ArticleBMC medicine2025
Effectiveness of sustained leisure-time physical activity strategies for obesity-related cancer prevention: an emulated target trial in a prospective US cohort.
Article in BMC medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundObesity-related cancers account for 40% of US cancer cases, and their global burden continues to rise. Cancer prevention guidelines recommend 150-300 min of moderate or 75-150 min of vigorous-intensity activity per week (7.5-15 MET-hrs/wk). However, the long-term causal effect of sustained leisure-time moderate-to-vigorous intensity physical activity (MVPA) on obesity-related cancer risk has not been quantified.
methodsWe emulated a target trial using data from 60,958 cancer-free adults in the Cancer Prevention Study-II Nutrition Cohort (2001-2013) to estimate 11-year risks of obesity-related cancers under four sustained MVPA strategies: (1) no intervention (observed MVPA); (2) below recommendations (> 0- < 7.5 MET-hrs/wk); (3) meeting recommendations (7.5-15 MET-hrs/wk); and (4) exceeding recommendations (> 15 MET-hrs/wk). MVPA was self-reported every 2 years. The parametric g-formula was used to estimate cancer risk under each strategy among all eligible participants and stratified by pre-intervention MVPA (meeting vs. not meeting recommendations 2 years prior to intervention).
resultsOver a median follow-up of 11.4 years (IQR 6.9-11.8), 4344 obesity-related cancers were diagnosed. Under no intervention, median baseline MVPA was 12.8 MET-hrs/wk (IQR 4.5-24.5) overall, 20.5 (IQR 15.2-30.8) among those meeting (n = 38,558), and 4.3 (IQR 1.5-6.2) among those not meeting recommendations pre-intervention (n = 22,400). The estimated 11-year cancer risk under no intervention was 8.2% overall, 8.1% among those meeting, and 8.7% among those not meeting recommendations pre-intervention. Compared to no intervention, risk differences were 0.18% (95% CI: 0.05% to 0.37%) for below-recommendation MVPA, 0.08% (95% CI: - 0.05% to 0.19%) for meeting, and - 0.18% (95% CI: - 0.44% to 0.01%) for exceeding recommendations. Among those meeting recommendations pre-intervention, risk differences were 0.34% (95% CI: 0.11% to 0.65%), 0.09% (95% CI: - 0.06% to 0.26%), and - 0.21% (95% CI: - 0.45% to - 0.05%), respectively. Among those not meeting recommendations, corresponding risk differences were - 0.02% (95% CI: - 0.31% to 0.27%), - 0.04% (95% CI: - 0.21% to 0.15%), and - 0.10% (95% CI: - 0.38% to 0.14%).
conclusionsWe estimated that, compared to no intervention, sustaining MVPA volumes below recommendations may modestly increase obesity-related cancer risk over 11 years, whereas exceeding recommendations may modestly reduce risk, particularly among participants already meeting the recommendations prior to intervention.
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