SMD = 1.32, 95% CI:0.77, 1.86), WAT + E&MH + SEP for MVPA (SUCRA = 91.2%; SMD = 0.94, 95% CI: 0.36, 1.52) and WAT + E&MH + SEP for sedentary time (SUCRA = 80.3%; SMD = -0.50, 95% CI: -0.87, -0.14). The quality of the evidences of daily steps, MVPA and sedentary time was evaluated by very low, very low and low, respectively.

Conclusions

In this NMA, there's low quality evidence that financial incentive combined with wearable activity tracker is the most effective intervention for increasing daily steps of older adults, wearable activity tracker combined with electronic and mobile health and structured exercise program is the most effective intervention to help older adults to increase MVPA and reduce sedentary time.

Non-exercise estimated cardiorespiratory fitness and cancer incidence: The NIH-AARP diet and health study

BACKGROUND

Non-exercise estimated cardiorespiratory fitness (NEE-CRF) has been shown to be associated with mortality, although its association with cancer incidence is unknown. The study aimed to assess the prospective association between NEE-CRF and cancer incidence in a large cohort of men and women.

METHODS

The National Institutes of Health-American Association of Retired Persons diet and health study is a prospective cohort that included 402,548 participants aged 50-71 years who were free from cancer at baseline (1995-1996) (men (n = 238,835) and women (n = 163,713)) and were followed until December 31, 2015. The exposure variable was NEE-CRF expressed in metabolic equivalents. NEE-CRF was estimated using a validated equation of self-reported predictors on demographics and lifestyle behaviors derived from baseline questionnaires. Primary outcomes were total cancer incidence and incidence of prostate, breast, lung, and colorectal cancers. Cox proportional hazards models were analyzed for the association between NEE-CRF and cancer incidence outcomes adjusted for established cancer risk factors.

RESULTS

During 13.7 ± 3.2 years of follow-up (mean ± SD), 64,344 men and 31,315 women developed a new cancer. For every 1-metabolic equivalent higher NEE-CRF, the hazard ratios and 95% confidence intervals (95%CIs) were 0.96 (95%CI: 0.94-0.97) and 0.88 (95%CI: 0.84-0.92) of total and colorectal cancer incidence among men, and 0.95 (95%CI: 0.93-0.97) and 0.94 (95%CI: 0.91-0.97) of total and breast cancer incidence among women, respectively (all p < 0.001). NEE-CRF was not associated with incidence of prostate and lung cancers in men or colorectal and lung cancers in women.

CONCLUSION

These results suggest that higher CRF levels, as assessed by the applied non-exercise estimated method, may provide preventive benefits against the development of cancer, while low CRF could potentially serve as a modifiable cancer risk factor. Integrating NEE-CRF into screening paradigms and referring low-fit individuals to improve CRF could complement the public health prevention strategy against cancer.

Functional proportional hazards mixture cure model with applications in cancer mortality in NHANES and post ICU recovery

We develop a functional proportional hazards mixture cure model with scalar and functional covariates measured at the baseline. The mixture cure model, useful in studying populations with a cure fraction of a particular event of interest is extended to functional data. We employ the expectation-maximization algorithm and develop a semiparametric penalized spline-based approach to estimate the dynamic functional coefficients of the incidence and the latency part. The proposed method is computationally efficient and simultaneously incorporates smoothness in the estimated functional coefficients via roughness penalty. Simulation studies illustrate a satisfactory performance of the proposed method in accurately estimating the model parameters and the baseline survival function. Finally, the clinical potential of the model is demonstrated in two real data examples that incorporate rich high-dimensional biomedical signals as functional covariates measured at the baseline and constitute novel domains to apply cure survival models in contemporary medical situations. In particular, we analyze (i) minute-by-minute physical activity data from the National Health And Nutrition Examination Survey 2003-2006 to study the association between diurnal patterns of physical activity at baseline and all cancer mortality through 2019 while adjusting for other biological factors; (ii) the impact of daily functional measures of disease severity collected in the intensive care unit on post intensive care unit recovery and mortality event. Our findings provide novel epidemiological insights into the association between daily patterns of physical activity and cancer mortality. Software implementation and illustration of the proposed estimation method are provided in R.

Association between regular physical activity and lower incidence of colorectal cancer in patients with diabetes mellitus: a nationwide cohort study

AIM

The aim of this work was to investigate the association between changes in physical activity (PA) status and the development of colorectal cancer (CRC) in patients with diabetes.

METHOD

This nationwide population study included 1 439 152 patients with diabetes who underwent a health screening provided by the Korean National Health Insurance Service between January 2009 and December 2012 and a follow-up screening after 2 years. Based on changes in PA status, participants were categorized into four groups: remained inactive, remained active, active-to-inactive and inactive-to-active.

RESULTS

During the median follow-up period of 5.2 years, 38 244 new cases of CRC were diagnosed. Compared with the remained inactive group, among the three other groups, the remained active group had the lowest risk of CRC [adjusted hazard ratio (aHR) 0.93; 95% CI 0.90-0.96], followed by the inactive-to-active group (aHR 0.97; 95% CI 0.94-1.00) and active-to-inactive group (aHR 0.99; 95% CI 0.96-1.02), after adjusting for confounding variables (p = 0.0007). This reduction in cancer incidence in the remained active group was observed for both rectal cancer (aHR 0.87, 95% CI 0.79-0.95) and colon cancer (aHR 0.93, 95% CI 0.90-0.97), irrespective of sex. In terms of the intensity and amount of PA, moderate intensity PA was the most effective, and a positive correlation was found between the amount of PA and the reduction in CRC incidence.

CONCLUSION

Regular PA was independently associated with a decreased risk of CRC in patients with diabetes. The intensity and amount of physical activity both play a role in reducing the risk.

Physical activity is inversely associated with overall cancer risk among college students in the United States: Results from the National College Health Assessment

To our knowledge, this is the first epidemiologic study to examine the association between physical activity (PA) and cancer using data from the American College Health Association-National College Health Assessment (ACHA-NCHA). The goal of the study was to understand the dose-response relation between PA and cancer, as well as the associations between meeting US PA guidelines and overall cancer risk in US college students. The ACHA-NCHA provided self-reported information on demographic characteristics, PA, body mass index, smoking status, and overall cancer during 2019-2022 (n = 293,682; 0.08% cancer cases). To illustrate the dose-response relationship, a restricted cubic spline logistic regression analysis was used to evaluate the association of overall cancer with moderate-to-vigorous PA (MVPA) on a continuous basis. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals for the associations between meeting the three U.S. PA guidelines and overall cancer risk. The cubic spline observed that MVPA was inversely associated with the odds of overall cancer risk after adjusting for covariates; a one hour/week increase in moderate and vigorous PA was associated with a 1% and 5% reduced overall cancer risk, respectively. Multivariable-adjusted logistic regression analyses showed that meeting the US guidelines for aerobic PA for adults (≥150 minutes/week of moderate aerobic PA or ≥75 minutes of vigorous PA) (OR: 0.85), for PA for adults (≥2 days of muscle strengthening activity in addition to aerobic MVPA) (OR: 0.90), and for highly active adults (≥2 days of muscle strengthening activity and ≥300 minutes/week of aerobic moderate PA or 150 minutes/week of vigorous PA) (OR: 0.89) were statistically significant and inversely associated with cancer risk. MVPA, especially meeting US guidelines, may be inversely associated with overall cancer among college students in the US. To reduce cancer risks, multilevel interventions to promote US physical activity guidelines among college students are warranted.

