Exercise is linked to lower cancer mortality for survivors of several less-studied cancers, according to a large pooled analysis published Feb. 17 in JAMA Network Open. Researchers found that doing moderate to vigorous physical activity after a cancer diagnosis was associated with reduced risk of dying from cancer across seven cancer types and that people who were inactive before diagnosis could still benefit by becoming active.
Study design and participants
The analysis combined data from six long-term cohorts: the Cancer Prevention Study-II Nutrition Cohort, the Health Professionals Follow-Up Study, the NIH–AARP Diet and Health Study, the Nurses’ Health Study, the Nurses’ Health Study II, and the Women’s Health Study. In total, 17,141 adults who had survived one of seven cancers (bladder, endometrial, kidney, lung, oral cavity, ovarian, or rectal) were included.
Participants reported leisure-time physical activity before and after their cancer diagnosis. Post-diagnosis activity was assessed on average 2.8 years after diagnosis to avoid capturing the lower activity typical during active treatment. Activity was classified by intensity (moderate to vigorous activities such as brisk walking, running, swimming, or cycling) and quantified in MET-hours per week (MET-h/wk). The study used current guidelines—7.5 to 15 MET-h/wk, equivalent to about 150–300 minutes of moderate activity per week—to create activity categories. Cancer deaths were tracked over an average follow-up of nearly 11 years.
Analyses adjusted for age, sex, race, smoking, alcohol use, cancer stage, and treatments (including chemotherapy and radiation), and examined changes in activity from before to after diagnosis. Sensitivity analyses excluded deaths occurring within two years of the post-diagnostic activity survey to reduce bias from poor health causing inactivity.
Key findings
– Any post-diagnostic moderate to vigorous activity was associated with lower cancer mortality overall.
– Bladder cancer survivors who reported some activity had a 33% lower risk of cancer death compared with inactive survivors.
– Endometrial survivors meeting recommended activity levels had a 60% lower cancer death risk.
– Lung cancer survivors saw reductions in cancer mortality of up to 62% when meeting recommended activity levels.
– Oral and rectal cancer survivors benefited most at activity levels equal to or exceeding double current guidelines: oral cancer survivors exercising >2x the guideline level had a 61% lower risk, while rectal survivors had about a 43% lower risk.
– Kidney cancer showed a trend toward benefit with higher activity but results were not statistically significant.
– Survivors of lung and rectal cancer who were inactive before diagnosis but became active afterward experienced notably lower cancer mortality, suggesting benefit even when activity starts after diagnosis.
Expert practical advice
Exercise professionals not involved in the study emphasize starting slowly and building up. Walking is an accessible starting point; “microwalks” (about 5 minutes or ~500 steps) can be accumulated through the day. To estimate target heart rates, subtract age from 220 and multiply by 0.7 for moderate intensity or 0.8 for vigorous; for example, a 40-year-old’s moderate threshold would be about 126 bpm. Aim ultimately for about 150 minutes per week of moderate activity (or 75 minutes of vigorous), and add two days of light strength training as tolerated. Monitor pain, fatigue, and symptoms, and consult a physician, physical therapist, or certified trainer if unsure. Choosing enjoyable activities and exercising with friends can aid adherence.
Implications
These findings add to evidence that post-diagnostic physical activity may improve survival across several cancer types. While observational and subject to potential residual confounding, results remained robust after adjustments and sensitivity checks, supporting exercise as a potentially beneficial survivor strategy.
