What is physical activity?
Physical activity is defined as any movement that uses skeletal muscles and requires more energy than resting. Physical activity can include walking, running, dancing, biking, swimming, performing household chores, exercising, and engaging in sports activities.
A measure called the metabolic equivalent of task, or MET, is used to characterize the intensity of physical activity. One MET is the rate of energy expended by a person sitting at rest. Light-intensity activities expend less than 3 METs, moderate-intensity activities expend 3 to 6 METs, and vigorous activities expend 6 or more METs (1).
Sedentary behavior is any waking behavior characterized by an energy expenditure of 1.5 or fewer METs while sitting, reclining, or lying down (1). Examples of sedentary behaviors include most office work, driving a vehicle, and sitting while watching television.
A person can be physically active and yet spend a substantial amount of time being sedentary.
What is known about the relationship between physical activity and cancer risk?
Evidence linking higher physical activity to lower cancer risk comes mainly from observational studies, in which individuals report on their physical activity and are followed for years for diagnoses of cancer. Although observational studies cannot prove a causal relationship, when studies in different populations have similar results and when a possible mechanism for a causal relationship exists, this provides evidence of a causal connection.
There is strong evidence that higher levels of physical activity are linked to lower risk of several types of cancer (2–4).
There is some evidence that physical activity is associated with a reduced risk of lung cancer (2, 4). However, it is possible that differences in smoking, rather than in physical activity, are what explain the association of physical activity with reduced risk of lung cancer. In a 2016 meta-analysis of 25 observational studies, physical activity was associated with reduced risk of lung cancer among former and current smokers but was not associated with risk of lung cancer among never smokers (19).
For several other cancers, there is more limited evidence of an association. These include certain cancers of the blood, as well as cancers of the pancreas, prostate, ovaries, thyroid, liver, and rectum (2, 6).
How might physical activity be linked to reduced risks of cancer?
Exercise has many biological effects on the body, some of which have been proposed to explain associations with specific cancers. These include:
What is known about the relationship between being sedentary and the risk of cancer?
Although there are fewer studies of sedentary behavior and cancer risk than of physical activity and cancer risk, sedentary behavior—sitting, reclining, or lying down for extended periods of time (other than sleeping)—is a risk factor for developing many chronic conditions and premature death (4, 23, 24). It may also be associated with increased risk for certain cancers (23, 25).
How much physical activity is recommended?
The U.S. Department of Health and Human Services Physical Activity Guidelines for Americans, 2nd edition, released in 2018 (1), recommends that, for substantial health benefits and to reduce the risk of chronic diseases, including cancer, adults engage in
Is physical activity beneficial for cancer survivors?
Yes. A report of the 2018 American College of Sports Medicine International Multidisciplinary Roundtable on Physical Activity and Cancer Prevention and Control (26) concluded that exercise training and testing are generally safe for cancer survivors and that every survivor should maintain some level of physical activity.
The Roundtable also found
In addition, research findings have raised the possibility that physical activity may have beneficial effects on survival for patients with breast, colorectal, and prostate cancers (26, 27).
There is very limited evidence for beneficial effects of physical activity on survival for other cancers, including non-Hodgkin lymphoma, stomach cancer, and malignant glioma (4).
What additional research is under way on the relationship between physical activity and cancer?
Findings from observational studies provide much evidence for a link between higher levels of physical activity and lower risk of cancer. However, these studies cannot fully rule out the possibility that active people have lower cancer risk because they engage in other healthy lifestyle behaviors. For this reason, clinical trials that randomly assign participants to exercise interventions provide the strongest evidence because they eliminate bias caused by pre-existing illness and attendant physical inactivity.
To confirm the observational evidence and define the potential magnitude of the effect, several large clinical trials are examining physical activity and/or exercise interventions in cancer patients and survivors. These include the Breast Cancer Weight Loss (BWEL) trial in newly diagnosed breast cancer patients, the CHALLENGE trial in colon cancer patients who have recently completed chemotherapy (29), and the INTERVAL-GAP4 trial in men with metastatic, castrate-resistant prostate cancer (30).
Many additional questions have yet to be answered in several broad areas of research on physical activity and cancer: