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Physical Activity and Colorectal Cancer

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Abstract

Physical activity has been shown to reduce risk of colon cancer. Some studies have shown site-specific associations while others have not. The inverse association between physical activity and colon cancer is consistent although only 7 of 13 studies that have collected both colon and rectal cancer data in the same manner report reduced risk for rectal cancer; four of these studies detected statistically significant inverse associations. The frequency, duration and intensity of activity are important components of a public health message to reduce risk of colon cancer through performance of physical activity. However, difficulties in estimating the exact amount of activity needed and frequency and intensity of activity result in only crude estimates of dose needed for a protective effect. Much of the literature suggest that more intense activity is needed to reduce colon cancer risk and that somewhere between 3.5 and 4 hours of vigorous activity per week may be needed to optimise protection. Several biological mechanisms have been proposed to explain the association between physical activity and colon cancer; many of these mechanisms also support the observation that intense activities are most protective. Biological mechanisms include: physical activity increasing gut motility; enhancing the immune system; decreasing insulin and insulin-like growth factor levels; decreasing obesity; enhancing free radical scavenger systems; and influencing prostaglandin levels. The evidence taken together provides strong support for lack of physical activity being causally related to colon cancer. It has been estimated that 12–14% of colon cancer could be attributed to lack of frequent involvement in vigorous physical activity.

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References

  1. American Cancer Society. Cancer facts and figures. Atlanta (GA): American Cancer Society, 1997

    Google Scholar 

  2. Ries LA, Eisner EP, Kosary CL, et al., editors. SEER cancer statistics review, 1973–1998. Bethesda (MD): National Cancer Institute, 2002

    Google Scholar 

  3. World Health Organization. The world health report. Geneva: World Health Organization, 1997

    Google Scholar 

  4. Giovannucci E. Modifiable risk factors for colon cancer. Gastroenterol Clin North Am 2002; 31(4): 925–43

    Article  PubMed  Google Scholar 

  5. Potter JD, Slattery ML, Bostick RM, et al. Colon cancer: a review of the epidemiology. Epidemiol Rev 1993; 15(2): 499–545

    PubMed  CAS  Google Scholar 

  6. Haenszel W, Kurihara M. Studies of Japanese migrants: I. Mortality from cancer and other diseases among Japanese in the United States. J Natl Cancer Inst 1968; 40(1): 43–68

    PubMed  CAS  Google Scholar 

  7. Correa P, Haenszel W. The epidemiology of large-bowel cancer. Adv Cancer Res 1978; 26: 1–141

    Article  PubMed  CAS  Google Scholar 

  8. Vainio H, Bianchini F. Weight control and physical activity. Lyon: IARC Press, 2002

    Google Scholar 

  9. Slattery ML, Potter J, Caan B, et al. Energy balance and colon cancer: beyond physical activity. Cancer Res 1997; 57(1): 75–80

    PubMed  CAS  Google Scholar 

  10. Slattery ML, Caan BJ, Potter JD, et al. Dietary energy sources and colon cancer risk. Am J Epidemiol 1997; 145(3): 199–210

    Article  PubMed  CAS  Google Scholar 

  11. Le Marchand L, Wilkens LR, Kolonel LN, et al. Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer. Cancer Res 1997; 57(21): 4787–94

    PubMed  Google Scholar 

  12. Friedenreich CM, Orenstein MR. Physical activity and cancer prevention: etiologic evidence and biological mechanisms. J Nutr 2002; 132 (11 Suppl.): 3456S–64S

    PubMed  CAS  Google Scholar 

  13. Friedenreich CM. Physical activity and cancer prevention: from observational to intervention research. Cancer Epidemiol Biomarkers Prev 2001; 10(4): 287–301

    PubMed  CAS  Google Scholar 

  14. McTiernan A, Ulrich C, Slate S, et al. Physical activity and cancer etiology: associations and mechanisms. Cancer Causes Control 1998; 9(5): 487–509