Muscle-derived exosomes and exercise in cancer prevention

There are a lot of evidences on the beneficial effects mediated by exercise on the prevention of not communicable diseases (NCDs) including different type of cancer. The production of circulating exerkines transported in exosomes represents a novel pathway activated by exercise. However, the biological mechanisms that could explain the role of exosomes in cancer prevention have been not fully elucidated. The aim of this mini-review is to provide an update on the biological mechanisms bringing the release of muscle-derived exosomes during exercise and cancer prevention.

The tumor-nerve circuit in breast cancer

It is well established that innervation is one of the updated hallmarks of cancer and that psychological stress promotes the initiation and progression of cancer. The breast tumor environment includes not only fibroblasts, adipocytes, endothelial cells, and lymphocytes but also neurons, which is increasingly discovered important in breast cancer progression. Peripheral nerves, especially sympathetic, parasympathetic, and sensory nerves, have been reported to play important but different roles in breast cancer. However, their roles in the breast cancer progression and treatment are still controversial. In addition, the brain is one of the favorite sites of breast cancer metastasis. In this review, we first summarize the innervation of breast cancer and its mechanism in regulating cancer growth and metastasis. Next, we summarize the neural-related molecular markers in breast cancer diagnosis and treatment. In addition, we review drugs and emerging technologies used to block the interactions between nerves and breast cancer. Finally, we discuss future research directions in this field. In conclusion, the further research in breast cancer and its interactions with innervated neurons or neurotransmitters is promising in the clinical management of breast cancer.

Risk-Reducing Measures for Cancer Prevention

Cancer, or malignancy, continues to be one of the most serious health problems in the world, leading to death and disability. Unlike in previous years, where new cases of cancer were predominant in developed nations, the number of cases of cancer and the resultant deaths are increasing in low- and middle-income countries. This is partially attributable to the current trend of adopting a Western lifestyle, substantial urbanization, and the rise in infections, such as the human papillomavirus (HPV) and hepatitis B virus (HBV), which together account for over 30% of cancer cases in underdeveloped and developing nations. The deleterious impact of cancer, as cases multiply worldwide, is multi-dimensional. Cancer exerts serious physical, psychological, and monetary burdens, not only on cancer patients but also on their family members, close friends, health care systems, and society at large. Importantly, over half of all cancer types can be prevented globally by mitigating the risk and causative factors as well as prompt adherence to scientifically recommended prevention measures. This review provides various scientifically based and people-centered strategies that every individual could adopt to reduce their risk of developing cancer in the future. It is recommended that, for these cancer prevention strategies to be effective, there should be a strong political will from the governments of individual countries to enact specific laws and implement policies that will significantly reduce sedentary lifestyles and unhealthy eating among the general public. Likewise, HPV and HBV vaccines, as well as cancer screenings, should be made available, affordable, and accessible on a timely basis for those who are eligible to take them. Finally, intensified campaigns and numerous informative and educational programs that promote cancer prevention should be initiated globally.

Physical activity and risk of lung cancer: A systematic review and dose-response meta-analysis of cohort studies

Objective

To synthesize the knowledge about the association of total physical activity (TPA), leisure-time physical activity (LTPA), occupational physical activity (OPA) and lung cancer risk and explore the dose-response relationship between LTPA level and lung cancer.

Methods

PubMed and Web of Science were searched up to 17 November 2021. The summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated by random-effects or fixed-effects model. The dose-response analysis was conducted with restricted cubic splines.

Results

We identified 25 articles (42 cohort studies) that assessed the physical activity-lung cancer association, including 9,983,295 study participants and 85,988 incident cases of lung cancer. When comparing the highest to the lowest level of TPA and LTPA, lung cancer risk reduced 22% (RR, 0.78; 95% CI: 0.70, 0.86) and 12% (RR, 0.88; 95% CI: 0.83, 0.93), respectively. We found an approximately U-shaped association between LTPA and lung cancer (P non-linearity < 0.001), with the lowest risk at 15 metabolic equivalent of task hours per week (h/wk) of LTPA. Compared to participants with sitting occupations, lung cancer risk significantly increased among those being unemployed (RR, 1.33; 95% CI: 1.17, 1.51) or with standing occupations (RR, 1.37; 95% CI: 1.15, 1.63), but not among those with light or high OPA.

Conclusions

Our meta-analysis supported a protective effect of TPA and LTPA, but not OPA, on lung cancer risk. The novel finding of a U-shaped association between LTPA and lung cancer risk warrants further investigation.

Motivational readiness for physical activity and health literacy: results of a cross-sectional survey of the adult population in Germany

BACKGROUND

Health literacy, defined as the knowledge, motivation, and competences to use health information to improve health and well-being, is associated with regular physical activity. However, there is limited evidence on whether health literacy is also related to the motivational readiness for physical activity in a general population. The aim of this study was to investigate whether motivational readiness for leisure-time physical activity is associated with health literacy.

METHODS

Analyses were based on data of 21,895 adults from the cross-sectional German Health Update and European Health Interview Survey 2014/2015 (GEDA 2014/2015-EHIS). Motivational readiness for leisure-time physical activity was assessed with stages of change for physical activity with a set of validated items. It was then classified, according to an established algorithm, into five stages: precontemplation, contemplation, preparation, action, and maintenance. Health literacy was measured with the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and categorised as low, medium, and high. For bivariate and multinomial logistic regression analyses, the stages were categorised in three phases as: (1) no intention (precontemplation), (2) planning (contemplation or preparation), and (3) in activity (action or maintenance). The models were adjusted for sex, age, education, health consciousness, self-efficacy, and self-perceived general health status.

RESULTS

High compared to low health literacy was associated with a 1.65-times (95% CI = 1.39-1.96) greater probability of being in activity than planning. High compared to low health literacy was associated with a reduced risk of having no intention to change physical activity behaviour (relative risk ratio, RRR = 0.84, 95% CI = 0.75-0.95). The associations persisted after adjusting for covariates.

CONCLUSION

High health literacy was positively associated with more advanced phases of motivational readiness for leisure-time physical activity. Therefore, taking health literacy into account in interventions to promote motivational readiness for leisure-time physical activity could be a useful approach.

Physical activity, polygenic risk score, and colorectal cancer risk

INTRODUCTION

Whether and to what extent the relationship between physical activity (PA) and colorectal cancer (CRC) differs according to CRC-related genetic risk remains to be determined, and no studies to date have quantified how much genetically determined risk could be compensated for with active exercise.

METHODS

Genetic risk was quantified by a polygenic risk score (PRS) summarizing the estimated effect of 140 CRC-associated genetic variants. Associations of PA with CRC risk were estimated by multivariable logistic regression across PRS levels. We also compared the impact of PA and specific PA types to the PRS using "genetic risk equivalent (GRE)", a novel approach to enhance effective risk communication.

RESULTS

Among 5058 CRC patients and 4134 controls, we observed no significant association between overall PA level in quartiles and CRC risk. However, the highest versus lowest lifetime leisure time physical activity (LTPA) was associated with a 13% lower CRC risk [odds ratio 0.87, 95% confidence interval (CI) 0.77-1.00] independent of PRS levels (adjusted p value for interaction = 0.18). This effect was equivalent to the effect of having 11 percentiles lower PRS (GRE -10.6, 95% CI -20.7 to -0.6). The GRE (95% CI) for the highest lifetime sports tertile was -23.0 (-33.9 to -12.0).

CONCLUSIONS

LTPA was inversely associated with CRC risk irrespective of polygenic risk for CRC, which reinforces the importance of LTPA in CRC prevention among the general population. Adequate sports activity can compensate for a large share of polygenic risk for CRC.

