Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study Exercise and Prognosis on the Basis of Clinicopathologic and Molecular Features in Early-Stage Breast Cancer: The LACE and Pathways Studies. A prospective study of lifetime physical activity and prostate cancer incidence and mortality Combined impact of lifestyle factors on mortality: prospective cohort study in US women Association of Physical Activity and Inflammation With All-Cause, Cardiovascular-Related, and Cancer-Related Mortality. Physical Activity and Survival in Women With Advanced Breast Cancer Body mass index, physical activity, and survival after endometrial cancer diagnosis: results from the Women's Health Initiative. The effect of resistance exercise on all-cause mortality in cancer survivors. Physical Exercise Training versus Relaxation in Allogeneic stem cell transplantation (PETRA Study) – Rationale and design of a randomized trial to evaluate a yearlong exercise intervention on overall survival and side-effects after allogeneic stem cell transplantation Body mass index, physical activity, and mortality in women diagnosed with ovarian cancer: results from the Women's Health Initiative. Combined effects of obesity and physical activity in predicting mortality among men. Exercise following breast cancer: exploratory survival analyses of two randomised, controlled trials Recreational physical activity and risk of prostate cancer: A prospective population-based study in Norway (the HUNT study). The Colon Health and Life-Long Exercise Change trial: a randomized trial of the National Cancer Institute of Canada Clinical Trials Group Physical activity and cancer-specific mortality in the NIH-AARP Diet and Health Study cohort. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study Physical activity and cause-specific mortality in men: Further evidence from the Whitehall study Physical activity and mortality among Norwegian women – the Norwegian Women and Cancer Study Association of “Weekend Warrior” and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality Physical activity and survival after breast cancer diagnosis. Physical activity protects against coronary death and deaths from all causes in middle-aged men. Evidence from a 20-year follow-up of the primary prevention study in Göteborg. Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis: The CALGB 89803/Alliance Trial Physical Activity and Risk of Recurrence and Mortality in Breast Cancer Survivors: Findings from the LACE Study Cigarette smoking and other lifestyle factors in relation to the risk of pancreatic cancer death: a prospective cohort study in Japan. Recreational physical activity, body mass index, and survival in women with colorectal cancer Physical Activity and Survival after Diagnosis of Invasive Breast Cancer Modifiable Lifestyle Factors and Triple-negative Breast Cancer Survival: A Population-based Prospective Study Accelerometer-measured sedentary time and physical activity-A 15 year follow-up of mortality in a Swedish population-based cohort. Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study1,4. Walking in Relation to Mortality in a Large Prospective Cohort of Older U.S. Adults. Proposal for standardized definitions for efficacy end points in adjuvant breast cancer trials: the STEEP system. Adherence to cancer prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective cohort study. Physical Activity and Survival After Prostate Cancer. Leisure time physical activity and long-term cardiovascular and cancer outcomes: the Busselton Health Study Long-term physical activity in leisure time and mortality from coronary heart disease, stroke, respiratory diseases, and cancer. The Copenhagen City Heart Study Intensity of leisure-time physical activity and cancer mortality in men The Prognostic Importance of Frailty in Cancer Survivors. Physical Activity Level and Colorectal Cancer Mortality Physical activity and cause-specific mortality in the Whitehall study. Physical activity and prostate cancer mortality in Puerto Rican men. Physical activity and survival after colorectal cancer diagnosis. The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women Association of pre-diagnosis physical activity with recurrence and mortality among women with breast cancer. Association between domains of physical activity and all-cause, cardiovascular and cancer mortality Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. Modifiable risk factors and survival in women diagnosed with primary breast cancer: results from a prospective cohort study Level of moderate-intensity leisure-time physical activity and reduced mortality in middle-aged and elderly Chinese Exercise behavior, functional capacity, and survival in adults with malignant recurrent glioma. Effects of physical exercise on survival after allogeneic stem cell transplantation. Risk factors for colonic and rectal cancer mortality: evidence from 40 years’ follow-up in the Whitehall I study Physical activity and survival after cancer diagnosis in men. Significantly greater reduction in breast cancer mortality from post-diagnosis running than walking. Physical activity and sedentary behavior in relation to mortality among renal cell cancer survivors Exercise and cancer mortality in Korean men and women: a prospective cohort study The association of physical activity before and after lymphoma diagnosis with survival outcomes Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study
Objective Research suggests that physical activity is associated with improved breast cancer survival , yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes . The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality . Methods A total of 2,361 post-treatment breast cancer survivors ( Stage I – III ) enrolled in a r and omized controlled trial of dietary change completed physical activity measures  at baseline and one year .  Physical activity variables ( total , moderate – vigorous , and adherence to guidelines )  were calculated for each time point . Median follow-up was 7.1 years . Outcomes were invasive breast cancer events and all-cause mortality . Results Those who were most active at baseline had a 53 % lower mortality risk compared to the least active women ( HR = 0.47 ; 95 % CI : 0.26 , 0.84 ; p = .01 ) . Adherence to activity guidelines was associated with a 35 % lower mortality risk ( HR = 0.65 , 95 % CI : 0.47 , 0.91 ; p < .01 ) . Neither baseline nor 1-year change in activity was associated with additional breast cancer events . Conclusions Higher baseline ( post-treatment ) physical activity was associated with improved survival . However , change in activity over the following year was not associated with outcomes . These data suggest that long-term physical activity levels are important for breast cancer prognosis To investigate whether the impact of postdiagnosis exercise on  breast cancer outcomes  in women diagnosed with early-stage breast cancer differs on the basis of tumor clinicopathologic and molecular features . Using a prospect i ve design , 6,211 patients with early-stage breast cancer from two large population -based cohort studies were studied . Age-adjusted and multivariable Cox regression models were performed to determine the relationship between exercise exposure ( total MET-hours/week ) and recurrence and breast cancer-related death for : ( i ) all patients ( " unselected " cohort ) , and on the basis of ( ii ) classic clinicopathologic features , ( iii ) clinical subtypes , ( iv ) PAM50-based molecular intrinsic subtypes , and ( v ) individual PAM50 target genes . After a median follow-up of 7.2 years , in the unselected cohort ( n = 6,211 ) increasing exercise exposure was not associated with a reduction in the risk of recurrence ( adjusted Ptrend = 0.60 ) or breast cancer-related death ( adjusted Ptrend = 0.39 ) . On the basis of clinicopathologic features , an exercise-associated reduction in breast cancer-related death was apparent for tumors < 2 cm [ HR , 0.50 ; 95 % confidence interval ( CI ) , 0.34 - 0.72 ] , well/moderately differentiated tumors ( HR , 0.63 ; 95 % CI , 0.43 - 0.91 ) , and ER-positive tumors ( HR , 0.72 ; 95 % CI , 0.53 - 0.97 ) . Stratification by clinical subtype indicated that the ER(+)/PR(+)/HER2(-)/low- grade clinical subtype was preferentially responsive to exercise ( recurrence : adjusted HR , 0.63 ; 95 % CI , 0.45 - 0.88 ; breast cancer-related death : adjusted HR , 0.57 ; 95 % CI , 0.37 - 0.86 ) . The impact of exercise on cancer outcomes appears to differ as a function of pathologic and molecular features in early-stage breast cancer . Cancer Res ; 76(18 ) ; 5415 - 22 . © 2016 AACR Background : The possible benefit of lifetime physical activity ( PA ) in reducing prostate cancer incidence and mortality is unclear . Methods : A prospect i ve cohort of 45 887 men aged 45–79 years was followed up from January 1998 to December 2007 for prostate cancer incidence ( n=2735 ) and to December 2006 for its subtypes and for fatal ( n=190 ) prostate cancer . Results : We observed an inverse association between lifetime ( average of age 30 and 50 years , and baseline age ) total PA levels and prostate cancer risk . Multivariate-adjusted incidence in the top quartile of lifetime total PA  decreased by 16 % ( 95 % confidence interval (CI)=2–27 % ) compared with that in the bottom quartile . We also observed an inverse association between average lifetime work or occupational activity and walking or bicycling duration and prostate cancer risk . Compared with men who mostly sit during their main work or occupation , men who sit half of the time experienced a 20 % lower risk ( 95 % CI=7–31 % ) . The rate ratio linearly decreased by 7 % ( 95 % CI=1–12 % ) for total , 8 % ( 95 % CI=0–16 % ) for localised and 12 % ( 95 % CI=2–20 % ) for advanced prostate cancer for every 30 min per day increment of lifetime walking or bicycling in the range of 30 to 120 min per day . Conclusions : Our results suggest that not sitting for most of the time during work or occupational activity and walking or bicycling more than 30 min per day during adult life is associated with reduced incidence of prostate cancer Objective To evaluate the impact of combinations of lifestyle factors on  mortality in middle aged women . Design Prospect i ve cohort study . Setting Nurses ’ health study , United States . Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980 . Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors ( cigarette smoking , being overweight , taking little moderate to vigorous physical activity , no light to moderate alcohol intake , and low diet quality score ) . Results 8882 deaths were documented , including 1790 from cardiovascular disease and 4527 from cancer . Each lifestyle factor independently and significantly predicted mortality . Relative risks for five compared with zero lifestyle risk factors were 3.26 ( 95 % confidence interval 2.45 to 4.34 ) for cancer mortality , 8.17 ( 4.96 to 13.47 ) for cardiovascular mortality , and 4.31 ( 3.51 to 5.31 ) for all cause mortality . A total of 28 % ( 25 % to 31 % ) of deaths during follow-up could be attributed to smoking and 55 % ( 47 % to 62 % ) to the combination of smoking , being overweight , lack of physical activity , and a low diet quality . Additionally considering alcohol intake did not substantially change this estimate . Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower  mortality in middle aged women . Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified OBJECTIVE To investigate the association between physical activity ( PA ) and risk of mortality in a large middle-aged cohort stratified by inflammatory status . PATIENTS AND METHODS A total of 336,560 individuals ( mean age , 39.7 years ; 58 % male ) who underwent comprehensive health screenings were enrolled in this prospect i ve cohort study . They were grouped according to self-reported PA level using a question naire : no regular PA with a sedentary lifestyle , regular but insufficient PA ( below the guidelines ) , sufficient PA ( concordant with the guidelines ) , and health-enhancing PA . Inflammation was assessed via high-sensitivity C-reactive protein ( hsCRP ) level . Study end points were all-cause , cardiovascular-related , and cancer-related mortality . RESULTS During the 1,976,882 person-years of follow-up ( median follow-up duration , 6.17 years ) , 2062 deaths occurred . Compared with a sedentary lifestyle , the hazard ratios ( 95 % CIs ) on the multivariable Cox proportional hazards regression analyses for all-cause mortality by PA level were 0.95 ( 0.84 - 1.07 ) , 0.85 ( 0.72 - 0.99 ) , and 0.75 ( 0.60 - 0.93 ) ( P for trend=.003 ) , and those for cardiovascular- and cancer-related mortality were 0.95 , 0.80 , and 0.55 ( P for trend=.05 ) and 0.82 , 0.83 , and 0.78 ( P for trend=.01 ) , respectively . Compared with participants with low hsCRP levels and any regular PA , those with high hsCRP levels and no regular PA had a significantly higher risk of mortality ( 1.59 [ 1.38 - 1.84 ] ) . CONCLUSION Higher PA levels were associated with a dose-dependent reduced risk of cardiovascular-related , cancer-related , and all-cause mortality . Individuals with high hsCRP levels and no regular PA had the highest risk of mortality Background : Several empirical investigations have attempted to characterize the effect of physical activity on cancer mortality , but these investigations have rarely focused on patients with advanced breast cancer . Objective : The current study examined the hypothesis that greater physical activity is associated with longer survival among women with advanced breast cancer . Methods : We conducted a secondary data analysis of a prospect i ve study of 103 patients with stage IV ( n = 100 ) or locally recurrent ( n = 3 ) breast cancer involved in a group psychotherapy trial .  