    Article  PubMed  CAS  Google Scholar 

  15. Thune I. Assessments of physical activity and cancer risk. Eur J Cancer Prev 2000; 9(6): 387–93

    Article  PubMed  CAS  Google Scholar 

  16. Lamonte MJ, Ainsworth BE. Quantifying energy expenditure and physical activity in the context of dose response. Med Sci Sports Exerc 2001; 33 (6 Suppl.): S370–8

    Article  PubMed  CAS  Google Scholar 

  17. Ainsworth BE. Challenges in measuring physical activity in women. Exerc Sport Sci Rev 2000; 28(2): 93–6

    PubMed  CAS  Google Scholar 

  18. Jacobs Jr DR, Ainsworth BE, Hartman TJ, et al. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc 1993; 25(1): 81–91

    Article  PubMed  Google Scholar 

  19. Garabrant DH, Peters JM, Mack TM, et al. Job activity and colon cancer risk. Am J Epidemiol 1984; 119(6): 1005–14

    PubMed  CAS  Google Scholar 

  20. Vena JE, Graham S, Zielezny M, et al. Lifetime occupational exercise and colon cancer. Am J Epidemiol 1985; 122(3): 357–65

    PubMed  CAS  Google Scholar 

  21. Ainsworth BE, Richardson MT, Jacobs Jr DR, et al. Accuracy of recall of occupational physical activity by questionnaire. J Clin Epidemiol 1999; 52(3): 219–27

    Article  PubMed  CAS  Google Scholar 

  22. Ainsworth BE, Sternfeld B, Slattery ML, et al. Physical activity and breast cancer: evaluation of physical activity assessment methods. Cancer 1998; 83 (3 Suppl.): 611–20

    Article  PubMed  CAS  Google Scholar 

  23. Slattery ML, David R, Jacobs J. Assessment of ability to recall physical activity of several years ago. Ann Epidemiol 1995; 5: 292–6

    Article  PubMed  CAS  Google Scholar 

  24. Fraser G, Pearce N. Occupational physical activity and risk of cancer of the colon and rectum in New Zealand males. Cancer Causes Control 1993; 4: 45–50

    Article  PubMed  CAS  Google Scholar 

  25. White E, Jacobs EJ, Daling JR. Physical activity in relation to colon cancer in middle-aged men and women. Am J Epidemiol 1996; 144(1): 42–50

    Article  PubMed  CAS  Google Scholar 

  26. Martinez ME, Giovannucci E, Spiegelman D, et al. Leisure-time physical activity, body size, and colon cancer in women: Nurses’ Health Study Research Group. J Natl Cancer Inst 1997; 89(13): 948–55

    Article  PubMed  CAS  Google Scholar 

  27. Slattery ML, Edwards SL, Ma K-N, et al. Physical activity and colon cancer: a public health perspective. Ann Epidemiol 1997; 7(2): 137–45

    Article  PubMed  CAS  Google Scholar 

  28. Nilsen TI, Vatten LJ. Prospective study of colorectal cancer risk and physical activity, diabetes, blood glucose and BMI: exploring the hyperinsulinaemia hypothesis. Br J Cancer 2001; 84(3): 417–22

    Article  PubMed  CAS  Google Scholar 

  29. Lee IM, Paffenbarger Jr RS, Hsieh C. Physical activity and risk of developing colorectal cancer among college alumni. J Natl Cancer Inst 1991; 83(18): 1324–9

    Article  PubMed  CAS  Google Scholar 

  30. Slattery M, Schumacher M, Smith K, et al. Physical activity, diet, and risk of colon cancer in Utah. Am J Epidemiol 1988; 128(5): 989–99

    PubMed  CAS  Google Scholar 

  31. Whittemore AS, Wu-Williams AH, Lee M, et al. Diet, physical activity, and colorectal cancer among Chinese in North America and China. J Natl Cancer Inst 1990; 82(11): 915–26

    Article  PubMed  CAS  Google Scholar 

  32. Peters RK, Pike MC, Garabrant D, et al. Diet and colon cancer in Los Angeles County, California. Cancer Causes Control 1992; 3(5): 457–73

    Article  PubMed  CAS  Google Scholar 

  33. Thune I, Lund E. Physical activity and risk of colorectal cancer in men and women. Br J Cancer 1996; 73(9): 1134–40

    Article  PubMed  CAS  Google Scholar 

  34. Friedenreich CM. Physical activity and cancer: lessons learned from nutritional epidemiology. Nutr Rev 2001; 59(11): 349–57

    Article  PubMed  CAS  Google Scholar 

  35. Wu AH, Paganini-Hill A, Ross RK, et al. Alcohol, physical activity and other risk factors for colorectal cancer: a prospective study. Br J Cancer 1987; 55: 687–94

    Article  PubMed  CAS  Google Scholar 

  36. Gerhardsson M, Floderus B, Norell SE. Physical activity and colon cancer risk. Int J Epidemiol 1988; 17(4): 743–6

    Article  PubMed  CAS  Google Scholar 

  37. Severson RK, Nomura AMY, Grove JS, et al. A prospective analysis of physical activity and cancer. Am J Epidemiol 1989; 130(3): 522–9

    PubMed  CAS  Google Scholar 

  38. Marcus PM, Newcomb PA, Storer BE. Early adulthood physical activity and colon cancer risk among Wisconsin women. Cancer Epidemiol Biomarkers Prev 1994; 3(8): 641–4

    PubMed  CAS  Google Scholar 

  39. Longnecker MP, Gerhardsson le Verdier M, Frumkin H, et al. A case-control study of physical activity in relation to risk of cancer of the right colon and rectum in men. Int J Epidemiol 1995; 24(1): 42–50

    Article  PubMed  CAS  Google Scholar 

  40. Giovannucci E, Ascherio A, Rimm EB, et al. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med 1995; 122: 327–34

    PubMed  CAS  Google Scholar 

  41. de Verdier MG, Steineck G, Hagman U, et al. Physical activity and colon cancer: a case-referent study in Stockholm. Int J Cancer 1990; 46: 985–9

    Article  Google Scholar 

  42. Kune GA, Kune S, Watson LF. Body weight and physical activity as predictors of colorectal cancer risk. Nutr Cancer 1990; 13: 9–17

    Article  PubMed  CAS  Google Scholar 

  43. Tavani A, Braga C, La Vecchia C, et al. Physical activity and risk of cancers of the colon and rectum: an Italian case-control study. Br J Cancer 1999; 79(11–12): 1912–6

    Article  PubMed  CAS  Google Scholar 

  44. Potter JD. Risk factors for colon neoplasia: epidemiology and biology. Eur J Cancer 1995; 31A(7–8): 1033–8

    Article  PubMed  CAS  Google Scholar 

  45. Colbert LH, Hartman TJ, Malila N, et al. Physical activity in relation to cancer of the colon and rectum in a cohort of male smokers. Cancer Epidemiol Biomarkers Prev 2001; 10(3): 265–8

    PubMed  CAS  Google Scholar 

  46. Slattery ML, Edwards S, Curtin K, et al. Physical activity and colorectal cancer. Am J Epidemiol 2003; 158(3): 214–24

    Article  PubMed  CAS  Google Scholar 

  47. Gerhardsson de Verdier M, Plato N, Steineck G, et al. Occupational exposures and cancer of the colon and rectum. Am J Ind Med 1992; 22(3): 291–303

    Article  PubMed  CAS  Google Scholar 

  48. Kato I, Tominaga S, Ikari A. A case-control study of male colorectal cancer in Aichi Prefecture, Japan: with special reference to occupational activity level, drinking habits and family history. Jpn J Cancer Res 1990 Feb; 81(2): 115–21

    Article  PubMed  CAS  Google Scholar 

  49. Markowitz S, Morabia A, Garibaldi K, et al. Effect of occupational and recreational activity on the risk of colorectal cancer among males: a case-control study. Int J Epidemiol 1992; 21(6): 1057–62

    Article  PubMed  CAS  Google Scholar 

  50. Levi F, Pasche C, Lucchini F, et al. Occupational and leisure-time physical activity and the risk of colorectal cancer. Eur J Cancer Prev 1999; 8(6): 487–93

    Article  PubMed  CAS  Google Scholar 

  51. Colbert LH, Lanza E, Ballard-Barbash R, et al. Adenomatous polyp recurrence and physical activity in the Polyp Prevention Trial (United States). Cancer Causes Control 2002; 13(5): 445–53

    Article  PubMed  Google Scholar 

  52. Mao Y, Pan S, Wen SW, et al. Physical inactivity, energy intake, obesity and the risk of rectal cancer in Canada. Int J Cancer 2003; 105(6): 831–7

    Article  PubMed  CAS  Google Scholar 

  53. Gerhardsson de Verdier M, Steineck G, Hagman U, et al. Physical activity and colon cancer: a case-referent study in Stockholm. Int J Cancer 1990; 46(6): 985–9

    Article  PubMed  CAS  Google Scholar 

  54. Tang R, Wang JY, Lo SK, et al. Physical activity, water intake and risk of colorectal cancer in Taiwan: a hospital-based case-control study. Int J Cancer 1999; 82(4): 484–9

    Article  PubMed  CAS  Google Scholar 

  55. Neugut AI, Terry MB, Hocking G, et al. Leisure and occupational physical activity and risk of colorectal adenomatous polyps. Int J Cancer 1996; 68(6): 744–8

    Article  PubMed  CAS  Google Scholar 

  56. Little J, Logan RF, Hawtin PG, et al. Colorectal adenomas and energy intake, body size and physical activity: a case-control study of subjects participating in the Nottingham faecal occult blood screening programme. Br J Cancer 1993; 67(1): 172–6

    Article  PubMed  CAS  Google Scholar 

  57. Giovannucci E, Colditz GA, Stampfer MJ, et al. Physical activity, obesity, and risk of colorectal adenoma in women (United States). Cancer Causes Control 1996; 7(2): 253–63

    Article  PubMed  CAS  Google Scholar 

  58. Sandler RS, Pritchard ML, Bangdiwala SI. Physical activity and the risk of colorectal adenomas. Epidemiology 1995; 6(6): 602–6

    Article  PubMed  CAS  Google Scholar 

  59. Slattery M, Abd-Elghany N, Kerber R, et al. Physical activity and colon cancer: a comparison of various indicators of physical activity to evaluate the association. Epidemiology 1990; 1(6): 481–5

    Article  PubMed  CAS  Google Scholar 

  60. Gerhardsson de Verdier M, Hagman U, Steineck G, et al. Diet, body mass and colorectal cancer: a case-referent study in Stockholm. Int J Cancer 1990; 46(5): 832–8

    Article  PubMed  CAS  Google Scholar 

  61. Slattery ML, Potter JD. Physical activity and colon cancer: confounding or interaction? Med Sci Sports Exerc 2002; 34(6): 913–9

    Article  PubMed  Google Scholar 

  62. Ballard-Barbash R, Schatzkin A, Albanes D, et al. Physical activity and risk of large bowel cancer in the Framingham Study. Cancer Res 1990 Jun 15; 50(12): 3610–3

    PubMed  CAS  Google Scholar 

  63. Slattery ML, Benson J, Berry TD, et al. Dietary sugar and colon cancer. Cancer Epidemiol Biomarkers Prev 1997; 6(9): 677–85

    PubMed  CAS  Google Scholar 

  64. Krotkiewski M, Bjorntorp P, Holm G, et al. Effects of physical training on insulin, connecting peptide (C-peptide), gastric inhibitory polypeptide (GIP) and pancreatic polypeptide (PP) levels in obese subjects. Int J Obes 1984; 8(3): 193–9

    PubMed  CAS  Google Scholar 

  65. Oktedalen O, Guldvog I, Opstad PK, et al. The effect of physical stress on gastric secretion and pancreatic polypeptide levels in man. Scand J Gastroenterol 1984; 19(6): 770–8

    PubMed  CAS  Google Scholar 

  66. Holdstock DJ, Misiewicz JJ. Factors controlling colonic motility: colonie pressures and transit after meals in patients with total gastrectomy, pernicious anaemia or duodenal ulcer. Gut 1970; 11(2): 100–10

    Article  PubMed  CAS  Google Scholar 

  67. Cordain L, Latin RW, Behnke JJ. The effects of an aerobic running program on bowel transit time. J Sports Med Phys Fitness 1986; 26(1): 101–4

    PubMed  CAS  Google Scholar 

  68. Blair SN. Evidence for success of exercise in weight loss and control. Ann Intern Med 1993; 119 (7 Pt 2): 702–6

    PubMed  CAS  Google Scholar 

  69. Wood PD. Impact of experimental manipulation of energy intake and expenditure on body composition. Crit Rev Food Sci Nutr 1993; 33(4–5): 369–73

    Article  PubMed  CAS  Google Scholar 

  70. Shephard RJ, Rhind S, Shek PN. The impact of exercise on the immune system: NK cells, interleukins 1 and 2, and related responses. Exerc Sport Sci Rev 1995; 23: 215–41

    Article  PubMed  CAS  Google Scholar 

  71. Shephard RJ, Shek PN. Cancer, immune function, and physical activity. Can J Appl Physiol 1995; 20(1): 1–25

    Article  PubMed  CAS  Google Scholar 

  72. Nieman DC, Henson DA. Role of endurance exercise in immune senescence. Med Sci Sports Exerc 1994; 26(2): 172–81

    Article  PubMed  CAS  Google Scholar 

  73. Nieman DC, Nehlsen-Cannarella SL, Markoff PA, et al. The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections. Int J Sports Med 1990; 11(6): 467–73

    Article  PubMed  CAS  Google Scholar 

  74. McCarty MF. Up-regulation of IGF binding protein-1 as an anticarcinogenic strategy: relevance to caloric restriction, exercise, and insulin sensitivity. Med Hypotheses 1997; 48(4): 297–308

    Article  PubMed  CAS  Google Scholar 

  75. McKeown-Eyssen G. Epidemiology of colorectal cancer revisited: are serum triglycerides and/or plasma glucose associated with risk. Cancer Epidemiol Biomarkers Prev 1994 Dec; 3(8): 687–95

    PubMed  CAS  Google Scholar 

  76. Tutton PJ, Barkla DH. Influence of prostaglandin analogues on epithelial cell proliferation and xenograft growth. Br J Cancer 1980; 41(1): 47–51

    Article  PubMed  CAS  Google Scholar 

  77. Demers LM, Harrison TS, Halbert DR, et al. Effect of prolonged exercise on plasma prostaglandin levels. Prostaglandins Med 1981; 6(4): 413–8

    Article  PubMed  CAS  Google Scholar 

  78. Martinez ME, Heddens D, Earnest DL, et al. Physical activity, body mass index, and prostaglandin E2 levels in rectal mucosa. J Natl Cancer Inst 1999; 91(11): 950–3

    Article  PubMed  CAS  Google Scholar 

  79. Slattery ML, Curtin K, Benson J, et al. Plant foods, fiber, and rectal cancer. Am J Clin Nutr 2004; 79: 274–81

    PubMed  CAS  Google Scholar 

  80. Saris WH, Blair SN, van Baak MA, et al. How much physical activity is enough to prevent unhealthy weight gain?: outcome of the IASO 1st Stock Conference and consensus statement. Obes Rev 2003; 4(2): 101–14

    Article  PubMed  CAS  Google Scholar 

  81. Hu FB. Sedentary lifestyle and risk of obesity and type 2 diabetes. Lipids 2003; 38(2): 103–8

    Article  PubMed  CAS  Google Scholar 

  82. Matsuzawa Y, Shimomura I, Nakamura T, et al. Pathophysiology and pathogenesis of visceral fat obesity. Obes Res 1995; 3Suppl. 2: 187S–94S