Metabolic Health, Mitochondrial Fitness, Physical Activity, and Cancer

Cancer continues to be a significant global health issue. Traditional genetic-based approaches to understanding and treating cancer have had limited success. Researchers are increasingly exploring the impact of the environment, specifically inflammation and metabolism, on cancer development. Examining the role of mitochondria in this context is crucial for understanding the connections between metabolic health, physical activity, and cancer. This study aimed to review the literature on this topic through a comprehensive narrative review of various databases including MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. The review highlighted the importance of mitochondrial function in overall health and in regulating key events in cancer development, such as apoptosis. The concept of "mitochondrial fitness" emphasizes the crucial role of mitochondria in cell metabolism, particularly their oxidative functions, and how proper function can prevent replication errors and regulate apoptosis. Engaging in high-energy-demanding movement, such as exercise, is a powerful intervention for improving mitochondrial function and increasing resistance to environmental stressors. These findings support the significance of considering the role of the environment, specifically inflammation and metabolism, in cancer development and treatment. Further research is required to fully understand the mechanisms by which physical activity improves mitochondrial function and potentially reduces the risk of cancer.

Bibliometric analysis of global research on physical activity and sedentary behavior in the context of cancer

Objective

Numerous studies focusing on sedentary behavior (SB) and physical activity (PA) in the context of cancer have been reported in recent years. We analyzed and visualized studies on SB and PA in patients with cancer over the last 20 years using scientometric methods, to provide insights on gaps and deficiencies in the literature, and to inform future research guidelines.

Methods

All relevant studies in the field from 2001 to October 2022 were reviewed using bibliometric tools, including VOSviewer, Bibliometric online analysis platform, and biblioshiny, to determine the most influential countries, institutions, journals, and authors. We explored current research hotpots and potential research trends, based on keyword clustering and dynamic changes. Our research focuses on PA, SB, and cancer across the entire cancer continuum, from primary prevention to treatment to cancer survivorship.

Results

Scientometric analysis identified 4,382 relevant manuscripts on SB and PA in the context of cancer, with a 10-fold increase in articles over the past 20 years. The United States, Canada, and Australia were the most influential countries. The journal, Supportive Care in Cancer, had the highest number of publications, while Clinical Oncology had the highest H-index. K.S. Courneya was the most influential author in this field, with the highest number of publications, total citations, and H-index. Keyword analysis revealed that current research is focused on PA and SB in patients with breast cancer, quality of life, and aerobic exercise. Future frontiers include cancer prehabilitation programs and cardiorespiratory fitness, and remote intervention and social support.

Conclusion

By using bibliometrics, we conducted a comprehensive review of SB and PA in cancer-related studies. The current research focused on exercise and sedentariness in breast cancer patients and the role of PA in improving quality of life in survivorship. Emerging research foci were generally around cancer prehabilitation programs and remote intervention issues for PA. In addition, some publication deficits are noted: studies of PA and SB in less common cancers; the recommended doses and intensities of exercise for cancer; the timing of interventions for prehabilitation and the establishment of individualized exercise protocols. These deficiencies align with the needs for future research topics.

Beyond colonoscopy: Physical activity as a viable adjunct to prevent colorectal cancer

Colorectal cancer (CRC) is a common cancer with an increasing incidence worldwide. The implementation of a mass screening program has been proven effective in reducing the global burden of CRC, but its effectiveness is not ideal and some metabolic derangements and lifestyle factors were reported to be attributable for such a deficit. Implementing positive lifestyle intervention as primary prevention therefore becomes critical because colorectal carcinogenesis can be promoted by several lifestyle factors, such as a lack of physical activity. Herein, we review the current evidence on the association and possible mechanisms between physical activity and CRC carcinogenesis. In addition, since CRC prevention heavily relies on resection of precancerous polyps and subsequent surveillance by colonoscopy, this review will also explore the impact of physical activity on populations with different colorectal polyp risks and its potential adjunct role in altering surveillance outcomes.

The underexplored links between cancer and the internal body climate: Implications for cancer prevention and treatment

In order to effectively manage and cure cancer we should move beyond the general view of cancer as a random process of genetic alterations leading to uncontrolled cell proliferation or simply a predictable evolutionary process involving selection for traits that increase cell fitness. In our view, cancer is a systemic disease that involves multiple interactions not only among cells within tumors or between tumors and surrounding tissues but also with the entire organism and its internal "milieu". We define the internal body climate as an emergent property resulting from spatial and temporal interactions among internal components themselves and with the external environment. The body climate itself can either prevent, promote or support cancer initiation and progression (top-down effect; i.e., body climate-induced effects on cancer), as well as be perturbed by cancer (bottom-up effect; i.e., cancer-induced body climate changes) to further favor cancer progression and spread. This positive feedback loop can move the system towards a "cancerized" organism and ultimately results in its demise. In our view, cancer not only affects the entire system; it is a reflection of an imbalance of the entire system. This model provides an integrated framework to study all aspects of cancer as a systemic disease, and also highlights unexplored links that can be altered to both prevent body climate changes that favor cancer initiation, progression and dissemination as well as manipulate or restore the body internal climate to hinder the success of cancer inception, progression and metastasis or improve therapy outcomes. To do so, we need to (i) identify cancer-relevant factors that affect specific climate components, (ii) develop 'body climate biomarkers', (iii) define 'body climate scores', and (iv) develop strategies to prevent climate changes, stop or slow the changes, or even revert the changes (climate restoration).

Behavioral factors to modulate immunotherapy efficacy in cancer

Immune checkpoint inhibitors, including anti-PD-1 and anti-CTLA-4 therapies, are used to (re)activate the immune system to treat cancer. Despite promising results, a large group of patients does not respond to checkpoint inhibition. In the vulnerability-stress model of behavioral medicine, behavioral factors, such as stress, exercise and classical pharmacological conditioning, predict cancer incidence, recurrence and the efficacy of conventional cancer treatments. Given the important role of the immune system in these processes, certain behavior may be promising to complement immune checkpoint inhibition therapy. Here, we discuss the preliminary evidence and suitability of three behavioral mechanisms, i.e. stress modulation, exercise and classical pharmacological conditioning for the benefit of immunotherapy. It is crucial to study the potential beneficial effects of behavioral strategies that support immunotherapeutic anti-tumor effects with rigorous experimental evidence, to exploit behavioral mechanisms in improving checkpoint inhibition efficacy.

Examining the Dose-Response Relationship between Physical Activity and Health Outcomes

Physical Activity and Health and LongevityPhysical activity is a powerful tool to improve health. This article reviews the evidence supporting a relationship between physical activity and health outcomes, including mortality, and discusses the optimal dose of physical activity.

Physical activity for health

Physical activity plays a substantial role in maintaining people's good health and mental wellbeing, but that is not all: not only it positively affects the individuals' mental and physical health, but a lack of physical exercise exerts a negative impact also on the overall economy of a nation. In addition, physical inactivity not only increases the risk of non-communicable diseases (NCD), but also contributes significantly to the increased morbidity and mortality in patients suffering from these diseases. On the contrary, physical activity reduces the risk of NCDs - such as cardiovascular diseases, type 2 diabetes, and cancer - in a dose-dependent manner; regular exercise is also associated with many health benefits and delayed mortality. However, understanding the role of physical activity in modern society and creating an awareness in the general population is one of the most important tasks of health and recreation promoters. Correspondingly, there is a dire need to enhance our knowledge, perception, and awareness of physical activity and its impacts on an individual's health, ultimately contributing to developing a healthy society. The current review will focus on the health benefits of the two most widely studied modifiable lifestyle risk factors, physical activity and diet, focusing particularly on the Mediterranean diet.

