Abstract
IMPORTANCE: There is insufficient evidence to determine whether physical activity lengthens survival among people with a history of cancers less commonly studied for such benefit. OBJECTIVE: To examine the associations between physical activity assessed after a cancer diagnosis with cancer mortality and, secondarily, changes in physical activity before vs after diagnosis with cancer mortality among people previously diagnosed with 1 of 7 cancers. DESIGN, SETTING, AND PARTICIPANTS: This study used a pooled dataset of 6 cohorts (Cancer Prevention Study-II Nutrition Cohort, Health Professionals Follow-Up Study, National Institutes of Health-AARP Diet and Health Study, Nurses' Health Study, Nurses' Health Study II, and Women's Health Study). Participants were survivors of bladder, endometrial, kidney, lung, oral cavity, ovarian, or rectal cancer who had completed surveys and had repeated measures of leisure-time physical activity. Baseline data were collected from 1976 through 1997. The mean (SD) follow-up was 10.9 (7.0) years. Data were analyzed from June 2023 to March 2024. EXPOSURES: Leisure-time moderate to vigorous physical activity (MVPA) before and after cancer diagnosis. MAIN OUTCOMES AND MEASURES: Association of MVPA in categories of metabolic equivalents of task hours per week (MET-h/wk) measured before and a mean (SD) of 2.8 (1.5) years after cancer diagnosis with cancer mortality. RESULTS: This pooled analysis included 17 141 cancer survivors (mean [SD] age, 67 [8] years; 60% female). Engagement in low amounts of MVPA (>0 to <7.5 vs 0 MET-h/wk) was associated with lower risk of cancer mortality among survivors who had been diagnosed with bladder (hazard ratio [HR], 0.67 [95% CI, 0.50-0.91]), endometrial (HR, 0.62 [95% CI, 0.45-0.87]), and lung cancer (HR, 0.56 [95% CI, 0.43-0.75]). Doubling the recommended MVPA guideline or more (eg, >15 vs 0 MET-h/wk) was associated with lower risk of cancer mortality among oral (HR, 0.39 [95% CI, 0.15-0.99] for >22.5 to 30.0 MET-h/wk) and rectal (HR, 0.57 [95% CI, 0.33-0.97] for >15.0 to 22.5 MET-h/wk) cancer survivors. Point estimates were less than 1 for cancer mortality among kidney cancer survivors (HR, 0.51 [95% CI, 0.22-1.18] for >15.0 to 22.5 MET-h/wk), although the confidence interval included the null. Compared with survivors who did not meet the MVPA guidelines before or after diagnosis, lung (HR, 0.58 [95% CI, 0.47-0.71]) and rectal (HR, 0.51 [95% CI, 0.32-0.83]) cancer survivors who met guidelines after diagnosis had a lower risk of cancer mortality, even if they were inactive before their diagnosis. CONCLUSIONS AND RELEVANCE: In this analysis of 6 pooled cohorts, higher levels of MVPA after a cancer diagnosis were associated with lower risk of cancer mortality among people previously diagnosed with 1 of 7 cancers not commonly studied for their association with MVPA. Findings suggest that it is important for health care professionals to promote physical activity for longevity and overall health among people living with and beyond cancer.