Physical activity  was assessed at baseline using the Seven-Day Physical Activity Recall question naire , and patients were followed until April 1 , 2016 , at which time 93 of 103 had died . Results : Greater  physical activity  level at baseline was significantly associated with longer subsequent survival time in a Cox proportional hazards model ( hazard ratio [ HR ] , 0.90 ; 95 % confidence interval [ CI ] , 0.84–0.97 ; P < .01 ) . Engaging in 1 additional hour per day of moderate activity reduced the hazard of subsequent mortality by 23 % ( HR , 0.77 ; 95 % CI , 0.65–0.92 ; P < .01 ) . These results remained significant even after controlling for demographic , medical , cancer , depression , and cortisol variables ( HR , 0.91 ; 95 % CI , 0.84–0.99 ; P < .05 ) . Conclusions : Women with advanced breast cancer who engaged in physical activity for 1 or more hours per day at baseline had an increased likelihood of survival compared with those who exercised less than 1 hour per day . Implication s for Practice : Nurses should consider recommending moderate physical activity for women with advanced breast cancer . R and omized trials of physical activity interventions for this population are needed OBJECTIVE While low physical activity and high body mass index ( BMI ) have been associated with higher endometrial cancer incidence , no previous studies have evaluated the association between physical activity and survival after endometrial cancer diagnosis , and studies on BMI and survival have not been performed in a prospect i ve cohort . METHODS We examined pre-diagnosis BMI and moderate- to vigorous-intensity physical activity in relation to overall and disease-specific survival among 983 postmenopausal women who were diagnosed with endometrial cancer in the Women 's Health Initiative Observational Study and Clinical Trials . RESULTS Over a median 5.2 ( max 14.1 ) years from diagnosis to death or end of follow-up , 163 total deaths were observed , 66 of which were due to endometrial cancer . We observed a higher all-cause mortality hazard ratio ( HR ) = 1.85 ( 95 % CI 1.19 - 2.88 ) comparing women with a BMI ≥ 35 kg/m(2 ) to women with BMI < 25 kg/m(2 ) . For endometrial cancer-specific mortality the HR = 2.23 ( 95 % CI 1.09 - 4.54 ) comparing extreme BMI categories . To examine histologic subtypes we analyzed type I endometrial tumors separately and found an HR = 1.20 ( 95 % CI 1.07 - 1.35 ) associated with all-cause mortality for each 5-unit change in BMI . Moderate- to vigorous-intensity physical activity was not associated with all-cause or endometrial cancer-specific mortality . CONCLUSIONS Pre-diagnosis BMI , but not physical activity , was associated with survival among women with endometrial cancer . Future studies should investigate mechanisms and timing of BMI onset to better underst and the burden of disease attributable to BMI OBJECTIVE To examine the independent associations of leisure-time aerobic physical activity ( PA ) and resistance exercise ( RE ) on  all-cause mortality in cancer survivors . PATIENTS AND METHODS Patients included 2863 male and female cancer survivors , aged 18 to 81 years , who received a preventive medical examination between April 8 , 1987 , and December 27 , 2002 , while enrolled in the Aerobics Center Longitudinal Study in Dallas , Texas .  Physical activity and RE were assessed by self-report at the baseline medical examination . Cox proportional hazards regression analysis was performed to determine the independent associations of PA and RE with all-cause mortality in participants who had a history of cancer . RESULTS Physical activity in cancer survivors was not associated with a lower risk of all-cause mortality . In contrast , RE was associated with a 33 % lower risk of all-cause mortality ( 95 % CI , 0.45 - 0.99 ) after adjusting for potential confounders , including PA . CONCLUSION Individuals who participated in RE during cancer survival had a lower risk for all-cause mortality . The present findings provide preliminary evidence for benefits of RE during cancer survival . Future r and omized controlled trials examining RE and its effect on lean body mass , muscular strength , and all-cause mortality in cancer survivors are warranted Background Allogeneic stem cell transplantation ( allo-HCT ) is associated with high treatment-related mortality and innumerable physical and psychosocial complications and side-effects , such as high fatigue levels , loss of physical performance , infections , graft-versus-host disease ( GvHD ) and distress . This leads to a reduced quality of life , not only during and after transplantation , but also in the long term . Exercise interventions have been shown to be beneficial in allo-HCT patients . However , to date , no study has focused on long-term effects and survival . Previous exercise studies used ‘ usual care ’ control groups , leaving it unclear to what extent the observed effects are based on the physical effects of exercise itself , or rather on psychosocial factors such as personal attention . Furthermore , effects of exercise on and severity of GvHD have not been examined so far . We therefore aim to investigate the effects and biological mechanisms of exercise on side-effects , complications and survival in allo-HCT patients during and after transplantation . Methods / design The PETRA study is a r and omized , controlled intervention trial investigating the effects of a yearlong partly supervised mixed exercise intervention ( endurance and resistance exercises , 3–5 times per week ) in 256 patients during and after allogeneic stem cell transplantation . Patients in the  control  group perform progressive muscle relaxation training ( Jacobsen method ) with the same frequency . Main inclusion criterion is planned allo-HCT . Main exclusion criteria are increased fracture risk , no walking capability or severe cardiorespiratory problems . Primary endpoint is overall survival after two years ; secondary endpoints are non-relapse mortality , median survival , patient reported outcomes including cancer related fatigue and quality of life , physical performance , body composition , haematological/immunological reconstitution , inflammatory parameters , severity of complications and side-effects ( e.g. GvHD and infections ) , and cognitive capacity . Discussion The PETRA study will contribute to a better underst and ing of the physiological and psychological effects of exercise training and their biological mechanisms in cancer patients after allo-HCT . The ultimate goal is the implementation of optimized intervention programs to reduce side-effects and improve quality of life and potentially prognosis after allogeneic stem cell transplantation . Trial registration Clinical Trials.gov Identifier : NCT01374399 BACKGROUND Ovarian cancer is often diagnosed at late stages and consequently the 5-year survival rate is only 44 % . However , there is limited knowledge of the association of modifiable lifestyle factors , such as physical activity and obesity on mortality among women diagnosed with ovarian cancer . The purpose of our study was to prospect ively investigate the association of ( 1 ) measured body mass index ( BMI ) , and ( 2 ) self-reported physical activity with ovarian cancer-specific and all-cause mortality in postmenopausal women enrolled in the Women 's Health Initiative ( WHI ) . METHODS Participants were 600 women diagnosed with primary ovarian cancer subsequent to enrollment in WHI . Exposure data , including measured height and weight and reported physical activity from recreation and walking , used in this analysis were ascertained at the baseline visit for the WHI . Cox proportional hazard regression was used to examine the associations between BMI , physical activity and mortality endpoints . RESULTS Vigorous-intensity physical activity was associated with a 26 % lower risk of ovarian cancer specific-mortality ( HR=0.74 ; 95 % CI : 0.56 - 0.98 ) and a 24 % lower risk of all-cause mortality ( HR=0.76 ; 95 % CI : 0.58 - 0.98 ) compared to no vigorous-intensity physical activity .  BMI was not associated with mortality . CONCLUSIONS Participating in vigorous-intensity physical activity , assessed prior to ovarian cancer diagnosis , appears to be associated with a lower risk of ovarian cancer mortality OBJECTIVE We evaluated the hypothesis that higher levels of total daily physical activity can eliminate the increased mortality rate associated with overweight and obesity . DESIGN Population -based prospect i ve cohort study . SETTING Central Sweden . SUBJECTS A total of 37,633 men at baseline 45 - 79 years of age and free of known cancer and cardiovascular disease and diabetes completed a  self-administered life-style question naire , which included questions on body-mass index ( BMI ) and physical activity . During 9.7 years of follow-up , we identified a total of 4086 deaths . MAIN OUTCOME MEASURES Mortality rate ratios ( RRs ) . RESULTS Compared to men who were lean ( BMI < 25 kg m(-2 ) ) and active ( top tertile of total physical activity level ) the multivariable adjusted RRs ( 95 % confidence interval ) of death from all causes were 1.44 ( 1.11 - 1.86 ) for obese ( BMI > or = 30 kg m(-2 ) ) and active men , 1.54 ( 1.34 - 1.77 ) for lean ( BMI < 25 kg m(-2 ) ) but inactive ( bottom tertile ) men , and 1.81 ( 1.48 - 2.23 ) for obese-inactive men . After excluding the first 3 years of follow-up , current and former smokers , those who had lost weight from age 20 years to age at baseline , and heavy manual workers , the adjusted RRs of death from all causes were 1.65 ( 1.20 - 2.27 ) for overweight-to-obese and active men , 2.15 ( 1.59 - 2.91 ) for lean-inactive men , and 2.04 ( 1.52 - 2.74 ) for overweight-to-obese and inactive men compared to lean-active men . CONCLUSIONS We conclude that both overweight and physical inactivity are important predictors of mortality . Our findings do not support the hypothesis that a higher level of physical activity compensates the excess mortality associated with overweight and obesity Purpose The Exercise for Health trials were r and omised , controlled trials design ed to evaluate an 8-month pragmatic exercise intervention , commencing 6 weeks post-surgery for women with newly diagnosed breast cancer residing in urban or rural/regional Australia . For these exploratory analyses , the primary and secondary outcomes were overall survival ( OS ) and disease-free survival ( DFS ) , respectively . Methods Consenting urban- ( n = 194 ) and rural/regional-residing women ( n = 143 ) were r and omised to exercise ( intervention delivered face-to-face or by telephone ) or usual care . Cox proportional hazards models were used to estimate hazard ratios ( HRs ) and 95 % confidence intervals ( CI ) for survival outcomes  ( exercise group , n = 207 , 65 % urban women ; usual care group , n = 130 , 46 % urban women ) . Results After a median follow-up of 8.3 years , there were 11 ( 5.3 % ) deaths in the exercise group compared with 15 ( 11.5 % ) deaths in the usual care group ( OS HR for the exercise group : 0.45 , 95 % CI 0.20–0.96 ; p = 0.04 ) . DFS events for the exercise versus usual care group were 25 ( 12.1 % ) and 23 ( 17.7 % ) , respectively ( HR : 0.66 , 95 % CI 0.38–1.17 ; p = 0.16 ) . HRs for OS favoured exercise irrespective of age , body mass index , stage of disease , intervention compliance , and physical activity levels at 12 months post-diagnosis , although were stronger ( p < 0.05 ) for younger women , women with stage II + disease , women with 1 + comorbidity at time of diagnosis , higher intervention compliance and for those who met national physical activity guidelines at 12 months post-diagnosis . Conclusion An exercise intervention delivered during and beyond treatment for breast cancer , and that was design ed to cater for all women irrespective of place of residence and access to health services , has clear potential to benefit survival . Trial numbers : ACT RN : 012606000233527 ; ACT RN : 12609000809235 Physical activity has been studied in relation to prostate cancer risk , but the findings have been inconclusive . We prospect ively examined the association between self-reported recreational physical activity and overall risk of prostate cancer , risk of advanced disease and risk of prostate cancer death in a cohort of 29,110 Norwegian men . Incident prostate cancers were obtained from the Norwegian Cancer Registry , and prostate cancer deaths were obtained from the national Cause of Death Registry . During 17 years of follow-up , 957 incident cases were identified , 266 of them were advanced ( i.e. metastases at diagnosis ) and 354 of the incident cases died from prostate cancer . In multivariable analysis , frequency and duration of exercise  were inversely associated with the risk of advanced prostate cancer ( p for trend = 0.04 and 0.02 ) . We computed a summary score that combined frequency , duration and intensity of exercise  , and this score showed inverse associations with advanced prostate cancer risk and mortality ( p for trend = 0.02 and 0.07 ) . Compared to men who reported no activity , the relative risks ( 95 % confidence intervals ) among men in the highest category of physical exercise was 0.64 ( 0.43 - 0.95 ) for advanced prostate cancer and 0.67 ( 0.48 - 0.94 ) for prostate cancer death . We found no association between physical activity and overall risk of prostate cancer . We conclude that recreational physical exercise is associated with reduced risk of advanced prostate cancer and prostate cancer death BACKGROUND Observational studies indicate that physical activity ( PA ) is strongly associated with improved disease outcomes in colon cancer survivors , but a r and omized controlled trial is needed to determine whether the association is causal and whether new policies to promote exercise are justified . PURPOSE The co.21 Colon Health and Life-Long Exercise Change ( challenge ) trial undertaken by the National Cancer Institute of Canada Clinical Trials Group ( NCIC CTG ) is design ed to determine the effects of a structured pa intervention on outcomes for survivors of high-risk stage II or III colon cancer who have completed adjuvant therapy within the previous 2 - 6 months . METHODS Trial participants ( n = 962 ) will be stratified by centre , disease stage , body mass index , and performance status , and will be r and omly assigned to a structured pa intervention or to general health education material s. The pa intervention will consist of a behavioural support program and supervised pa sessions delivered over a 3-year period , beginning with regular face-to-face sessions and tapering to less frequent face-to-face or telephone sessions . The primary endpoint is disease-free survival . Important secondary endpoints include multiple patient-reported outcomes , objective physical functioning , biologic correlative markers , and an economic analysis . SUMMARY Cancer survivors and cancer care professionals are interested in the potential role of PA to improve multiple disease-related outcomes , but a r and omized controlled trial is needed to provide compelling evidence to justify changes in health care policies and practice Higher physical activity levels have been associated with a lower risk of developing various cancers and all-cancer mortality , but the impact of pre-diagnosis physical activity on cancer-specific death has not been fully characterized . In the prospect i ve National Institutes of Health-AARP Diet and Health Study with 293,511 men and women , we studied prediagnosis moderate to vigorous intensity leisure time physical activity ( MVPA ) in the past 10 years and cancer-specific mortality . Over a median 12.1 years , we observed 15,001 cancer deaths . Using Cox proportional hazards regression , we estimated hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) for MVPA with cancer mortality overall and by 20 specific cancer sites , adjusting for relevant risk factors . Compared to participants reporting never/rare MVPA , those reporting > 7 hr/week MVPA had a lower risk of total cancer mortality ( HR = 0.89 , 95 % CI 0.84 - 0.94 ; p-trend < 0.001 ) . When analyzed by cancer site-specific deaths , comparing those reporting > 7 hr/week of MVPA to those reporting never/rare MVPA , we observed a lower risk of death from colon ( HR = 0.70 ; 95 % CI 0.57 - 0.85 ; p-trend < 0.001 ) , liver ( 0.71 ; 0.52 - 0.98 ; p-trend = 0.012 ) and lung cancer ( 0.84 ; 0.77 - 0.92 ; p-trend < 0.001 ) and a significant p-trend for non-Hodgkins lymphoma ( 0.80 ; 0.62 - 1.04 ; p-trend = 0.017 ) . An unexpected increased mortality p-trend with increasing MVPA was observed for death from kidney cancer ( 1.42 ; 0.98 - 2.03 ; p-trend = 0.016 ) . Our findings suggest that higher prediagnosis leisure time physical activity is associated with lower risk of overall cancer mortality and mortality from multiple cancer sites . Future studies should confirm observed associations and further explore timing of physical activity and underlying biological mechanisms BACKGROUND The health benefits of leisure-time physical activity are well known , but whether less exercise than the recommended 150 min a week can have life expectancy benefits is unclear . We assessed the health benefits of a range of volumes of physical activity in a Taiwanese population . METHODS In this prospect i ve cohort study , 416,175 individuals ( 199,265 men and 216,910 women ) participated in a st and ard medical screening programme in Taiwan between 1996 and 2008 , with an average follow-up of 8·05 years ( SD 4·21 ) . On the basis of the amount of weekly exercise indicated in a self-administered question naire , participants were placed into one of five categories of exercise volumes : inactive , or low , medium , high , or very high activity . We calculated hazard ratios ( HR ) for mortality risks for every group compared with the inactive group , and calculated life expectancy for every group . FINDINGS Compared with individuals in the inactive group , those in the low-volume activity group , who exercised for an average of 92 min per week ( 95 % CI 71 - 112 ) or 15 min a day ( SD 1·8 ) , had a 14 % reduced risk of all-cause mortality ( 0·86 , 0·81 - 0·91 ) , and had a 3 year longer life expectancy . Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduced all-cause mortality by 4 % ( 95 % CI 2·5 - 7·0 ) and all-cancer mortality by 1 % ( 0·3 - 4·5 ) . These benefits were applicable to all age groups and both sexes , and to those with cardiovascular disease risks . Individuals who were inactive had a 17 % ( HR 1·17 , 95 % CI 1·10 - 1·24 ) increased risk of mortality compared with individuals in the low-volume group . INTERPRETATION 15 min a day or 90 min a week of moderate-intensity exercise might be of benefit , even for individuals at risk of cardiovascular disease . FUNDING Taiwan Department of Health Clinical Trial and Research Center of Excellence and National Health Research Institutes Reports of studies relating physical activity to stroke and cancer sub-types indicate inconsistent findings . Some are hampered by low statistical power , owing to a low number of events , and a failure to adjust for potential confounding variables . The purpose of this study was to relate physical activity to 12 mortality endpoints in a prospect i ve cohort study of 11,663 men aged 40–64 years who responded to an enquiry about travel activity during a baseline medical examination conducted between 1967 and 1969 . During 25 years of follow-up there were 4672  deaths .  Travel activity  was inversely related to mortality attributable to all-causes , coronary heart disease , respiratory disease and lung cancer , whereas the association with stroke was positive . There was evidence for attenuation of some of these associations on adjustment for potentially confounding variables . Our simplistic measure of physical activity may , in part , explain the weak associations seen Background : Physical activity ( PA ) and its relationship with all-cause mortality suggest a strong and consistent inverse association . This study prospect ively investigated the association between  PA level and mortality among participants of the Norwegian Women and Cancer ( NOWAC ) Study . Methods : A total of 66,136 NOWAC participants were followed-up until December 31st 2008 .  PA level and possible confounding factors were obtained through a self-administered question naire at enrolment . Cox proportional hazards regression was used to calculate adjusted relative risks ( RRs ) and 95 % confidence intervals ( CIs ) for all-cause , cardiovascular disease ( CVD ) and cancer mortality and PA levels defined from 1 to 10 on a global scale . Results : PA levels 1–4 were associated with a significantly increased risk of all-cause mortality ( level 1 RR = 2.35 ; 95 % CI : 1.94–2.84 , level 2 RR = 1.71 ; 95 % CI : 1.45–2.00 , level 3 RR = 1.30 ; 95 % CI : 1.14–1.49 , level 4 RR = 1.07 ; 95 % CI : 0.95–1.22 ) , compared with PA level 5 . CVD mortality risk increased in PA levels 1–3 ( level 1 RR = 3.50 ; 95 % CI : 2.41–5.10 , level 2 RR = 1.50 ; 95 % CI : 0.99–2.25 , level 3 RR = 1.12 ; 95 % CI : 0.79–1.60 ) as did cancer mortality risk ( RR = 1.32 ; 95 % CI : 0.96–1.81 , RR = 1.48 ; 95 % CI : 1.19–1.84 , RR = 1.26 ; 95 % CI : 1.06–1.50 , respectively ) . The magnitude of the associations was consistent across strata of age , smoking , and body mass index . The population attributable fractions for PA levels 1–4 were : all-cause mortality , 11.5 % ; CVD mortality , 11.3 % ; cancer mortality , 7.8 % . Conclusion : There is a significant trend of increased risk of all-cause , CVD and cancer mortality in relation to low PA levels among Norwegian women Importance More research is required to clarify the association between physical activity and health in  “ weekend warriors ” who perform all their exercise in 1 or 2 sessions per week . Objective To investigate associations between the weekend warrior and other physical activity patterns and the risks for all-cause , cardiovascular disease ( CVD ) , and cancer mortality . Design , Setting , and Participants This pooled analysis of household-based surveillance studies included 11 cohorts of respondents to the Health Survey for Engl and and Scottish Health Survey with prospect i ve linkage to mortality records . Respondents 40 years or older were included in the analysis . Data were collected from 1994 to 2012 and analyzed in 2016 . Exposures Self-reported leisure time physical activity , with activity patterns defined as inactive ( reporting no moderate- or vigorous-intensity activities ) , insufficiently active ( reporting < 150 min/wk in moderate-intensity and < 75 min/wk in vigorous-intensity activities ) , weekend warrior ( reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from 1 or 2 sessions ) , and regularly active ( reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from ≥3 sessions ) . The insufficiently active participants were also characterized by physical activity frequency . Main Outcomes and Measures All-cause , CVD , and cancer mortality ascertained from death certificates . Results Among the 63 591 adult respondents ( 45.9 % male ; 44.1 % female ; mean [ SD ] age , 58.6 [ 11.9 ] years ) , 8802 deaths from all causes , 2780 deaths from CVD , and 2526 from  cancer  occurred during 561 159 person-years of follow-up . Compared with the inactive participants , the hazard ratio ( HR ) for all-cause mortality was 0.66 ( 95 % CI , 0.62 - 0.72 ) in insufficiently active participants who reported 1 to 2 sessions per week , 0.70 ( 95 % CI , 0.60 - 0.82 ) in weekend warrior participants , and 0.65 ( 95 % CI , 0.58 - 0.73 ) in regularly active participants . Compared with the inactive participants , the HR for CVD mortality was 0.60 ( 95 % CI , 0.52 - 0.69 ) in insufficiently active participants who reported 1 or 2 sessions per week , 0.60 ( 95 % CI , 0.45 - 0.82 ) in weekend warrior participants , and 0.59 ( 95 % CI , 0.48 - 0.73 ) in regularly active participants . Compared with the inactive participants , the HR for cancer mortality was 0.83 ( 95 % CI , 0.73 - 0.94 ) in insufficiently active participants who reported 1 or 2 sessions per week , 0.82 ( 95 % CI , 0.63 - 1.06 ) in weekend warrior participants , and 0.79 ( 95 % CI , 0.66 - 0.94 ) in regularly active participants . Conclusions and Relevance Weekend warrior and other leisure time physical activity patterns characterized by 1 or 2 sessions per week may be sufficient to reduce all-cause , CVD , and cancer mortality risks regardless of adherence to prevailing physical activity guidelines CONTEXT Physical activity has been shown to decrease the incidence of breast cancer , but the effect on recurrence or survival after a breast cancer diagnosis is not known . OBJECTIVE To determine whether physical activity among women with breast cancer decreases their risk of death from  breast cancer  compared with more sedentary women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational study based on responses from 2987 female registered nurses in the Nurses ' Health Study who were diagnosed with stage I , II , or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002 , whichever came first . MAIN OUTCOME MEASURE Breast cancer mortality risk according to  physical activity  category ( <3 , 3 - 8.9 , 9 - 14.9 , 15 - 23.9 , or > or = 24 metabolic equivalent task [ MET ] hours per week ) . RESULTS Compared with women who engaged in less than 3 MET-hours per week of physical activity , the adjusted relative risk ( RR ) of death from breast cancer was 0.80 ( 95 % confidence interval [ CI ] , 0.60 - 1.06 ) for 3 to 8.9 MET-hours per week ; 0.50 ( 95 % CI , 0.31 - 0.82 ) for 9 to 14.9 MET-hours per week ; 0.56 ( 95 % CI , 0.38 - 0.84 ) for 15 to 23.9 MET-hours per week ; and 0.60 ( 95 % CI , 0.40 - 0.89 ) for 24 or more MET-hours per week ( P for trend = .004 ) . Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour . The benefit of physical activity was particularly apparent among women with hormone-responsive tumors . The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more MET-hours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 ( 95 % CI , 0.34 - 0.74 ) . Compared with women who engaged in less than 3 MET-hours per week of activity , the absolute unadjusted mortality risk reduction was 6 % at 10 years for women who engaged in 9 or more MET-hours per week . CONCLUSIONS Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease . The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace , with little evidence of a correlation between increased benefit and greater energy expenditure . Women with breast cancer who follow US physical activity recommendations may improve their survival We set out to examine the long-term effect of work-related and leisure time physical activity on risk of death from  coronary heart disease ( CHD ) and other causes . Data were obtained from a large prospect i ve population study of 7142 participant men aged 47 to 55 years at baseline in 1970 - 1973 and without symptomatic CHD . Data on physical activity at work and at leisure were assessed by way of a question naire . After 20 years follow-up men with physically dem and ing work had a slightly higher mortality from all causes , but not from CHD . The association with all-cause mortality disappeared after controlling for smoking , occupational class , and alcohol abuse . Men who were physically active during leisure time had a lower risk of death from CHD , cancer , and all causes . After controlling for smoking , diastolic blood pressure , serum cholesterol , body mass index , diabetes alcohol abuse , and low occupational class , the most active men had a relative risk ( RR ) of dying from CHD of 0.72 ( 0.56 - 0.92 95 % CI ) and of all causes of 0.70 ( 0.61 - 0.80 95 % CI ) . The adjusted relative risk for cancer death was of borderline significance . Noncardiovascular deaths other than cancer showed a strong relationship with low physical activity in the present study that remained after controlling for smoking , alcohol abuse , and other factors ( adjusted RR 0.55 ( 0.42 - 0.73 95 % CI ) ) . The protective effect of CHD and on mortality was present after excluding the first 8 years of follow-up , and at all levels of other risk factors , such as smoking , diastolic blood pressure , serum cholesterol , and body mass index . In conclusion , this long-term study demonstrates the protective effect of  leisure time physical activity on CHD death , cancer death , and on death from all causes . The effect on coronary death and on death from all causes was independent of other risk factors Importance The American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors ( ACS guidelines ) include maintaining ( 1 ) a healthy body weight ; ( 2 ) physical activity ; and ( 3 ) a diet that includes vegetables , fruits , and whole grains . It is not known whether patients with colon cancer who follow these guidelines have improved survival . Objective To examine whether a lifestyle consistent with the ACS guidelines is associated with improved survival rates after colon cancer . Design , Setting , and Participants This prospect i ve cohort study included 992 patients with stage III colon cancer who were enrolled in the CALGB 89803 r and omized adjuvant chemotherapy trial from 1999 through 2001 . Data for the present study were analyzed between November 2016 and December 2017 . Exposures We assigned an ACS guidelines score for each included patient based on body mass index ; physical activity ; and intake of vegetables , fruits , whole grains , and red/processed meats ( score range , 0 - 6 , with higher score indicating healthier behaviors ) . Secondarily , we examined a score that also included alcohol intake in addition to the other factors ( range , 0 - 8 ) . Lifestyle was assessed during and 6 months after chemotherapy . Main Outcomes and Measures Hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) for disease-free , recurrence-free , and overall survival . Results Of the 992 patients enrolled in the study , 430 ( 43 % ) were women , and the mean ( SD ) age was 59.6 ( 11.2 ) years ( range , 21 - 85 years ) . Over a 7-year median follow-up , we observed 335 recurrences and 299 deaths ( 43 deaths without recurrence ) . Compared with patients with a 0 to 1 ACS guidelines score ( n = 262 ; 26 % ) , patients with a 5 to 6 score ( n = 91 ; 9 % ) had a 42 % lower risk of death during the study period ( HR , 0.58 ; 95 % CI , 0.34 - 0.99 ; P = .01 for trend ) and improved disease-free survival ( HR , 0.69 ; 95 % CI , 0.45 - 1.06 ; P = .03 for trend ) . When alcohol consumption was included in the score , the adjusted HRs comparing patients with scores of 6 to 8 ( n = 162 ; 16 % ) vs those with scores of 0 to 2 ( 187 ; 91 % ) were 0.49 for overall survival ( 95 % CI , 0.32 - 0.76 ; P = .002 for trend ) , 0.58 for disease-free survival ( 95 % CI , 0.40 , 0.84 ; P = .01 for trend ) , and 0.64 for recurrence-free survival ( 95 % CI , 0.44 - 0.94 ; P = .05 for trend ) . Conclusions and Relevance Having a healthy body weight , being physically active , and eating a diet rich in vegetables , fruits , and whole grains after diagnosis of stage III colon cancer was associated with a longer survival . Trial Registration clinical trials.gov Identifier : Introduction : Identifying modifiable factors that reduce the risk of recurrence and improve survival in breast cancer survivors is a pressing concern . The purpose of this study was to examine the association of physical activity following diagnosis and treatment with the risk of breast cancer recurrence and mortality and all-cause mortality in women with early-stage breast cancer . Material s and Methods : The sample consisted of 1,970 women from the Life After Cancer Epidemiology study , a prospect i ve investigation of behavioral risk factors and health outcomes .  Self-reported frequency and duration of work-related , household and caregiving , recreational , and transportation-related activities during the six months prior to enrollment were assessed . Outcomes were ascertained from electronic or paper medical charts . Hazard ratios and 95 % confidence intervals were estimated from delayed entry Cox proportional hazards models . Results : Although age-adjusted results suggested that higher levels of physical activity were associated with reduced risk of recurrence and breast cancer mortality ( P for trend = 0.05 and 0.07 , respectively for highest versus lowest level of hours per week of moderate physical activity ) , these associations were attenuated after adjustment for prognostic factors and other confounding variables ( P for trend = 0.36 and 0.26 ) . In contrast , a statistically significant protective association between physical activity and all-cause mortality remained in multivariable analyses ( hazard ratio , 0.66 ; 95 % confidence interval , 0.42 - 1.03 ; P for trend = 0.04 ) . Conclusions : These findings do not support a protective effect of physical activity on breast cancer recurrence or mortality but do suggest that regular physical activity is beneficial for breast cancer survivors in terms of total mortality . ( Cancer Epidemiol Biomarkers Prev 2009;18(1):87–95 OBJECTIVE To examine the association of smoking and lifestyle factors with  pancreatic cancer death  in the prospect i ve design . METHODS Mortality from pancreatic cancer in regard to smoking , body mass index , physical activity , and alcohol , coffee and green tea intake , was studied in a prospect i ve cohort of 30,826 inhabitants in Takayama , Japan . In 1992 , each subject completed a self-administered question naire on demographic information , smoking , drinking habits , diet , exercise and medical histories . The response rate was 85.3 % . RESULTS From 1992 to 1999 , 33 men and 19 women died due to pancreatic cancer . Hazard ratios and 95 % confidence intervals were determined using Cox proportional hazards models . Women who were defined as current smokers at baseline had significant and increased risk of pancreatic cancer death after adjustment for age , body mass index and history of diabetes mellitus ( Hazard ratio : 4.77 , 95 % confidence intervals : 1.58 - 14.4 ) . There were significant positive associations of pancreatic cancer death with the years of smoking and the number of cigarettes consumed daily in women in a dose-dependent manner . Current smokers indicated a non-significant risk increase in men ( Hazard ratio : 3.81 , 95 % confidence intervals : 0.88 - 16.6 ) . Body mass index , physical activity , and alcohol , coffee and green tea intake were not significantly associated with pancreatic cancer death . CONCLUSIONS These data suggested that smoking increases the risk of death from pancreatic cancer in Japanese women Background and purpose Previous studies have shown that physical inactivity and obesity are risk factors for the development of colorectal cancer . However , controversy exists regarding the influence of these factors on survival in colorectal cancer patients . We evaluated the impact of recreational physical activity and body mass index ( BMI )  before and after colorectal cancer diagnosis on disease-specific mortality and all-cause mortality . Patients and methods This prospect i ve cohort study included 1,339 women enrolled in the Women ’s Health Initiative study who were diagnosed with colorectal cancer subsequent to study enrollment .  BMI and recreational physical activity  were measured before cancer diagnosis at study entry ( pre-diagnostic ) and after diagnosis at study follow-up interviews ( post-diagnostic ) . We used Cox regression to estimate the association between pre- and post-diagnostic exposures and survival after colorectal cancer diagnosis . Results Among women diagnosed with colorectal cancer , 265 ( 13 % ) deaths occurred during a median study follow-up of 11.9 years , of which 171 ( 65 % ) were attributed to colorectal cancer . Compared with women reporting no pre-diagnostic recreational physical activity , those reporting activity levels of ≥18 MET-h/week had significantly lower colorectal cancer-specific mortality ( hazard ratio ( HR ) = 0.68 ; 95 % confidence interval ( CI ) : 0.41–1.13 ) and all-cause mortality ( HR = 0.63 ; 95 % CI : 0.42–0.96 ) . Similar inverse associations were seen for post-diagnostic recreational physical activity . Neither pre- nor post-diagnostic BMI were associated with mortality after colorectal cancer diagnosis . Conclusion Recreational physical activity before and after colorectal cancer diagnosis , but not BMI , is associated with more favorable survival Previous studies suggest that increased physical activity may lower the risk of breast cancer incidence , but less is known about whether levels of physical activity after breast cancer diagnosis can influence survival . We prospect ively examined the relation between postdiagnosis recreational physical activity and risk of breast cancer death  in women who had a previous invasive breast cancer diagnosed between 1988 and 2001 ( at ages 20 - 79 years ) . All women completed a question naire on recent  postdiagnosis physical activity and other lifestyle factors . Among 4,482 women without history of recurrence at the time of completing the question naire , 109 died from breast cancer within 6 years of enrollment .  Physical activity was expressed as metabolic equivalent task-hours per week ( MET-h/wk ) ; hazard ratios ( HR ) and 95 % confidence intervals ( 95 % CI ) were estimated using Cox proportional hazards regression . After adjusting for age at diagnosis , stage of disease , state of residence , interval between diagnosis and physical activity assessment , body mass index , menopausal status , hormone therapy use , energy intake , education , family history of breast cancer , and treatment modality compared with women expending < 2.8 MET-h/wk in physical activity , women who engaged in greater levels of activity had a significantly lower risk of dying from breast cancer ( HR , 0.65 ; 95 % CI , 0.39 - 1.08 for 2.8 - 7.9 MET-h/wk ; HR , 0.59 ; 95 % CI , 0.35 - 1.01 for 8.0 - 20.9 MET-h/wk ; and HR , 0.51 ; 95 % CI , 0.29 - 0.89 for ≥21.0 MET-h/wk ; P for trend = 0.05 ) . Results were similar for overall survival ( HR , 0.44 ; 95 % CI , 0.32 - 0.60 for ≥21.0 versus < 2.8 MET-h/wk ; P for trend < 0.001 ) and were similar regardless of a woman ’s age , stage of disease , and body mass index . This study provides support for reduced overall mortality and mortality from breast cancer among women who engage in physical activity  after breast cancer diagnosis . ( Cancer Epidemiol Biomarkers Prev 2008;17(2):379–86 Background : Very little is known about the effect of modifiable lifestyle factors on outcomes of triple-negative breast cancer . We examined this association in a population -based prospect i ve cohort study of patients with triple-negative breast cancer . Methods : A total of 518 women with confirmed triple-negative breast cancer , recruited by the Shanghai Breast Cancer Survival Study , completed 6- , 18- , 36- , and 60-month postdiagnosis surveys . We applied Cox proportional hazard models to evaluate the associations . Results : The mean age at diagnosis was 53.4 ( st and ard deviation = 10.6 ) years old . After a median follow-up of 9.1 years ( range : 0.6–11.8 ) , 128 deaths and 112 recurrences were documented . Exercise during the first 60 months postdiagnosis was inversely associated with total mortality and recurrence/disease-specific mortality with adjusted hazard ratios ( HRs ) of 0.67 ( 95 % confidence interval [ CI ] = 0.46 , 0.96 ) and 0.58 ( 95 % CI = 0.39 , 0.86 ) , respectively . Women with higher exercise-metabolic equivalent scores ( ≥7.6 metabolic equivalent-hours/week ) and longer duration of exercise ( ≥2.5 hours/week ) had lower risk of total and recurrence/disease-specific mortality than did nonexercisers . Compared with nontea drinkers , survival was better among women who were regular tea drinkers during the first 60 months for all cause ( HR = 0.57 , 95 % CI = 0.34 , 0.93 ) and recurrence/disease-specific mortality ( HR = 0.54 , 95 % CI = 0.31 , 0.96 ) . There was no dose – response pattern for tea consumption . No interactions were observed for body mass index , menopausal status , and comorbidity . Conclusions : These findings show that postdiagnosis exercise and tea intake were associated with improved survival among women with triple-negative breast cancer OBJECTIVES To investigate the associations of objective ly assessed sedentary time , light intensity physical activity ( PA ) , moderate to vigorous intensity PA ( MVPA ) , and total PA with all-cause mortality and mortality from cardiovascular disease ( CVD ) or cancer in a Swedish population -based cohort with 15 years follow-up time . DESIGN Longitudinal prospect i ve cohort study . METHODS Data from 851 persons ( 56 % women ) ≥35 years at baseline were included . Primary exposure variables were  time ( min/day ) spent sedentary , in light intensity PA and in MVPA , and total counts from an Actigraph 7164 accelerometer . Data on all-cause mortality and mortality from CVD or cancer were obtained from Swedish registers . Cox proportional hazards models estimated hazard ratios ( HR ) of mortality with 95 % confidence intervals ( CI ) . RESULTS Compared with the least sedentary participants , those in the most sedentary tertile had an increased risk of all-cause mortality , HR : 2.7 ( 1.4 , 5.3 ) , CVD mortality , HR : 5.5 ( 1.4 , 21.2 ) and cancer mortality , HR : 4.3 ( 1.2 , 16.0 ) . For all-cause mortality , those in the highest light intensity PA tertile had a HR 0.34 ( 0.17 , 0.67 ) compared with the lowest tertile . A similar pattern was found for CVD and cancer mortality . More time spent in MVPA was associated with the largest risk reduction for CVD mortality , with an almost 90 % lower risk in the tertile with the most time in MVPA . CONCLUSIONS This study confirms a strong inverse relationship between MVPA and mortality , and adds new insight for the underst and ing of the associations between sedentary time  and light intensity PA  and mortality BACKGROUND In 2007 , the World Cancer Research Fund ( WCRF ) and the American Institute for Cancer Research ( AICR ) issued recommendations on diet , physical activity , and weight management for cancer prevention on the basis of the most comprehensive collection of available evidence . OBJECTIVE We investigated whether concordance with WCRF/AICR recommendations is related to risk of death . DESIGN The current study included 378,864 participants from 9 European countries enrolled in the European Prospect i ve Investigation into Cancer and Nutrition study . At recruitment ( 1992 - 1998 ) , dietary , anthropometric , and lifestyle information was collected . A WCRF/AICR score , which incorporated 6 of the WCRF/AICR recommendations for men [ regarding body fatness , physical activity , foods and drinks that promote weight gain , plant foods , animal foods , and alcoholic drinks ( score range : 0 - 6 ) ] and 7 WCRF/AICR recommendations for women [ plus breastfeeding ( score range : 0 - 7 ) ] , was constructed . Higher scores indicated greater concordance with WCRF/AICR recommendations . Associations between the WCRF/AICR score and risks of total and cause-specific death were estimated by using Cox regression analysis . RESULTS After a median follow-up time of 12.8 y , 23,828 deaths were identified . Participants within the highest category of the WCRF/AICR score ( 5 - 6 points in men ; 6 - 7 points in women ) had a 34 % lower hazard of death ( 95 % CI : 0.59 , 0.75 ) compared with participants within the lowest category of the WCRF/AICR score ( 0 - 2 points in men ; 0 - 3 points in women ) . Significant inverse associations were observed in all countries . The WCRF/AICR score was also significantly associated with a lower hazard of dying from cancer , circulatory disease , and respiratory disease . CONCLUSION Results of this study suggest that following WCRF/AICR recommendations could significantly increase longevity INTRODUCTION Engaging in > 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity weekly is recommended for optimal health . The relationship between walking , the most common activity especially for older adults , and total mortality is not well documented . METHODS Data from a large U.S. prospect i ve cohort study including 62,178 men ( mean age 70.7 years ) and 77,077 women ( mean age 68.9 years ) , among whom 24,688 men and 18,933 women died during 13 years of follow-up ( 1999 - 2012 ) , were used to compute multivariable-adjusted hazard rate ratios and 95 % CIs for walking as the sole form of activity or adjusted for other moderate- or vigorous-intensity physical activity in relation to total and cause-specific mortality ( data analysis 2015 - 2016 ) . RESULTS Inactivity compared with walking only at less than recommended levels was associated with higher all-cause mortality ( hazard rate ratio=1.26 , 95 % CI=1.21 , 1.31 ) . Meeting one to two times the recommendations through walking only was associated with lower all-cause mortality ( hazard rate ratio=0.80 , 95 % CI=0.78 , 0.83 ) . Associations with walking adjusted for other moderate- or vigorous-intensity physical activity were similar to walking only . Walking was most strongly associated with respiratory disease mortality followed by cardiovascular disease mortality and then cancer mortality . CONCLUSIONS In older adults , walking below minimum recommended levels is associated with lower all-cause mortality compared with inactivity . Walking at or above physical activity recommendations is associated with even greater decreased risk . Walking is simple , free , and does not require any training , and thus is an ideal activity for most Americans , especially as they age PURPOSE St and ardized definitions of breast cancer clinical trial end points must be adopted to permit the consistent interpretation and analysis of breast cancer clinical trials and to facilitate cross-trial comparisons and meta-analyses . St and ardizing terms will allow for uniformity in data collection across studies , which will optimize clinical trial utility and efficiency . A given end point term ( eg , overall survival ) used in a breast cancer trial should always encompass the same set of events ( eg , death attributable to breast cancer , death attributable to cause other than breast cancer , death from unknown cause ) , and , in turn , each event within that end point should be commonly defined across end points and studies . METHODS A panel of experts in breast cancer clinical trials representing medical oncology , biostatistics , and correlative science convened to formulate st and ard definitions and address the confusion that nonst and ard definitions of widely used end point terms for a breast cancer clinical trial can generate . We propose st and ard definitions for efficacy end points and events in early-stage adjuvant breast cancer clinical trials . In some cases , it is expected that the st and ard end points may not address a specific trial question , so that modified or customized end points would need to be prospect ively defined and consistently used . CONCLUSION The use of the proposed common end point definitions will facilitate interpretation of trial outcomes . This approach may be adopted to develop st and ard outcome definitions for use in trials involving other cancer sites BACKGROUND Several health agencies have issued guidelines promoting behaviors to reduce chronic disease risk ; however , little is known about the impact of such guidelines , particularly on cancer incidence . OBJECTIVE The objective was to determine whether greater adherence to the American Cancer Society ( ACS ) cancer prevention guidelines is associated with a reduction in cancer incidence , cancer mortality , and total mortality . DESIGN The NIH-AARP Diet and Health Study , a prospect i ve cohort study of 566,401 adults aged 50 - 71 y at recruitment in 1995 - 1996 , was followed for a median of 10.5 y for cancer incidence , 12.6 y for cancer mortality , and 13.6 y for total mortality . Participants who reported a history of cancer or who had missing data were excluded , yielding 476,396 subjects for analysis . We constructed a 5-level score measuring adherence to ACS guidelines , which included baseline body mass index , physical activity , alcohol intake , and several aspects of diet . Cox proportional hazards models were used to compute HRs and 95 % CIs for the association of the adherence score with cancer incidence , cancer mortality , and total mortality . All analyses included fine adjustment for cigarette smoking . RESULTS Among 476,396 participants , 73,784 incident first cancers , 16,193 cancer deaths , and 81,433 deaths from all causes were identified in the cohort . Adherence to ACS guidelines was associated with reduced risk of all cancers combined : HRs ( 95 % CIs ) for the highest compared with the lowest level of adherence were 0.90 ( 0.87 , 0.93 ) in men and 0.81 ( 0.77 , 0.84 ) in women . Fourteen of 25 specific cancer sites showed a reduction in risk associated with increased adherence . Adherence was also associated with reduced cancer mortality [ HRs ( 95 % CIs ) were 0.75 ( 0.70 , 0.80 ) in men and 0.76 ( 0.70 , 0.83 ) in women ] and reduced all-cause mortality [ HRs ( 95 % CIs ) were 0.74 ( 0.72 , 0.76 ) in men and 0.67 ( 0.65 , 0.70 ) in women ] . CONCLUSIONS In both men and women , adherence to the ACS guidelines was associated with reductions in all-cancer incidence and the incidence of cancer at specific sites , as well as with reductions in cancer mortality and total mortality . These data suggest that , after accounting for cigarette smoking , adherence to a set of healthy behaviors may have considerable health benefits BACKGROUND Despite the high global prevalence of prostate cancer ( PCa ) , few epidemiologic studies have assessed physical activity in relation to PCa survival . OBJECTIVE To evaluate different types , intensities , and timing of physical activity relative to PCa survival . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve study was conducted in Alberta , Canada , in a cohort of 830 stage II-IV incident PCa cases diagnosed between 1997 and 2000 with follow-up to 2014 ( up to 17 yr ) . Prediagnosis lifetime activity was self-reported at diagnosis . Postdiagnosis activity was self-reported up to three times during follow-up . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cox proportional hazards models related  physical activity to all-cause and PCa-specific deaths and to first recurrence/progression of PCa . RESULTS AND LIMITATIONS A total of 458 deaths , 170 PCa-specific deaths , and , after first follow-up , 239 first recurrences/progressions occurred . Postdiagnosis  total  activity ( > 119 vs ≤42 metabolic equivalent [MET]-hours/week per year ) was associated with a significantly lower all-cause mortality risk ( hazard ratio [ HR ] : 0.58 ; 95 % confidence interval [ CI ] , 0.42 - 0.79 ; p value for trend < 0.01 ) . Postdiagnosis recreational activity ( > 26 vs ≤4 MET-hours/week per year ) was associated with a significantly lower PCa-specific mortality risk ( HR : 0.56 ; 95 % CI , 0.35 - 0.90 ; p value for trend = 0.01 ) .  Sustained recreational activity before and after diagnosis ( > 18 - 20 vs < 7 - 8 MET-hours/week per year ) was associated with a lower risk of all-cause mortality ( HR : 0.66 ; 95 % CI , 0.49 - 0.88 ) . Limitations included generalisability to healthier cases and an observational study design . CONCLUSIONS These findings support emerging recommendations to increase physical activity after the diagnosis of PCa and would inform a future exercise intervention trial examining PCa outcomes . PATIENT SUMMARY In a 17-yr prostate cancer ( PCa ) survival study , men who survived at least 2 yr who were more physically active postdiagnosis or  performed more recreational physical activity  before and after diagnosis survived longer . Recreational physical activity  after diagnosis was associated with a lower risk of PCa death Abstract The study aim ed to investigate whether meeting leisure time physical activity recommendations was associated with reduced incident and fatal cancer or cardiovascular disease ( CVD )  in a community-based cohort of middle- to late-aged adults with long-term follow-up . At baseline , 2,320 individuals were assessed on a large number of lifestyle and clinical parameters including their level of physical activity  per week , other risk factors ( e.g. smoking and alcohol use ) various anthropometric measures , blood tests and medical history . Individuals were linked to hospital and mortality registry data to identify future cancer and cardiovascular events ( fatal and non-fatal ) out to 15 years of follow-up . Cox regression analyses adjusted for relevant confounders identified a priori were used to estimate risk for all-cause , cancer-specific and CVD-specific mortality . In the full cohort an estimated 21 % decreased risk for all-cause mortality ( HR 0.79 ; 95 % CI 0.66–0.96 ) and 22 % decreased risk for fatal/non-fatal CVD events ( HR 0.78 ; 95 % CI 0.66–0.92 ) was associated with baseline self-reported physical activity levels of 150 min or more . After exclusion of those with chronic co-morbidities ( CVD , cancer , diabetes , chronic obstructive pulmonary disease , hypertension treatment ) at baseline , lower risk for fatal/non-fatal CVD events remained significantly associated with 150 min or more of physical activity ( HR 0.77 ; 95 % CI 0.62–0.96 ) . Results from this well established prospect i ve community-based cohort study support the role of leisure time physical activity in reducing all-cause mortality and CVD events ( fatal/nonfatal ) in the broader population studied . The data also suggest that physical activity associated reductions in risk for CVD events ( fatal/nonfatal ) were not overly impacted by prevalent key non-communicable diseases Background The purpose of this study was to describe the associations between different levels of long-term physical activity in leisure time and subsequent causes of deaths . Design The Copenhagen City Heart Study is a prospect i ve cardiovascular population study of 19 329 men and women aged 20–93 in 1976 .  Physical activity in leisure time was estimated at the examinations in 1976–78 and 1981–83 . This analysis consists of 2136 healthy men and 2758 women aged 20–79 years , with unchanged physical activity at the two examinations , and with all covariates included in the multivariate analyses : smoking , total-cholesterol , high-density lipoprotein-cholesterol , systolic blood pressure , diabetes mellitus , alcohol consumption , body mass index , education , income , and forced expiratory volume in 10.78 ( % predicted ) . Results Adjusted relative risks ( 95 % confidence interval ) for coronary heart disease were , for moderate physical activity 0.71 ( 0.51 , 0.99 ) and for high 0.56 ( 0.38 , 0.82 ) . For cancer , moderate activity 0.77 ( 0.61 , 0.97 ) and high activity 0.73 ( 0.56 , 0.95 ) and for all-cause mortality , moderate 0.78 ( 0.68 , 0.89 ) and high 0.75 ( 0.64 , 0.87 ) for both sexes combined . Using Kaplan — Meier plots we calculated gained years of expected lifetime from age 50 . Men with high physical activity  survived 6.8 years longer , and men with moderate physical activity 4.9 years longer than sedentary men . For women the figures were 6.4 and 5.5 years , respectively . Conclusion Long-term  moderate or high physical activity  was in both sexes associated with significantly lower mortality from coronary heart disease , cancer and all-causes . The same tendency was found for stroke and respiratory diseases , but the associations did not reach statistical significance . Eur J Cardiovasc Prev Rehabil 13:173–179 © 2006 The European Society of Objective There is a lack of evidence to show the role of exercise intensity in the prevention of cancer mortality because no previous studies have shown this relation . The relationship of leisure-time physical activity with cancer mortality was therefore assessed . Methods Participants were from a population -based sample of 2560 men from eastern Finl and with no history of cancer at baseline .  Physical activity was assessed using the 12-month leisure-time physical activity question naire . During an average follow-up of 16.7 years , a total of 181 cancer related deaths occurred . Results An increase of 1.2 metabolic units ( MET or metabolic equivalents of oxygen consumption ; 1 SD in metabolic equivalents ) in the mean intensity of  leisure-time physical activity  was related to a decrease ( relative risk ( RR ) 0.85 , 95 % CI 0.72 to 0.99 ) in cancer mortality mainly due to lung and gastrointestinal cancers , after adjustment for age , examination year , alcohol consumption , smoking , body mass index and energy , fibre and fat intake . Men with leisure-time physical activity of more than 5.2 MET ( highest quartile ) had a lower ( RR 0.63 , 95 % CI 0.40 to 0.99 ) cancer mortality compared with men whose mean intensity of physical activity was less than 3.7 MET ( lowest quartile ) . The mean intensity of physical activity  was related to the risk of cancer death among men who exercised at least 30 minutes per day on average . Conclusions This prospect i ve study indicates that the mean intensity of leisure-time physical activity is inversely associated with the risk of premature death from cancer in men OBJECTIVES To quantify the prognostic importance of prefrailty and frailty in a population -based sample of cancer survivors . DESIGN The Third National Health and Nutrition Examination Survey mortality-linked prospect i ve cohort study . SETTING Eighty-nine survey locations across the United States . PARTICIPANTS Population -based sample of older adults ( average age 72.2 ) with a self-reported diagnosis of non-skin-related cancer ( N = 416 ) . MEASUREMENTS The primary outcome was all-cause mortality . Frailty components included low weight for height , slow walking , weakness , exhaustion , and low physical activity . Participants with none of the five criteria were classified as nonfrail , those with one or two as prefrail , and those with three or more as frail . RESULTS The prevalence of prefrailty was 37.3 % and of frailty was 9.1 % . During a median follow-up of 11.2 years , 319 ( 76.7 % ) participants died . Median survival was 13.9 years for participants classified as nonfrail , 9.5 years for those classified as prefrail , and 2.5 years for those classified as frail . Cancer survivors classified as prefrail ( hazard ratio ( HR ) = 1.84 , 95 % confidence interval ( CI ) = 1.28 - 2.65 , P = .001 ) or frail ( HR = 2.79 , 95 % CI = 1.34 - 5.81 , P = .006 ) had a higher risk of premature mortality than those classified as nonfrail . CONCLUSION Prefrailty and frailty are prevalent clinical syndromes that may confer greater risk of premature mortality in older adult cancer survivors . Identifying frail cancer survivors and targeting interventions for them may be a strategy to improve survival after cancer Physical activity has been shown to reduce colorectal cancer risk . However , the association of physical activity levels separately with colon and rectum cancer mortality is less clear . We included 226 089 Korean in a large prospect i ve cohort study . We assessed the associations of  physical activity levels ( length , frequency , and intensity ) with colon and rectum cancer mortality using Cox proportional hazards model . Men , but not women , who had regular physical activity showed a lower risk of death from colon cancer . The association for high intensity of physical activity  was borderline significant in men ( hazard ratio 0.67 ; 95 % CI = 0.45 - 1.00 for > 17.5 MET-hour/week ) . The associations were largely consistent among those aged < 55 years , body mass index < 25 kg/m2 , low high-density lipoprotein cholesterol , current smoker , and without hypertension or history of cardiovascular disease . In conclusion , higher length or intensity of physical activity  decreased colon , but not rectum cancer mortality in men .  Regular physical activity may have beneficial effects on colon cancer survival A prospect i ve cohort study of London civil servants was used to examine the relation of physical activity to various causes of death .  6,702 men aged 40 - 64 y who participated in a baseline examination between 1969 and 1970 were followed up for 25 y during which time there were 2859 deaths . The association of two measures of physical activity ( leisure time activity and usual walking pace ) with cause-specific mortality was examined . Walking pace demonstrated inverse relations with mortality from all-causes , coronary heart disease ( CHD ) , other cardiovascular disease ( CVD ) , all cancers , respiratory disease , colorectal cancer and haematopoietic cancer following adjustment for risk factors which included age , employment grade , smoking , body mass index , and forced expiratory volume ( P [trend]<0.05 for all ) . In analyses restricted to men without disease at entry , walking pace retained inverse associations with all-cause , CHD , other cardiovascular disease , and haematopoietic cancer mortality ( P [trend]<0.05 for all ) .  Leisure time activity  was also inversely associated with mortality from all-causes , CHD , other CVD , and all-cancers following adjustment for risk factors ( P [trend]<0.05 for all ) . Eliminating deaths in the first 5 and 10 y of follow-up did not greatly alter these associations . It is concluded that physical activity may confer protection against death due to some cancers , in addition to reducing cardiovascular disease risk Studies on the association between physical activity and fatal prostate cancer  have produced inconclusive results . The  Puerto Rico Heart Health Program  was a cohort study of a r and omly selected sample of 9824 men age 35 to 79 years at baseline who were followed for mortality until 2002 . Multiple examinations collected information on lifestyle , diet , body composition , exercise , urban-rural residence , and smoking habits .  Physical activity  status was measured using the Framingham Physical Activity Index  , an assessment of occupational , leisure-time , and other physical activities measured as usual activity over the course of a 24-hour day .  Physical activity  was stratified into quartiles . Multivariate logistic regression analysis was used to assess the association of  physical activity  with prostate cancer mortality . Other covariates included age , education , urban-rural residence , smoking , and body mass index . Compared with the lowest level of physical activity ( Q1 ) , the risk of prostate cancer mortality was OR = 0.99 ( 95 % CI = 0.64 - 1.55 ) for Q2 , OR = 1.34 ( 95 % CI = 0.88 - 2.05 ) for Q3 , and OR = 1.19 ( 95 % CI = 0.75 - 1.90 ) for Q4 . Further analyses by age group , overweight status , or vigorous physical activity also did not show a significant association between physical activity and prostate cancer mortality .  Physical activity did not predict prostate cancer mortality in this group of Puerto Rican men PURPOSE Physically active individuals have a lower risk of developing colorectal cancer but the influence of exercise on cancer survival is unknown . PATIENTS AND METHODS By a prospect i ve , observational study of 573 women with stage I to III colorectal cancer , we studied colorectal cancer-specific and overall mortality according to predefined physical activity categories before and after diagnosis and by change in activity after diagnosis . To minimize bias by occult recurrences , we excluded women who died within 6 months of their postdiagnosis physical activity assessment . RESULTS Increasing levels of exercise after diagnosis of nonmetastatic colorectal cancer reduced cancer-specific mortality ( P for trend = .008 ) and overall mortality ( P for trend = .003 ) . Compared with women who engaged in less than 3 metabolic equivalent task [ MET ] -hours per week of physical activity , those engaging in at least 18 MET-hours per week had an adjusted hazard ratio for colorectal cancer-specific mortality of 0.39 ( 95 % CI , 0.18 to 0.82 ) and an adjusted hazard ratio for overall mortality of 0.43 ( 95 % CI , 0.25 to 0.74 ) . These results remained unchanged even after excluding women who died within 12 and 24 months of activity assessment . Prediagnosis physical activity was not predictive of mortality . Women who increased their activity ( when comparing prediagnosis to postdiagnosis values ) had a hazard ratio of 0.48 ( 95 % CI , 0.24 to 0.97 ) for colorectal cancer deaths and a hazard ratio of 0.51 ( 95 % CI , 0.30 to 0.85 ) for any-cause death , compared with those with no change in activity . CONCLUSION Recreational physical activity after the diagnosis of stages I to III colorectal cancer may reduce the risk of colorectal cancer-specific and overall mortality OBJECTIVE : To examine the association of physical activity and body mass index ( BMI ) , and their combined effect , with the risk of total , cardiovascular disease ( CVD ) and cancer mortality .  DESIGN : Prospect i ve follow-up study .SUBJECTS : In all , 22 528 men and 24 684 women aged 25–64 y at baseline having 7394 deaths during a mean follow-up of 17.7 y . MEASUREMENT : A self-administered question naire data on smoking , socioeconomic factors , physical activity and medical history , together with measured height , weight , blood pressure and serum cholesterol using st and ardized protocol . RESULT : Physically active subjects had significantly lower age-adjusted mortality from cardiovascular , cancer and all causes compared with sedentary ones . Further adjustment for smoking , systolic blood pressure , cholesterol , BMI , diabetes and education affected the results only slightly . Obese subjects ( BMI ≥30 kg/m2 ) had significantly higher cardiovascular and total mortality than the normal weight ( 18.5≤ BMI < 25 kg/m2 ) subjects . Part of increased mortality among obese subjects was mediated through obesity-related cardiovascular risk factors . BMI had an inverse association with cancer mortality among men and almost significant direct association among women . Total mortality was also increased among the lean ( BMI < 18.5 kg/m2 ) subjects . However , less than 0.3 % of deaths were attributed to low body weight , whereas in men 5.5 % and in women 17.7 % of deaths were attributed to obesity . CONCLUSION : Regular physical activity and normal weight are both important indicators for a decreased risk of mortality from all causes , CVD and cancer . Physical activity had a strong independent effect on mortality , whereas the effect of BMI was partly mediated through other obesity-related risk factors Evidence is emerging that physical activity ( PA ) may improve overall survival after breast cancer diagnosis . However , the effect of PA on breast cancer recurrence and on cause-specific mortality is less investigated . We assessed the association of pre-diagnosis PA with recurrence , overall and cause-specific survival in a prospect i ve cohort study in Germany including 3,393 non-metastatic breast cancer patients aged 50 - 74 years .  Cox proportional hazards models were calculated adjusted for relevant prognostic factors . During a median follow-up of 5.6 years , 367 patients deceased .  Overall mortality was significantly inversely associated with pre-diagnosis recreational PA . However , this effect was mainly attributed to deaths due to causes other than breast cancer . Multiple fractional polynomial analyses yielded a nonlinear association with markedly increased non-breast cancer mortality for women who did not engage in any sports or cycling in the years before the breast cancer diagnosis with a hazard ratio ( HR , none vs. any ) of 1.71 , 95 % confidence interval ( 1.16 , 2.52 ) . There were no further risk reductions with increasing activity levels . The association with breast cancer-specific mortality showed a similar dose-response but was far less pronounced with HR ( none vs. any ) = 1.22 ( 0.91 , 1.64 ) . In contrast , regarding cancer recurrence the dose-response was linear . However , this association was restricted to estrogen/progesterone receptor-negative ( ER-/PR- ) cases ( p interaction = 0.033 ) with HR ( highest vs. no recreational PA ) = 0.53 ( 0.24 , 1.16 ) , p trend = 0.0045 . Thus , breast cancer patients with a physically inactive lifestyle pre-diagnosis may decease prematurely irrespective of their cancer prognosis . Higher levels of exercise may reduce the risk of recurrence of ER-/PR- breast tumors Few studies have investigated the independent effects of domain-specific physical activity on mortality . We sought to investigate the association of physical activity performed in different domains of daily living on all-cause , cardiovascular ( CVD ) and cancer mortality .  Using a prospect i ve cohort design , 4,672 men and women , aged 25–74 years , who participated in the baseline examination of the MONICA/KORA Augsburg Survey 1989/1990 were classified according to their activity level ( no , light , moderate , vigorous ) . Domains of self-reported physical activity ( work , transportation , household , leisure time ) and total activity were assessed by the vali date d MOSPA ( MONICA Optional Study on Physical Activity ) question naire . After a median follow-up of 17.8 years , a total of 995 deaths occurred , with 452 from CVD and 326 from cancer . For all-cause mortality , hazard ratios and 95 % confidence interval ( HR , 95 % CI ) of the highly active versus the inactive reference group were 0.69 ( 0.48–1.00 ) for work , 0.48 ( 0.36–0.65 ) for leisure time , and 0.73 ( 0.59–0.90 ) for total activity after multivariable adjustments . Reduced risks of CVD mortality were observed for high levels of work ( 0.54 , 0.31–0.93 ) , household ( 0.80 , 0.54–1.19 ) , leisure time ( 0.50 , 0.31–0.79 ) and total activity ( 0.75 , 0.55–1.03 ) . Leisure time ( 0.36 , 0.23–0.59 ) and total activity ( 0.62 , 0.43–0.88 ) were associated with reduced risks of cancer mortality . Light household activity was related to lower all-cause ( 0.82 , 0.71–0.95 ) and CVD ( 0.72 , 0.58–0.89 ) mortality . No clear effects were found for transportation activities . Our findings suggest that work , household , leisure time and total physical activity  , but not transportation activity , may protect from premature mortality PURPOSE To investigate the association between pre- and postdiagnosis physical activity ( as well as change in prediagnosis to postdiagnosis physical activity ) and mortality among women with breast cancer . PATIENTS AND METHODS This was a prospect i ve observational study of 933 women enrolled onto the Health , Eating , Activity , and Lifestyle Study who were diagnosed with local or regional breast cancer between 1995 and 1998 and observed until death or September 2004 , whichever came first . The primary outcomes measured were total deaths and breast cancer deaths . The primary exposures were  physical activity in the year before and 2 years after diagnosis and the pre- to postdiagnosis change in physical activity . RESULTS Compared with inactive women , the multivariable hazard ratios ( HRs ) for total deaths for women expending at least 9 metabolic equivalent hours per week ( approximately 2 to 3 h/wk of brisk walking ) were 0.69 ( 95 % CI , 0.45 to 1.06 ; P = .045 ) for those active in the year before diagnosis and 0.33 ( 95 % CI , 0.15 to 0.73 ; P = .046 ) for those active 2 years after diagnosis . Compared with women who were inactive both before and after diagnosis , women who increased physical activity  after diagnosis had a 45 % lower risk of death ( HR = 0.55 ; 95 % CI , 0.22 to 1.38 ) , and women who decreased physical activity  after diagnosis had a four-fold greater risk of death ( HR = 3.95 ; 95 % CI , 1.45 to 10.50 ) . CONCLUSION Moderate-intensity physical activity after a diagnosis of breast cancer may improve prognosis This study examines the impact of smoking , body mass index , alcohol consumption , hormone replacement therapy , and physical activity on all-cause mortality among 528 Danish women diagnosed with primary breast cancer . Participants were women enrolled in the Copenhagen City Heart Study . Prospect i ve self-reported exposure information was collected from four points of follow-up in 1976–1978 , 1981–1983 , 1991–1994 , and 2001–2003 . Kaplan – Meier survival curves and multivariate Cox regression analyses were performed adjusting for age , disease stage , adjuvant treatment , menopausal status , parity , alcohol intake , smoking , physical activity , body mass index , and hormone replacement therapy . The study shows that smoking for total mortality [ hazard ratio , 1.16 ; 95 % confidence interval , 1.05–1.29 ] and obesity for both total mortality ( 1.61 ; 1.12–2.33 ) and breast cancer-specific mortality ( 1.82 ; 1.11–2.99 ) were significantly associated with decreased survival after breast cancer diagnosis . A moderate alcohol intake of 1 - 6 units/week ( 0.85 ; 0.64–1.12 ) , 7–14 units/week ( 0.77 ; 0.56–1.08 ) , and treatment with hormone replacement therapy ( 0.79 ; 0.59–1.05 ) were less than 1 , but not statistically significantly associated with prolonged survival . A moderate physical activity of 2–4 h/week ( 1.07 ; 0.77–1.49 ) and a high physical activity of more than 4 h/week ( 1.00 ; 0.69–1.45 ) showed no association with survival after breast cancer diagnosis Background Few studies have prospect ively evaluated the association of leisure-time physical activity ( LTPA ) with  mortality in Asians , who are more susceptible to insulin resistance than their Caucasian counterparts . Methods Data from two large prospect i ve cohort studies conducted in Shanghai were evaluated . After excluding participants who had a history of cancer , coronary heart disease or stroke at baseline , or who died within the first 3 years after study enrolment , 53 839 men and 66 888 women , followed for an average of 9.2 and 14.7 years , respectively , remained for the study . Results Compared with those who reported no exercise , a reduction in mortality with an HR of 0.86 ( 95 % CI 0.80 to 0.93 ) was observed in those who regularly engage in moderate-intensity LTPA , even those who reported an LTPA level lower than the minimum amount recommended by the current physical activity guidelines ( 150 min or 7.5 metabolic equivalent hours per week ) . The association between  moderate-intensity exercise and mortality followed a dose – response pattern until the amount of LTPA reached 3–5 times the recommended minimum level . A similar pattern of association was observed for cause-specific mortality due to cardiovascular disease ( CVD ) , cancer or other causes . Conclusion Regular participation in moderate-intensity LTPA was associated with reduced mortality , particularly CVD mortality , even when the LTPA was below the minimum level recommended by current guidelines . Increasing the amount of moderate-intensity LTPA was associated with further risk reduction up to a potential threshold of 3–5 times the recommended minimum PURPOSE Identifying strong markers of prognosis are critical to optimize treatment and survival outcomes in patients with malignant recurrent glioma . We investigated the prognostic significance of exercise  behavior  and functional capacity in this population . PATIENTS AND METHODS Using a prospect i ve design , 243 patients with WHO grade s 3 to 4 recurrent malignant glioma and Karnofsky performance status ( KPS ) ≥ 70 completed a self-administered question naire that assessed exercise behavior and performed a 6-minute walk test ( 6MWT ) to assess functional capacity . Cox proportional models were used to estimate the risk of all-cause mortality according to 6MWT distance ( 6MWD ; < 390 meters , 390 - 489 meters , > 489 meters ) and exercise behavior ( metabolic equivalent [ MET ] -h/wk ) adjusted for KPS and other important clinical factors . RESULTS Median follow-up was 27.43 months . During this period , 149 deaths were recorded ( 61 % of the total sample ) . Exercise behavior was an independent predictor of survival ( P = .0081 ) . Median survival was 13.03 months for patients reporting < 9 MET-h/wk relative to 21.84 months for those reporting ≥ 9 MET-h/wk . Exercise behavior  added incremental prognostic value beyond that provided by KPS , age , sex , grade , and number of prior progressions ( P < .001 ) . Compared with patients reporting < 9 MET-h/wk , the adjusted hazard ratio for mortality was 0.64 ( 95 % CI , 0.46 to 0.91 ) for patients reporting ≥ 9 MET-h/wk . Functional capacity was not an independent predictor of prognosis . CONCLUSION  Exercise behavior  is a strong independent predictor of survival that provides incremental prognostic value to KPS as well as traditional markers of prognosis in malignant recurrent glioma Observational studies have suggested that physical activity may be associated with improved survival after cancer treatment . However , data from controlled clinical trials are required . We analyzed survival data of 103 patients from a previously published r and omized controlled trial in allogeneic stem cell transplant patients who were r and omized to either an exercise intervention ( EX ) or to a social contact control group . EX patients trained prior to hospital admission , during inpatient treatment , and for 6 - 8 weeks after discharge .  Survival analyses were used to compare both total mortality ( TM ) and non-relapse mortality ( NRM ) after discharge and transplantation during an observation period of 2 years after transplantation . Analyses were corroborated with Cox and Fine & Gray regression models adjusting for potential confounders . After discharge , EX patients had a significantly lower TM rate than controls ( 12.0 vs. 28.3 % , p = 0.030 ) and a numerically lower NRM rate ( 4.0 vs. 13.5 % , p = 0.086 ) . When the inpatient period was included , absolute risk reductions were similar but not significantly different ( TM : 34.0 vs. 50.9 % , p = 0.112 ; NRM : 26.0 vs. 36.5 % , p = 0.293 ) . The number needed to treat ( NNT ) to prevent one death with EX was about 6 . Furthermore , regression analyses revealed that baseline fitness was protective against mortality . The data suggest that exercise might improve survival in patients undergoing allo-HCT . However , the results should be interpreted with caution as the study was not design ed to detect differences in survival rates , and as no stratification on relevant prognostic factors was carried out Background Modifiable behavioural risk factors — including exercise , obesity and smoking — have been causally associated with  colorectal cancer mortality . However , results have been inconsistent and undiagnosed cancers may affect baseline risk factors , distorting the temporal relationship that is observed between them . Objective To determine whether risk factors for colorectal cancers available in the Whitehall I study were predictive of colonic or rectal cancer mortality . Methods Prospect i ve cohort study over 40 years on Whitehall I men aged 40–69 on entry between 1967 and 1970 . Associations between baseline risk factors and cause-specific mortality were tested with Cox proportional hazards models . Events within the first 10 years of follow-up were excluded to minimise ‘ reverse causality . ’ Results 329 colon and 121 rectal cancer deaths occurred among 17 949 men followed up for a total of 472 523 person-years . Age and smoking were associated with increased mortality from colorectal cancers . Compared with never-smokers , current smoking was associated with age-adjusted HRs for colon and rectal cancers of 1.45 ( 95 % CI 1.03 to 2.03 ) and 1.97 ( 95 % CI 1.02 to 3.80 ) , respectively . A significant effect of current smoking on rectal cancer mortality was only apparent after events in the first 10 years of follow-up were excluded . No convincing evidence was found that body mass index , diabetes mellitus , blood pressure or physical activity were associated with colorectal cancer mortality . Conclusion Smoking significantly increases mortality from colorectal cancer  and its decreasing prevalence in the UK may partly explain falling mortality from the disease . Changes in health behaviours in response to early cancer symptoms may result in differential misclassification or ‘ reverse causality ’ unless early events are excluded . Although many individual cohort studies have not shown significant relationships between behavioural risk factors and colorectal cancer mortality , their contribution to meta-analyses remains important BACKGROUND The number of cancer survivors is increasing rapidly ; however , little is known about whether engaging in physical activity after a cancer diagnosis is associated with lower mortality rates in men . METHODS We conducted a prospect i ve cohort study of 1021 men ( mean age , 71.3 years ) who were diagnosed with cancer ( other than nonmelanoma skin cancer ) . Men reported their physical activities ( walking , stair climbing , and participation in sports and recreational activities ) on question naires in 1988 , a median of 6 years after their cancer diagnosis .  