Detrimental effects of physical inactivity on peripheral and brain vasculature in humans: Insights into mechanisms, long-term health consequences and protective strategies

The growing prevalence of physical inactivity in the population highlights the urgent need for a more comprehensive understanding of how sedentary behaviour affects health, the mechanisms involved and what strategies are effective in counteracting its negative effects. Physical inactivity is an independent risk factor for different pathologies including atherosclerosis, hypertension and cardiovascular disease. It is known to progressively lead to reduced life expectancy and quality of life, and it is the fourth leading risk factor for mortality worldwide. Recent evidence indicates that uninterrupted prolonged sitting and short-term inactivity periods impair endothelial function (measured by flow-mediated dilation) and induce arterial structural alterations, predominantly in the lower body vasculature. Similar effects may occur in the cerebral vasculature, with recent evidence showing impairments in cerebral blood flow following prolonged sitting. The precise molecular and physiological mechanisms underlying inactivity-induced vascular dysfunction in humans are yet to be fully established, although evidence to date indicates that it may involve modulation of shear stress, inflammatory and vascular biomarkers. Despite the steady increase in sedentarism in our societies, only a few intervention strategies have been investigated for their efficacy in counteracting the associated vascular impairments. The current review provides a comprehensive overview of the evidence linking acute and short-term physical inactivity to detrimental effects on peripheral, central and cerebral vascular health in humans. We further examine the underlying molecular and physiological mechanisms and attempt to link these to long-term consequences for cardiovascular health. Finally, we summarize and discuss the efficacy of lifestyle interventions in offsetting the negative consequences of physical inactivity.

Muscle-to-tumor crosstalk: The effect of exercise-induced myokine on cancer progression

Physical exercise has gradually become a focus in cancer treatment due to its pronounced role in reducing cancer risk, enhancing therapeutic efficacy, and improving prognosis. In recent decades, skeletal muscles have been considered endocrine organs, exerting their biological functions via the endocrine, autocrine, and paracrine systems by secreting various types of myokines. The amount of myokines secreted varies depending on the intensity, type, and duration of exercise. Recent studies have shown that muscle-derived myokines are highly involved the effects of exercise on cancer. Multiple myokines, such as interleukin-6 (IL-6), oncostatin M (OSM), secreted protein acidic and rich in cysteine (SPARC), and irisin, directly mediate cancer progression by influencing the proliferation, apoptosis, stemness, drug resistance, metabolic reprogramming, and epithelial-mesenchymal transformation (EMT) of cancer cells. In addition, IL-6, interleukin-8 (IL-8), interleukin-15 (IL-15), brain-derived neurotrophic factor (BDNF), and irisin can improve obesity-induced inflammation by stimulating lipolysis of adipose tissues, promoting glucose uptake, and accelerating the browning of white fat. Furthermore, some myokines could regulate the tumor microenvironment, such as angiogenesis and the immune microenvironment. Cancer cachexia occurs in up to 80% of cancer patients and is responsible for 22%-30% of patient deaths. It is characterized by systemic inflammation and decreased muscle mass. Exercise-induced myokine production is important in regulating cancer cachexia. This review summarizes the roles and underlying mechanisms of myokines, such as IL-6, myostatin, IL-15, irisin, fibroblast growth factor 21 (FGF21) and musclin, in cancer cachexia. Through comprehensive analysis, we conclude that myokines are potential targets for inhibiting cancer progression and the associated cachexia.

Physical activity and/or sedentary behaviour and the development of functional disability in community-dwelling older adults in Tsuru, Japan: a prospective cohort study (the Tsuru Longitudinal Study)

OBJECTIVES

To clarify the association between moderate-to-vigorous physical activity (MVPA) and/or sedentary behaviour (SB) and the incidence of functional disability (FD) in older adults.

DESIGN

Prospective cohort study.

SETTING

Local municipality of Tsuru, Yamanashi, Japan. We conducted a baseline survey in January 2016. Follow-up was commenced on 1 February 2016 and completed on 31 October 2018.

PARTICIPANTS

All individuals (6661 people) aged >65 years who were independently living in the community were eligible.

METHODS AND OUTCOME MEASURES

MVPA (min/week) and SB (min/day) were measured using self-administered questionnaires in 5311 independently living older adults who participated in this study. The follow-up period was 33 months, and the incidence of FD was objectively determined by experts. The participants were divided into three groups based on MVPA distribution (non-MVPA, 0 min; short-MVPA, 1-299 min and long-MVPA, ≥300 min/week) and into two groups based on the median value of SB (short-SB,<190 min; and long-SB, ≥190 min/day). The participants were also classified into six categories based on different combinations of MVPA and SB. Cox proportional hazards model was used to calculate the HR and 95% CI for FD development with MVPA, SB and a combination of these behaviours.

RESULTS

Among the included participants, 2415 were male and 2896 were female. The mean ages (SD) of the male and female participants were 74.5 (6.8) and 74.9 (6.9) years, respectively. The total number of participants with chronic conditions was 3489 (65.7%). Using the non-MVPA group as the reference, the multivariable-adjusted HR (95% CI) was 0.68 (0.54 to 0.84) in the short-MVPA group and 0.53 (0.41 to 0.69) in the long-MVPA group. Regarding SB, the short-SB group had an HR of 0.86 (0.71 to 1.03) compared with the long-SB group. The combined behaviour showed the lowest HR in the long-MVPA and short-SB group 0.49 (0.34 to 0.72) and the long-MVPA and long-SB group 0.49 (0.34 to 0.68), respectively.

CONCLUSIONS

Long-MVPA had a robust association with FD development, whereas short-SB had a modest association. Moreover, a combination of these behaviours had a stronger association than individual behaviours. If the identified associations are assumed to be causal in nature, these findings suggest that encouraging older adults to engage in MVPA and reduce SB in their daily lives could be effective to prevent or delay FD development.

Why exercise has a crucial role in cancer prevention, risk reduction and improved outcomes

INTRODUCTION

Exercise is one of several factors known to lower the risk of developing cancer, as well as improve outcomes in patients already diagnosed. People who exercise after cancer have lower rates of cancer complications, treatment toxicities, relapse and improved survival. This review highlights the supportive data and biochemical processes, which explain these potential benefits.

SOURCES OF DATA

PubMed, Embase, Medline and Cochrane libraries were searched for papers which addressed the effects of exercise and physical activity on cancer for this review. The search terms used were physical activity, exercise and cancer up to February 2021. We also referred to the background research required for international exercise intervention study involving men with prostate cancer (INTERVAL-GAP4) and scrutinized references within the robust papers published on this subject to ensure we did not miss any clinically studies. One hundred and eighty eight papers were included.

AREAS OF AGREEMENT

Exercise programmes mitigate many of the complications and risks associated with cancer, particularly thromboembolism, fatigue, weight gain, arthralgia, cognitive impairment and depression.

AREAS OF CONTROVERSY

Molecular and biomarker changes, resulting from exercise, suggest that exercise elicits beneficial changes in insulin-related pathways, down-regulates inflammation and serum oestrogen levels, and enhances oxidative, immune and cellular repair pathways. Nonetheless, the evidence remains preliminary.

GROWING POINTS

The timing, intensity and challenges of prehabilitation, adjunct and rehabilitation exercise programmes are being increasingly understood but their implementation remains sporadic.

AREAS FOR DEVELOPING RESEARCH

More robust clinical trial data are needed to substantiate a causal effect of exercise on overall and cancer-specific survival. These studies are ongoing. Research evaluating the most cost-efficient ways of incorporating prehabilitation, adjunct and rehabilitation programmes into routine practice would be helpful to funding bodies and health care strategists.

