Abstract
BACKGROUND: Although higher pre-diagnosis physical activity is linked to lower mortality among cancer survivors, it is unclear whether this is due to a reduced likelihood of metastatic cancer at diagnosis. This study evaluated whether adherence to physical activity guidelines before diagnosis is associated with all-cause mortality and metastatic cancer at diagnosis. METHODS: In the prospective Lifelines Cohort Study of 152,915 adults, we identified individuals diagnosed with primary cancer at any site through linkage to the Netherlands Cancer Registry. Adherence to physical activity guidelines was defined as ≥150 minutes of moderate-intensity activity, ≥75 minutes of vigorous-intensity activity, or an equivalent combination per week. Cox and logistic regression estimated adjusted HRs and ORs with 95% confidence intervals (CI) for associations between adherence to physical activity guidelines, all-cause mortality, and metastatic cancer at diagnosis. RESULTS: A total of 5,990 patients with cancer were included: 10.7% reported no physical activity, 19.1% were insufficiently active, and 70.2% were sufficiently active. Patients with cancer adhering to physical activity guidelines had a 16% lower risk of all-cause mortality compared with those who reported no physical activity (HR = 0.84; 95% CI, 0.72-0.98). However, meeting physical activity guidelines was not significantly associated with a reduced likelihood of metastatic cancer at diagnosis (OR = 0.98; 95% CI, 0.79-1.23). CONCLUSIONS: Physical activity at recommended levels before cancer diagnosis is linked to reduced mortality among cancer survivors, independent of metastatic cancer at diagnosis. IMPACT: These findings highlight the beneficial role of physical activity in reducing mortality in patients with cancer.