Physical activity was up date d in 1993 and men were followed until 2008 , with mortality follow-up > 99 % complete , during which 777 men died ( 337 from cancer , 190 from cardiovascular disease ) . RESULTS In multivariate analyses , the relative risks for all-cause mortality associated with expending < 2100 , 2100 - 4199 , 4200 - 8399 , 8400 - 12,599 , and ≥ 12,600 kJ/week in physical activity were 1.00 ( referent ) , 0.77 , 0.74 , 0.76 , and 0.52 , respectively ( P-trend < 0.0001 ) . Higher levels of physical activity also were associated with lower rates of death from cancer and cardiovascular disease ( P- trend = 0.01 and 0.002 , respectively ) . CONCLUSIONS Engaging in physical activity after cancer diagnosis is associated with better survival among men The purpose of these analyses is to test prospect ively whether post-diagnosis running and walking differ significantly in their association with breast cancer mortality .  Cox proportional hazard analyses were used to compare breast cancer mortality to baseline exercise energy expenditure ( METs , 1 MET-hour ≅1 km run ) in 272 runners and 714 walkers previously diagnosed with breast cancer from the National Runners ' and Walkers ' Health Studies when adjusted for age , race , menopause , family history , breastfeeding and oral contraceptive use . Diagnosis occurred ( mean ± SD ) 7.9 ± 7.3 years before baseline . Forty-six women ( 13 runners and 33 walkers ) died from breast cancer during 9.1-year mortality surveillance . For the 986 runners and walkers  combined , breast cancer mortality decreased an average of 23.9 % MET-hours/day [ 95 % confidence interval ( CI ) : 7.9 - 38.3 % ; p = 0.004 ] . There was a significantly greater decrease in risk for running than walking ( risk per MET-hours/day run vs. walked : p = 0.03 ) . For the 272 runners analyzed separately , breast cancer mortality decreased an average of 40.9 % per MET-hours/day run ( 95 % CI : 19.3 - 60.0 % , p = 0.0004 ) . When analyzed by categories of running energy expenditure , breast cancer mortality was 87.4 % lower for the 1.8 - 3.6 MET-hours/day category ( 95 % CI : 41.3 - 98.2 % lower , p = 0.008 ) and 95.4 % lower for the ≥3.6 MET-hours/day category ( 95 % CI : 71.9 - 100 % lower , p = 0.0004 ) compared to the < 1.07 MET-hours/day category . In contrast , the 714 walkers showed a nonsignificant 4.6 % decrease in breast cancer mortality per MET-hours/day walked ( 95 % CI : 27.3 % decreased risk to 21.3 % increased risk , p = 0.71 ) . These results suggest that post-diagnosis running is associated with significantly lower breast cancer mortality than post-diagnosis walking Background The relations of physical activity and sedentary behavior to mortality risk among patients with renal cell cancer have not yet been evaluated . Methods We conducted a prospect i ve cohort study among 667 renal cell cancer survivors aged 50–71 years of the National Institutes of Health (NIH)-AARP Diet and Health Study with a median follow-up time of 7.1 years . Post-diagnosis  physical activity , TV viewing , and total sitting time  were assessed using self-administered question naires . Hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) for mortality were estimated using Cox proportional hazards models . Results Increasing levels of moderate to vigorous physical activity were related to decreased risk of overall mortality [ multivariable-adjusted HRs for < 1 hr/wk ( reference ) , 1 to 3 hrs/wk , ≥3 to < 7 hrs/wk , and ≥7 hrs/wk = 1.0 , 1.16 , 0.94 , and 0.60 ( 95 % CI = 0.38–0.96 ; p-trend = 0.03 ) ] . In contrast , television viewing was associated with increased risk of overall mortality in the age- and sex-adjusted model ( HR for > 4 hrs/d vs. 0 to 2 hrs/d = 1.52 , 95 % CI = 1.02–2.26 ; p-trend = 0.04 ) , but the relation was attenuated following further control for other covariates ( multivariable-adjusted HR = 1.44 , 95 % CI = 0.92–2.24 ; p-trend = 0.11 ) . Total sitting time was unrelated to all-cause mortality . Conclusion Among renal cancer patients , moderate to vigorous physical activity is associated with decreased risk of overall mortality . Clinicians should consider discussing the potential benefits of physical activity for longevity among survivors of renal cell cancer Background Little is known about longitudinal associations of exercise with different types of cancer , particularly in Asian population s. The purpose of this research was to estimate the association between the duration of exercise and all-cause and cancer-specific mortality . Method Data were obtained from the Korean Metabolic Syndrome Mortality Study ( KMSMS ) , a prospect i ve cohort study of 303,428 Korean adults aged 20 years or older at baseline between 1994 and 2004 after exclusion of individuals with missing variables on smoking and exercise . Death certificate-linked data until 31 December 2015 were provided by the Korean National Statistical Office . Cox regression models were constructed to evaluate the associations of exercise with cancer mortality after adjusting for potential confounders such as age , alcohol consumption and smoking status . Results During the follow-up period of 15.3 years ( 4,638,863 person-years ) , a total of 16,884 participants died . Both men and women who exercised showed approximately 30 % decreased hazards of mortality , compared to those who did no exercise ( hazard ratio ( HR ) 0.70 , 95 % confidence interval (CI)=0.68 - 0.73 for men , HR=0.71 , CI : 0.67 - 0.75 ) . A notable observation of this study is the curvilinear associations between the total duration of exercise per week and cancer mortality , with the lowest risk being observed at the low-to-medium levels of exercise ; this trend of associations was found for esophagus , liver , lung , and colorectal cancer mortality in men , and all-cause , all-cancer and lung cancer mortality in women . Conclusions Individuals  who exercised showed considerably lower all-cause and cancer mortality risks compared with those who did no exercise . Policies and clinical trials aim ed at promoting minimal or moderate participation in exercise may minimize cancer mortality risk The impact of  physical activity ( PA ) on lymphoma survival is not known . The association of PA and change in PA  with overall ( OS ) , lymphoma‐specific ( LSS ) and event‐free ( EFS ) survival was evaluated in a prospect i ve cohort of newly diagnosed lymphoma patients ( 2002‐2012 ) . We calculated  Leisure Score Indexes ( mLSI  ) from the self‐reported usual adult PA ( baseline ) and at 3‐years post‐diagnosis ( FU3 ) , grouping patients by active vs insufficiently active by the American Cancer Society PA guidelines . Associations of PA with survival were assessed using hazard ratios ( HRs ) and 95 % confidence intervals ( CI ) from Cox models stratified by lymphoma subtype , adjusted for age , sex , baseline BMI , and comorbidity score with change scores further adjusted for baseline PA . Three thous and sixty participants were evaluable at baseline and 1371 at FU3 . Active patients had superior survival from baseline [ HR ( CI ) : OS 0.82 ( 0.72‐0.94 ) ; LSS 0.74 ( 0.61‐0.90 ) ; EFS 0.92 ( 0.82‐1.02 ) ] and FU3 [ HR ( CI ) : OS 0.64 ( 0.46‐0.88 ) ; LSS 0.32 ( 0.18‐0.59 ) ; EFS 0.82 ( 0.61‐1.10 ) ] compared to insufficiently active . An increase in mLSI from baseline to FU3 ( vs stable mLSI ) was associated with superior OS ( HR = 0.70 , CI 0.49‐1.00 ) and LSS ( HR = 0.49 , CI 0.26‐0.94).The continuous change in mLSI at FU3 was significantly associated with OS , LSS and EFS ; maintained across subgroups and appeared linear . Higher PA among lymphoma patients at diagnosis and 3 years is significantly associated with OS , LSS , and EFS  . Increasing PA after diagnosis is significantly associated with improved OS and LSS supporting an important role for PA in lymphoma survivorship and the need for intervention trials UNLABELLED Observational studies suggest that physical activity after a breast cancer diagnosis is associated with improved cancer outcomes ; however , no r and omized data are available . Here , we report an exploratory follow-up of cancer outcomes from the Supervised Trial of Aerobic versus Resistance Training ( START ) . METHODS The START was a Canadian multicenter trial that r and omized 242 breast cancer patients between 2003 and 2005 to usual care ( n = 82 ) , supervised aerobic ( n = 78 ) , or resistance ( n = 82 ) exercise during chemotherapy .  The primary end point for this exploratory analysis was disease-free survival ( DFS ) . Secondary end points were overall survival , distant DFS , and recurrence-free interval . The two exercise arms were combined for analysis ( n = 160 ) , and selected subgroups were explored . RESULTS After a median follow-up of 89 months , there were 25/160 ( 15.6 % ) DFS events in the exercise groups and 18/82 ( 22.0 % ) in the control group . Eight-year DFS was 82.7 % for the exercise groups compared with 75.6 % for the control group ( HR , 0.68 ; 95 % confidence interval ( CI ) , 0.37 - 1.24 ; log-rank , P = 0.21 ) . Slightly stronger effects were observed for overall survival ( HR , 0.60 ; 95 % CI , 0.27 - 1.33 ; log-rank , P = 0.21 ) , distant DFS ( HR , 0.62 ; 95 % CI , 0.32 - 1.19 ; log-rank , P = 0.15 ) , and recurrence-free interval ( HR , 0.58 ; 95 % CI , 0.30 - 1.11 ; Gray test , P = 0.095 ) . Subgroup analyses suggested potentially stronger exercise effects on DFS for women who were overweight/obese ( HR , 0.59 ; 95 % CI , 0.27 - 1.27 ) , had stage II/III cancer ( HR , 0.61 ; 95 % CI , 0.31 - 1.20 ) , estrogen receptor-positive tumors ( HR , 0.58 ; 95 % CI , 0.26 - 1.29 ) , human epidermal growth factor receptor 2-positive tumors ( HR , 0.21 ; 95 % CI , 0.04 - 1.02 ) , received taxane-based chemotherapies ( HR , 0.46 ; 95 % CI , 0.19 - 1.15 ) , and ≥85 % of their planned chemotherapy ( HR , 0.50 ; 95 % CI , 0.25 - 1.01 ) . CONCLUSIONS This exploratory follow-up of the START provides the first r and omized data to suggest that adding exercise to st and ard chemotherapy may improve breast cancer outcomes . A definitive phase III trial is warranted Background Cancer survivors are advised to follow lifestyle recommendations on diet , physical activity , and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research ( WCRF/AICR ) for cancer prevention . Previous studies have demonstrated that higher concordance with these recommendations measured using an index score ( the WCRF/AICR score ) was associated with lower cancer incidence and mortality . The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer ( CRC ) patients . Methods The association between the WCRF/AICR score ( score range 0–6 in men and 0–7 in women ; higher scores indicate greater concordance ) assessed on average 6.4 years before diagnosis and CRC-specific ( n = 872 ) and overall mortality ( n = 1,113 ) was prospect ively examined among 3,292 participants diagnosed with CRC in the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) cohort ( mean follow-up time after diagnosis 4.2 years ) . Multivariable Cox proportional hazard models were used to estimate hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) for mortality . Results The HRs ( 95 % CIs ) for CRC-specific mortality among participants in the second ( score range in men/women : 2.25–2.75/3.25–3.75 ) , third ( 3–3.75/4–4.75 ) , and fourth ( 4–6/5–7 ) categories of the score were 0.87 ( 0.72–1.06 ) , 0.74 ( 0.61–0.90 ) , and 0.70 ( 0.56–0.89 ) , respectively ( P for trend < 0.0001 ) , compared to participants with the lowest concordance with the recommendations ( category 1 of the score : 0–2/0–3 ) . Similar HRs for overall mortality were observed ( P for trend 0.004 ) . Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models . Conclusions Greater concordance with the WCRF/AICR recommendations on diet , physical activity , and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients
Background Recommendations for improved survival after cancer through physical activity ( PA ) exist , although the evidence is still emerging .
Our primary objective was to conduct a systematic review and meta- analysis of the association between prediagnosis and postdiagnosis PA and survival ( cancer-specific , all-cause , and cardiovascular disease mortality ) for all cancers and by tumor site .
Secondary objectives were to examine the associations within population subgroups , by PA domain , and to determine the optimal dose of PA related to survival .