Special Attention to Physical Activity in Breast Cancer Patients during the First Wave of COVID-19 Pandemic in Italy: The DianaWeb Cohort

Recent evidence highlights that physical activity (PA) is associated with decreased recurrence risk, improved survival and quality of life for breast cancer (BC) patients. Our study aimed to explore patterns of increased/decreased PA, and sedentary behaviors among BC women of the DianaWeb cohort during the first wave of COVID-19 pandemic, and examined the association with residential locations, work changes, different modality used to increase PA, and quality of life. The study analyzed the questionnaires completed by the 781 BC women (age 54.68 ± 8.75 years on both December 2019 and June 2020. Results showed a decrease of 22%, 57%, and 26% for walking activity, vigorous activity, and total PA, respectively. Sitting/lying time increased up to 54.2% of the subjects recruited. High quality of life was associated with lower odds of being sedentary (p = 0.003). Our findings suggest that innovative health management fostering compliance with current guidelines for PA and active behavior should be implemented, especially in unpredictable emergency conditions.

A Physically Active Status Affects the Circulating Profile of Cancer-Associated miRNAs

Circulating miRNAs are ideal diagnostics and prognostics biomarkers in cancer since altered levels of specific miRNAs have been associated to development/progression of several cancers. Physical activity is a recognized preventive strategy against several cancers, but it may also modify the baseline levels of cancer-associated miRNAs and, hence, may act as a confounding pre-analytical variable. This study aimed at understanding whether physical activity-dependent changes in cancer-associated circulating miRNAs profile could act as a confounding variable. A panel comprising 179 miRNAs was assayed in plasma from 20 highly trained and 10 sedentary men. RT-qPCR data were analyzed with the 2^−2ΔΔCT methods and normalized on hsa-miR-320d, as determined by bioinformatics analysis. miRNAs associated with the diagnosis of the most prevalent cancers were considered. Only those miRNAs, relevantly associated with cancers, found ≥2-fold up- or downregulated in highly trained subjects compared to sedentary were disclosed. The results reveal that chronic physical activity determined modifications altering the baseline level of several cancer-associated miRNAs and, hence, their diagnostic and prognostic potential. In conclusion, based on our results, a physically active status emerges as an important pre-analytical variable able to alter the basal level of circulating miRNAs, and these alterations might be considered as potentially misleading the analytical output.

Roles and molecular mechanisms of physical exercise in cancer prevention and treatment

Exercise can enhance motivation to change lifestyle behaviors, improve aerobic fitness, improve physical function, control fatigue, and enhance quality of life. Studies have demonstrated the benefits to be gained from physical exercise, highlighting the importance of popularizing the concept of physical exercise for individuals and making professional exercise-treatment programs available to patients with cancer. However, the correlation between physical exercise and carcinogenesis is easily overlooked, and exercise interventions are not routinely provided to patients with cancer, especially those with advanced cancer. In this article, we present a literature review of the effects of exercise on cancer development and progression and give recent evidence for the type of exercise best suited for different types of cancer and in different disease stages. Moreover, the molecular mechanisms about regulating metabolism and systemic immune function in cancer are summarized and discussed. In conclusion, physical exercise should be considered as an important intervention for preventing and treating cancer and its complications.

Fitness and prostate cancer screening, incidence, and mortality: Results from the Henry Ford Exercise Testing (FIT) Project

BACKGROUND

The relation between cardiorespiratory fitness (CRF) and prostate cancer is not well established. The objective of this study was to determine whether CRF is associated with prostate cancer screening, incidence, or mortality.

METHODS

The Henry Ford Exercise Testing Project is a retrospective cohort study of men aged 40 to 70 years without cancer who underwent physician-referred exercise stress testing from 1995 to 2009. CRF was quantified in metabolic equivalents of task (METs) (<6 [reference], 6-9, 10-11, and ≥12 METs), estimated from the peak workload achieved during a symptom-limited, maximal exercise stress test. Prostate-specific antigen (PSA) testing, incident prostate cancer, and all-cause mortality were analyzed with multivariable adjusted Poisson regression and Cox proportional hazard models.

RESULTS

In total, 22,827 men were included, of whom 739 developed prostate cancer, with a median follow-up of 7.5 years. Men who had high fitness (≥12 METs) had an 28% higher risk of PSA screening (95% CI, 1.2-1.3) compared with those who had low fitness (<6 METs. After adjusting for PSA screening, fitness was associated with higher prostate cancer incidence (men aged <55 years, P = .02; men aged >55 years, P ≤ .01), but not with advanced prostate cancer. Among the men who were diagnosed with prostate cancer, high fitness was associated with a 60% lower risk of all-cause mortality (95% CI, 0.2-0.9).

CONCLUSIONS

Although men with high fitness are more likely to undergo PSA screening, this does not fully account for the increased incidence of prostate cancer seen among these individuals. However, men with high fitness have a lower risk of death after a prostate cancer diagnosis, suggesting that the cancers identified may be low-risk with little impact on long-term outcomes.

Model with the GBDT for Colorectal Adenoma Risk Diagnosis

Background and Objective:

Colorectal cancer (CRC) is a common malignant tumor of the digestive system; it is associated with high morbidity and mortality. However, an early prediction of colorectal adenoma (CRA) that is a precancerous disease of most CRC patients provides an opportunity to make an appropriate strategy for prevention, early diagnosis and treatment. It has been aimed to develop a machine learning model to predict CRA that could assist physicians in classifying high-risk patients, make informed choices and prevent CRC.

Methods:

Patients who had undergone a colonoscopy to fill out a questionnaire at the Sixth People Hospital of Shanghai in China from July 2018 to November 2018 were instructed. A classification model with the gradient boosting decision tree (GBDT) was developed to predict CRA. This model was compared with three other models, namely, random forest (RF), support vector machine (SVM), and logistic regression (LR). The area under the receiver operating characteristic curve (AUC) was used to evaluate performance of the models.

Results:

Among the 245 included patients, 65 patients had CRA. The area under the receiver operating characteristic (AUCs) of GBDT, RF, SVM ,and LR with 10 fold-cross validation was 0.8131, 0.74, 0.769 and 0.763. An online prediction service, CRA Inference System, to substantialize the proposed solution for patients with CRA was also built.

Conclusion:

Four classification models for CRA prediction were developed and compared, and the GBDT model showed the highest performance. Implementing a GBDT model for screening can reduce the cost of time and money and help physicians identify high-risk groups for primary prevention.

Role of physical activity and fitness on sleep in sedentary middle-aged adults: the FIT-AGEING study

The association of physical activity and fitness with sleep still remains unclear since there is a lack of studies in this field of research using objective measurements of these variables. This study aimed to investigate the association of objectively-measured sedentariness, physical activity levels, and physical fitness with sleep quantity and quality in sedentary middle-aged adults. A total of 74 volunteers (52.7% women; aged 53.7 ± 5.1) were recruited for the present study. Cardiorespiratory fitness was measured through a maximal treadmill test, and muscular strength by extension and flexion peak torque, and by the hand grip test. Physical activity and objective sleep parameters were determined through accelerometry, and subjective sleep by the Pittsburgh Sleep Quality Index (PSQI). Reduced levels of sedentariness, greater VO_2max, and greater muscular strength were positively related to improved objective sleep quantity and quality (all P ≤ 0.05). Furthermore, higher levels of overall physical activity, VO_2max, and muscular strength were related to better subjective sleep quantity and quality (all P ≤ 0.05). Reduced sedentariness and increased physical activity and fitness may be a potential prevention and/or treatment pathway to reduce sleep disturbances and, in general, to improve patients physical and psychological health for a successful aging process.

Physical Activity and Liver Cancer Risk: A Systematic Review and Meta-analyses

OBJECTIVE

Liver cancer is the second most common cause of death from cancer. Physical activity (PA) was found to be associated with lower risks of several types of cancer. However, the association between PA and the risk of liver cancer is still inconclusive. This systematic review and meta-analysis was aiming to summarize the association between PA and liver cancer risk.

