Abstract
BackgroundThe relative contributions of demographic and lifestyle behaviors to the association between physical activity (PA) and cancer are poorly understood. This study assesses the relationship between PA level and cancer status considering the full activity spectrum within a large and representative Chinese population.MethodsData were derived from the Chinese Health and Retirement Longitudinal Study (using four-stage stratified probability-proportional-to-size sampling), including 416 cancer survivors and 14,574 individuals without cancer from 28 provinces in China. Cancer status and sites were self-reported, and PA, other health behaviors (e.g., smoking, drinking) and comorbidities (e.g., hypertension, diabetes) were assessed by a questionnaire. The total PA score was calculated using metabolic equivalent (MET) multipliers. Multivariable logistic regression was used to estimate differences in PA levels between cancer survivors and those without a cancer diagnosis, adjusting for age, sex, and other potential confounding factors.ResultsCancer survivors (416, 2.8%) were more likely to be women than men (65.4 vs. 34.6%). They were older (age ≥65 years, 43.8 vs. 38.9%) and more likely to be overweight (18.3 vs. 13.3%), be depressed (49.5 vs. 37.6%), have quit smoking (17.8 vs. 14.4%), drink less (17.5 vs. 26.6%), sleep less (65.9 vs. 56.8%) and have more chronic comorbidities (≥2 comorbidities, 26.0 vs. 19.2%) than those without cancer. There was a significant associations between cancer status and participation in vigorous-intensity activity for at least 10 min every week, when compared with the inactivity [odds ratio (OR) = 0.56, 95% CI = 0.39–0.80], while no differences were observed in the moderate and light activity groups. Individuals who spent more than half an hour performing moderate or vigorous intensity activity every day were significantly less likely to report a cancer diagnosis than inactive individuals (moderate OR = 0.64, 95% CI = 0.48–0.86; vigorous OR = 0.50, 95% CI = 0.37–0.68). Participants who spent more than 2 h performing light, moderate or vigorous intensity activity reported fewer cancer cases than their inactive counterparts. In addition, there was an inverse dose-response relationship between the total PA score and cancer status (P–trend < 0.001).ConclusionAssociations between PA and cancer status were independent of demographics, lifestyle confounders, and comorbidities. Cancer survivors are less physically active than those without cancer.
Highlights
Cancer is a leading cause of morbidity and mortality around the world and contributes to one in eight deaths globally (Fitzmaurice et al, 2019)
Compared with cancer-free participants, cancer survivors were more often women than men (OR = 1.63, 95% confidence intervals (CIs) = 1.18– 2.24) and were more likely to quit smoking (OR = 1.60, 95% CI = 1.13–2.27), sleep less than 8 h (OR = 0.66, 95% CI = 0.47– 0.92), and have depressive symptoms (OR = 1.46, 95% CI = 1.19– 1.79) or chronic comorbidities (1 chronic disease: Odds ratios (ORs) = 1.42, 95% CI = 1.13–1.79, ≥2 chronic diseases: OR = 1.41, 95% CI = 1.09– 1.84) (Supplementary Table 2)
Researchers in the United States carried out a secondary data analysis to compare physical activity (PA) levels between 31,078 cancer survivors with a history of single-site cancer diagnosis and participants without cancer, and the results demonstrated that higher PA levels were present among prostate cancer survivors, while lower PA levels were present among cervical and endometrial cancer survivors (Kwon et al, 2012)
Summary
Cancer is a leading cause of morbidity and mortality around the world and contributes to one in eight deaths globally (Fitzmaurice et al, 2019). New cancer incidence is expected to increase by nearly 70% by 2030 (Fitzmaurice et al, 2019). Compared with individuals without cancer, cancer survivors are at increased risk for other chronic diseases, secondary complications, recurrence, and decreased physical function and quality of life (Aziz and Rowland, 2003; Jemal et al, 2007). Cancer incidence and recurrence can be prevented with a healthy lifestyle, including regular physical activity (PA), to some extent (Loprinzi et al, 2012; Lahart et al, 2015; Murray et al, 2020). The relative contributions of demographic and lifestyle behaviors to the association between physical activity (PA) and cancer are poorly understood. This study assesses the relationship between PA level and cancer status considering the full activity spectrum within a large and representative Chinese population
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