    PubMed  Google Scholar 

  83. Rissanen A, Fogelholm M. Physical activity in the prevention and treatment of other morbid conditions and impairments associated with obesity: current evidence and research issues. Med Sci Sports Exerc 1999; 31 (11 Suppl.): S635–45

    PubMed  CAS  Google Scholar 

  84. Rogers AE. Selected recent studies of exercise, energy metabolism, body weight, and blood lipids relevant to interpretation and design of studies of exercise and cancer. Adv Exp Med Biol 1992; 322: 239–45

    Article  PubMed  CAS  Google Scholar 

  85. Kim YI. Diet, lifestyle, and colorectal cancer: is hyperinsulinemia the missing link? Nutr Rev 1998; 56(9): 275–9

    Article  PubMed  CAS  Google Scholar 

  86. Giovannucci E. Insulin and colon cancer. Cancer Causes Control 1995; 6(2): 164–79

    Article  PubMed  CAS  Google Scholar 

  87. Kaaks R, Toniolo P, Akhmedkhanov A, et al. Serum C-peptide, insulin-like growth factor (IGF)-I, IGF-binding proteins, and colorectal cancer risk in women. J Natl Cancer Inst 2000; 92(19): 1592–600

    Article  PubMed  CAS  Google Scholar 

  88. Ma J, Pollak MN, Giovannucci E, et al. Prospective study of colorectal cancer risk in men and plasma levels of insulin-like growth factor (IGF)-I and IGF-binding protein-3. J Natl Cancer Inst 1999; 91(7): 620–5

    Article  PubMed  CAS  Google Scholar 

  89. Moore MA, Park CB, Tsuda H. Implications of the hyperinsulinaemia-diabetes-cancer link for preventive efforts. Eur J Cancer Prev 1998; 7(2): 89–107

    PubMed  CAS  Google Scholar 

  90. Woods JA, Davis JM. Exercise, monocyte/macrophage function, and cancer. Med Sci Sports Exerc 1994; 26(2): 147–56

    Article  PubMed  CAS  Google Scholar 

  91. Bennett A, Tacca MD, Stamford IF, et al. Prostaglandins from tumours of human large bowel. Br J Cancer 1977; 35(6): 881–4

    Article  PubMed  CAS  Google Scholar 

  92. Rauramaa R, Salonen JT, Kukkonen-Harjula K, et al. Effects of mild physical exercise on serum lipoproteins and metabolites of arachidonic acid: a controlled randomised trial in middle aged men. BMJ (Clin Res Ed) 1984; 288(6417): 603–6

    Article  CAS  Google Scholar 

  93. Slattery ML, Curtin K, Ma K, et al. Diet activity, and lifestyle associations with p53 mutations in colon tumors. Cancer Epidemiol Biomarkers Prev 2002; 11(6): 541–8

    PubMed  CAS  Google Scholar 

  94. Slattery ML, Anderson K, Curtin K, et al. Lifestyle factors and Ki-ras mutations in colon cancer tumors. Mutat Res 2001; 483(1–2): 73–81

    PubMed  CAS  Google Scholar 

  95. Martinez ME, Maltzman T, Marshall JR, et al. Risk factors for Ki-ras protooncogene mutation in sporadic colorectal adenomas. Cancer Res 1999; 59(20): 5181–5

    PubMed  CAS  Google Scholar 

  96. La Vecchia C, Braga C, Franceschi S, et al. Population-attributable risk for colon cancer in Italy. Nutr Cancer 1999; 33(2): 196–200

    Article  PubMed  Google Scholar 

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Acknowledgements

This manuscript was supported by CA48998 from the National Cancer Institute. The author has no conflicts of interest that are directly relevant to the content of this review.

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Slattery, M.L. Physical Activity and Colorectal Cancer. Sports Med 34, 239–252 (2004). https://doi.org/10.2165/00007256-200434040-00004

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