METHODS

Literatures related were identified by searching PubMed, EMBASE, and Chinese Biomedical literature database from 1965 to 2017 without language limitation. Meta-analyses were performed using random effect model.

RESULTS

A total of 5 cohort studies involving 2 513 975 subjects were identified. The pooled relative risk of leisure-time PA with liver cancer risk was 0.92 [95% confidence interval (CI), 0.84-1.01]. There is no significant association between leisure-time PA and liver cancer risk. However, leisure-time PA significantly reduced liver cancer risk in never smokers. The pooled hazard ratio of daily total PA with liver cancer risk was 0.75 (95% CI, 0.66-0.86).

CONCLUSIONS

Daily total PA significantly reduces liver cancer risk, whereas leisure-time PA significantly reduces liver cancer risk only in never smokers.

Association between physical activity and digestive-system cancer: An updated systematic review and meta-analysis

BACKGROUND

Physical activity (PA) may have an impact on digestive-system cancer (DSC) by improving insulin sensitivity and anticancer immune function and by reducing the exposure of the digestive tract to carcinogens by stimulating gastrointestinal motility, thus reducing transit time. The current study aimed to determine the effect of PA on different types of DSC via a systematic review and meta-analysis.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched for relevant studies in PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. Using a random effects model, the relationship between PA and different types of DSC was analyzed.

RESULTS

The data used for meta-analysis were derived from 161 risk estimates in 47 studies involving 5,797,768 participants and 55,162 cases. We assessed the pooled associations between high vs. low PA levels and the risk of DSC (risk ratio (RR)  = 0.82, 95% confidence interval (95%CI): 0.79-0.85), colon cancer (RR = 0.81, 95%CI: 0.76-0.87), rectal cancer (RR = 0.88, 95%CI: 0.80-0.98), colorectal cancer (RR = 0.77, 95%CI: 0.69-0.85), gallbladder cancer (RR = 0.79, 95%CI: 0.64-0.98), gastric cancer (RR = 0.83, 95%CI: 0.76-0.91), liver cancer (RR = 0.73, 0.60-0.89), oropharyngeal cancer (RR = 0.79, 95%CI: 0.72-0.87), and pancreatic cancer (RR = 0.85, 95%CI: 0.78-0.93). The findings were comparable between case-control studies (RR = 0.73, 95%CI: 0.68-0.78) and prospective cohort studies (RR = 0.88, 95%CI: 0.80-0.91). The meta-analysis of 9 studies reporting low, moderate, and high PA levels, with 17 risk estimates, showed that compared to low PA, moderate PA may also reduce the risk of DSC (RR = 0.89, 95%CI: 0.80-1.00), while compared to moderate PA, high PA seemed to slightly increase the risk of DSC, although the results were not statistically significant (RR = 1.11, 95%CI: 0.94-1.32). In addition, limited evidence from 5 studies suggested that meeting the international PA guidelines might not significantly reduce the risk of DSC (RR = 0.96, 95%CI: 0.91-1.02).

CONCLUSION

Compared to previous research, this systematic review has provided more comprehensive information about the inverse relationship between PA and DSC risk. The updated evidence from the current meta-analysis indicates that a moderate-to-high PA level is a common protective factor that can significantly lower the overall risk of DSC. However, the reduction rate for specific cancers may vary. In addition, limited evidence suggests that meeting the international PA guidelines might not significantly reduce the risk of DSC. Thus, future studies must be conducted to determine the optimal dosage, frequency, intensity, and duration of PA required to reduce DSC risk effectively.

What is the gut feeling telling us about physical activity in colorectal carcinogenesis?

In the last decades, more efforts are focused on the prevention and treatment of malignant diseases, given the increase in all cancers incidence A lifestyle change, including healthy eating habits and regular physical activity, has significantly impacted colorectal cancer prevention. The effect of dose-dependent physical activity on mortality and recurrence rates of colorectal carcinoma has been unequivocally demonstrated in observational studies. However, clear recommendations are not available on the frequency, duration, and intensity of exercise in patients with colorectal cancer due to the lack of evidence in randomized clinical trials. Regarding pathophysiological mechanisms, the most plausible explanation appears to be the influence of physical activity on reducing chronic inflammation and insulin resistance with a consequent positive effect on insulin growth factor 1 signaling pathways.

Healthy lifestyle and cancer risk among Chinese population in the Dongfeng-Tongji cohort

BACKGROUND

Studies on the association between healthy lifestyle and cancer risk are limited among the old Chinese population.

METHODS

The healthy lifestyle score was derived from smoking, drinking, diet, body mass index and physical activity among 23734 retired employees from the Dongfeng-Tongji Cohort. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs). The rate advancement periods (RAPs) and the population attributable risk percentage (PAR%) were estimated to indicate the benefits of removing risk lifestyle factors.

RESULTS

During a median follow-up of 8.16 years, 2023 cancer cases were identified. Compared with 0-2 points of the healthy lifestyle score, the HRs were 0.87 (95% CI: 0.76, 0.99), 0.83 (95% CI: 0.73, 0.94), and 0.74 (95% CI: 0.64, 0.86) for 3, 4, and 5 points, respectively, with the corresponding RAPs of -4.40 (95% CI: -8.39, -0.41), -5.84 (95% CI: -9.77, -1.90), and -9.14 (95% CI: -14.03, -4.25), respectively. Approximately 15% of incident cancer cases among total population and 22% among men would be prevented by following all 5 healthy lifestyle factors.

CONCLUSIONS

The current study suggests that healthy lifestyle could reduce cancer risk in the retired Chinese population, especially in males. Key messages Healthy lifestyle derived by smoking, drinking, diet, body mass index and physical activity presented a strong protective effect on cancer risk among the retired Chinese population, especially in males. We employed the rate advancement periods and the population attributable risk percentage to indicate the benefits of adopting healthy lifestyle and we found that following all 5 healthy lifestyle factors could delay the risk of developing cancer by 9.14 years and prevent 15% of incident cancer cases.

Electronic wearable device and physical activity among US adults: An analysis of 2019 HINTS data

BACKGROUND

Promoting physical activity is one of the most critical components in strategies to improve both individual and population health. Previous studies on electronic wearable devices (EWDs) have shown modest improvements in physical activity, including daily steps and energy expenditures. Large population-based evidence on EWDs and physical activity is needed to better understand the patterns of EWD use and physical activity.

METHODS

This cross-sectional study used data from the Health Information National Trends Survey 2019. We calculated weighted frequencies and prevalence of EWD utilization. Wald Chi-square test was used to compare individual characteristics by EWD use, and multivariable logistic regression model was fitted to examine the associations between EWD use and physical activity level while adjusting for sociodemographic/health-related characteristics.

RESULTS

The final sample included 4219 respondents representing 212,976,500 US adults aged 18 years or older. The overall utilization of EWDs in this group was 28.2 % (95 % CI, 26.0-30.5%). Respondents who used EWDs were more likely to have 150 min/week or over physical activities compared to those who did not use EWDs in the past 12 months (OR, 1.53, 95 % CI, 1.16-2.02). When restricting the analaysis to those with chronic conditions only, EWD use was still associated with higher level of physical activity (OR, 1.74, 95 % CI, 1.02-2.98).

CONCLUSIONS

About three in ten Americans reported using EWDs in the past year. EWD use seems to be associated with achieving a higher level of physical activity. Further studies are needed to examine the effect of EWD use on other clinical measures and subsequent health outcomes.

Aerobic Fitness is a Predictor of Body Composition in Women With Breast Cancer at Diagnosis

BACKGROUND

The objective of this study was to investigate the relationship of aerobic fitness (AF) at diagnosis, before treatment and its relationship with body composition, physical function, lipidic profile, comorbidities, tumor characteristics, and quality of life of women with breast cancer (BC) PATIENTS AND METHODS: This cross-sectional cohort study included 78 women with BC that were assessed before treatment. A 6-minute walk test was used to evaluate the subjects' AF, estimating the maximum oxygen consumption (VO_2max) to classify the women with BC into 2 groups: good/excellent AF or fair/weak/very weak AF. Dual-energy x-ray absorptiometry was performed to assess body composition. The International Global Physical Activity Questionnaire and the Functional Assessment of Cancer Therapy - Fatigue questionnaires were applied to assess the level of physical activity and the quality of life, respectively.

RESULTS

Among the women included, the majority (81%) had the luminal subtype of BC. Most of the women were diagnosed with T1/T2 tumors and with negative axillary lymph nodes. We found that women with BC with good/excellent AF (VO_2max = 32.9 ± 6.0 mL/kg/min^-1) presented significantly lower weight, body mass index, abdominal circumference, percentual and total body fat, and bone mineral density compared with women with fair/weak/very weak AF (VO_2max = 21.8 ± 6.9 mL/kg/min^-1). Also, women with BC with good/excellent AF showed better performance on physical functional tests. No relationship between estimated VO_2max and comorbidities, tumor characteristics, or quality of life was found.

CONCLUSION

AF is a predictor of body composition and physical function in women with BC. These data suggest that women with BC with higher AF can decrease the chance of adverse effects during BC treatment.

Physical Activity and Breast Cancer Prevention: Possible Role of Immune Mediators

There is strong evidence that physical activity (PA) reduces risk, recurrence, and mortality from breast cancer. Emerging data suggest that PA induces changes in inflammatory and immune mediators that may contribute to beneficial effects on breast cancer outcomes. Thus, the goal of this review was to evaluate the evidence linking the protective benefit of PA to modulation of immune responses in breast cancer. A literature search was conducted to identify studies that evaluated the impact of PA on tumor and immune outcomes in breast cancer patients and in mammary tumor models. Nineteen studies investigated the effect of PA interventions on cancer immune outcomes using preclinical breast cancer models. Tumor growth was reduced in 11 studies, unchanged in three studies, and increased in one study. Spontaneous metastasis was reduced in two studies and survival was improved in four studies. Frequently assessed immune outcomes include splenic cell number and function, circulating inflammatory cytokines, and intratumoral immune cells and inflammatory markers. Circulating inflammatory cytokine responses were heterogeneous in preclinical models. Within the tumor microenvironment (TME), several studies documented a change in the infiltration of immune cells with an increase in effector cells and a reduction in immune suppressive cells. Twenty-three studies investigated the effect of PA interventions on immune outcomes in breast cancer patients. Thirteen studies used aerobic PA interventions and 10 studies used a combination of aerobic and resistance exercise interventions. Cycling and treadmill activities were the most commonly used PA modalities. Circulating immune cells and inflammatory cytokines were the most frequently assessed immune outcomes in the clinical studies. Among the 19 studies that evaluated a PA intervention during the post treatment period, 10 reported a reduction in the levels of at least one inflammatory cytokine. No inflammatory cytokines were quantified in the three studies that evaluated a PA intervention during treatment with chemotherapy. Immune outcomes within the tumor were assessed in only one study performing a PA intervention prior to surgery. Results from preclinical and clinical studies suggest that PA exerts heterogeneous effects on inflammatory cytokines, but may alter the gene expression profile and immune infiltrates in the tumor which may result in a reduction in immunosuppressive factors. However, additional studies are needed to better understand the effect of PA on immune outcomes in the TME.

Equity impacts of interventions to increase physical activity among older adults: a quantitative health impact assessment

BACKGROUND

Behavioural interventions may increase social inequalities in health. This study aimed to project the equity impact of physical activity interventions that have differential effectiveness across education groups on the long-term health inequalities by education and gender among older adults in Germany.

METHODS

We created six intervention scenarios targeting the elderly population: Scenarios #1-#4 applied realistic intervention effects that varied by education (low, medium high). Under scenario #5, all older adults adapted the physical activity pattern of those with a high education. Under scenario #6, all increased their physical activity level to the recommended 300 min weekly. The number of incident ischemic heart disease, stroke and diabetes cases as well as deaths from all causes under each of these six intervention scenarios was simulated for males and females over a 10-year projection period using the DYNAMO-HIA tool. Results were compared against a reference-scenario with unchanged physical activity.

RESULTS

Under scenarios #1-#4, approximately 3589-5829 incident disease cases and 6248-10,320 deaths could be avoided among males over a 10-year projection period, as well as 4381-7163 disease cases and 6914-12,605 deaths among females. The highest reduction for males would be achieved under scenario #4, under which the intervention is most effective for those with a high education level. Scenario #4 realizes 2.7 and 2.4% of the prevented disease cases and deaths observed under scenario #6, while increasing inequalities between education groups. In females, the highest reduction would be achieved under scenario #3, under which the intervention is most effective amongst those with low levels of education. This scenario realizes 2.7 and 2.9% of the prevented disease cases and deaths under scenario #6, while decreasing inequalities between education groups. Under scenario #5, approximately 31,687 incident disease cases and 59,068 deaths could be prevented among males over a 10-year projection period, as well as 59,173 incident disease cases and 121,689 deaths among females. This translates to 14.4 and 22.2% of the prevented diseases cases among males and females under scenario #6, and 13.7 and 27.7% of the prevented deaths under scenario #6.

CONCLUSIONS

This study shows how the overall population health impact varies depending on how the intervention-induced physical activity change differs across education groups. For decision-makers, both the assessment of health impacts overall as well as within a population is relevant as interventions with the greatest population health gain might be accompanied by an unintended increase in health inequalities.

Myokines: a descriptive review

In the last years, scientists have shown that skeletal muscle is not a pure locomotor unit or responsible for propulsion and posture. Skeletal muscle encompasses one of the major organs of the body (constituting about 40% of the body mass in non-obese men). It regulates energy and metabolic processes and is now recognized as an organ capable of producing molecules with vital functions. These molecules are termed myokines, a new field of research in the health sciences, and represent an open field of discoveries and applications in several areas. The aim of this review was to show the role of some well-known myokines in the maintenance of homeostasis. Our search was performed in databases such as Medline/Pubmed, Embase and Scielo. Some relevant myokines are interleukin-6 (IL-6), IL-8, IL-15, irisin, myostatin, fibroblast growth factor 21 (FGF21), leukemia inhibitory factor (LIF), brain-derived neurotrophic factor (BDNF), and insulin-like growth factor-1 (IGF-1). They are related to play a positive or negative role in muscle function and metabolism homeostasis. They are associated with the regulation of glucose and lipid metabolism, the deposition of fat in the adipose tissue, and the "browning" of the white adipose tissue. For these reasons, they can interfere with the prevention of obesity, diabetes, metabolic syndrome, and cardiovascular diseases. The discovery of the myokines has opened a new direction in understanding the effects of exercises on humans.

American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control

INTRODUCTION

The American College of Sports Medicine convened an International Multidisciplinary Roundtable on Exercise and Cancer in March 2018 to evaluate and translate the evidence linking physical activity and cancer prevention, treatment, and control. This article discusses findings from the Roundtable in relation to the biologic and epidemiologic evidence for the role of physical activity in cancer prevention and survival.

RESULTS

The evidence supports that there are a number of biologically plausible mechanisms, whereby physical activity can influence cancer risk, and that physical activity is beneficial for the prevention of several types of cancer including breast, colon, endometrial, kidney, bladder, esophageal, and stomach. Minimizing time spent in sedentary behavior may also lower risk of endometrial, colon and lung cancers. Conversely, physical activity is associated with higher risk of melanoma, a serious form of skin cancer. Further, physical activity before and after a cancer diagnosis is also likely to be relevant for improved survival for those diagnosed with breast and colon cancer; with data suggesting that postdiagnosis physical activity provides greater mortality benefits than prediagnosis physical activity.

CONCLUSIONS

Collectively, there is consistent, compelling evidence that physical activity plays a role in preventing many types of cancer and for improving longevity among cancer survivors, although the evidence related to higher risk of melanoma demonstrates the importance of sun safe practices while being physically active. Together, these findings underscore the importance of physical activity in cancer prevention and control. Fitness and public health professionals and health care providers worldwide are encouraged to spread the message to the general population and cancer survivors to be physically active as their age, abilities, and cancer status will allow.

Older adults' experiences of using a wearable activity tracker with health professional feedback over a 12-month randomised controlled trial

Objective

Wearable activity trackers can help older adults remain physically active. However, knowledge of the user experience during long-term use is scarce. Therefore, this study examined older adults' experiences with, and perceptions of, wearable activity trackers combined with health professional feedback after a year's use as part of a randomised controlled trial.

Methods

Twenty older adults (73.6 ± 5.5 years) who had used a Jawbone UP24 activity tracker for 12 months during a randomised controlled trial were recruited for this study. All participants had at least one chronic condition. Acceptability data relating to activity tracker wear time was combined with focus group data to explore participants experiences of long-term activity tracker use. Data was analysed using thematic analysis.

Results

The activity tracker was well-accepted with the device worn on an average of 86% of possible days and participants reported an overall positive experience. Four themes were identified: (a) increased sense of awareness of activity levels is related to motivation; (b) the level of engagement with the activity tracker influences the user experience; (c) the role of feedback from a health professional in providing ongoing support; d) the role of habits in supporting long-term behaviour change.

Conclusions

The use of an activity tracker combined with health professional support can assist older adults to maintain their activity levels over 12 months. Consideration should be given to the previous technology experience of users and the design and accuracy of an activity tracker when recommending their use in a research or clinical setting.

Associations of accelerometer-measured physical activity and physical activity-related cancer incidence in older women: results from the WHI OPACH Study

BACKGROUND

We examined the associations between accelerometry-measured physical activity (PA) and incidence of 13 cancers among a cohort of postmenopausal women.

METHODS

In this prospective study, 6382 women wore ActiGraph GT3X+ accelerometers at the hip for up to 7 days during 2012-2013, and were followed over a median of 4.7 years for diagnosis of 13 invasive cancers. Calibrated intensity cut points were used to define minutes per day of total, light and moderate-to-vigorous PA. We used multivariable Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for tertiles, and one-standard deviation (SD) unit increments of PA exposures in relation to cancer incidence. We examined effect measure modification by age, race/ethnicity, body mass index and smoking history.

RESULTS

The highest (vs. lowest) tertiles of total, light and moderate-to-vigorous PA were associated with covariate-adjusted HRs of 0.72 (95% CI = 0.53-0.97), 0.81 (95% CI = 0.60-1.09) and 0.66 (95% CI = 0.48-0.91), respectively. In age-stratified analyses, HRs for total PA were lower among women <80 years (HRper one-SD = 0.75, 95% CI = 0.63-0.90) than among women ≥80 years (HRper one-SD = 0.99, 95% CI = 0.82-1.18) (PInteraction = 0.03). Race/ethnicity, BMI and smoking did not strongly modify these associations.

CONCLUSIONS

Engaging in physical activity may play a beneficial role in the prevention of certain cancers in older women.

The impact of leisure time physical activity on mental health and health perception among people with cancer

Background: People with cancer often report high levels of negative psychological symptoms and poor perception of health due to cancer treatment and activity limitations. Prior studies have suggested that participation in leisure time physical activity (LTPA) can reduce negative psychological symptoms and improve health perception. However, a few studies have examined the contribution of LTPA to health benefits among people with cancer. Thus, we aimed to examine how a different level of LTPA engagement contributed to mental health and health perceptions among people with cancer.

Methods: Using the 2017 Health Information National Trends Survey (HINTS) data, cross sectional data of 504 respondents diagnosed with any types of 22 cancers listed in the survey questionnaire were analyzed. A multivariate analysis of variance (MANOVA) was used to test for mean differences in mental health and health perception among the three different LTPA groups(i.e., inactive, moderately active, and vigorously active groups).

Results: Results indicated that people with cancer who reported higher levels of LTPA scored higher on mental health and health perception than those with lower levels of LTPA (Pillai’s trace= 0.060, F (4,944) = 15.06, P < 0.001).

Conclusion: This finding suggests that individuals with cancer gained more health benefits through high engagement in LTPA. Moreover, we suggested that LTPA can be used as an important therapeutic intervention to promote health quality and wellbeing among people with cancer. Implications for practical suggestions are further discussed.

Walking and biologic ageing: Evidence based on NHANES telomere data

The length of telomeres is an objective measure of biologic ageing. This study evaluated the extent minutes of walking per week are associated with leukocyte telomere length (LTL) in a random sample of 5,823 U.S. adults. The investigation was cross-sectional and data were obtained from the National Health and Nutrition Examination Survey (NHANES). LTL was measured by the quantitative polymerase chain reaction method. Walking minutes was calculated from walking frequency and duration measures. Results showed that for each year of chronological age, telomeres were 15.6 base pairs shorter (P < 0.0001). With walking minutes and LTL treated as continuous variables, the relationship was quadratic, not linear (F = 11.2, P = 0.0023). With walking time divided into three categories, adults who performed ≥ 150 minutes of walking per week had longer telomeres than those who did no regular walking, and those who did some, but less than the recommendation (F = 5.0, P = 0.0137). Regular walkers were estimated to have a biologic ageing advantage associated with 6.5-7.6 years less biologic ageing compared to non-walkers, after adjusting for covariates. Additional investigations designed to study causality and the mechanisms associated with the walking and LTL relationship are needed.

Weight Training and Risk of 10 Common Types of Cancer

INTRODUCTION

Ample data support that leisure time aerobic moderate to vigorous physical activity (MVPA) is associated with lower risk of at least seven types of cancer. However, the link between muscle-strengthening activities and cancer etiology is not well understood. Our objective was to determine the association of weight lifting with incidence of 10 common cancer types.

METHODS

We used multivariable Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for association of weight lifting with incidence of 10 cancer types in the National Institutes of Health-American Association of Retired Persons Diet and Health Study follow-up. Weight lifting was modeled continuously and categorically. Dose-response relationships were evaluated using cubic restricted spline models. We explored whether associations varied by subgroups defined by sex, age, and body mass index using the Wald test for homogeneity. We examined joint categories of MVPA and weight lifting in relation to cancer risk for significant associations.

RESULTS

After adjusting for all covariates including MVPA, we observed a statistically significant lower risk of colon cancer (Ptrend = 0.003) in individuals who weight lifted; the HR and 95% CI associated with low and high weight lifting as compared with no weight lifting were 0.75 (95% CI, 0.66-0.87) and 0.78 (95% CI, 0.61-0.98), respectively. The weight lifting-colon cancer relationship differed between men and women (any weight lifting vs no weight lifting: HRmen = 0.91; 95% CI, 0.84-0.98; HRwomen = 1.00; 95% CI, 0.93-1.08; Pinteraction = 0.008). A lower risk of kidney cancer among weight lifters was observed but became nonsignificant after adjusting for MVPA (Ptrend = 0.06), resulting in an HR of 0.94 (95% CI, 0.78-1.12) for low weight lifting and 0.80 (95% CI, 0.59-1.11) for high weight lifting.

CONCLUSIONS

Participants who engaged in weight lifting had a significantly lower risk of colon cancer and a trend toward a lower risk of kidney cancer than participants who did not weight lift.