1. physical activity and
cancer:
appraising the evidence
Kate Wolin, ScD, FACSM
Loyola University Chicago

2. conflict of interest disclosure:
Theraband research support
Up to Date publishing royalty
Dr. Oz Show travel expenses
AICR travel expenses

3. where have we been

4. Wolin et al 2010

5. where we are
Second Expert Report 2007

6. why what we don’t know
matters

7. polyps
Wolin et al 2010
I–V overall (I 2
= 46.2%, P = 0.005)
Shinchi et al, 1994
Tiemersma et al, 2003
Larsen et al, 2006
D+L overall
Rosenberg et al, 2006
Neugut, 1996
Kahn et al, 1998
Hauret et al, 2004
Tiemersma et al, 2003
Kono et al, 1991
Kono et al, 1999
Wallace et al, 2005
Lubin et al, 1997
Neugut, 1996
Label
Lieberman et al, 2003
Enger et al, 1997
Sandler, 1995
Little et al, 1993
Boutron-Ruault et al, 2001
Boutron-Ruault et al, 2001
Giovannucci et al, 1996
Colbert et al, 2002
Kahn et al, 1998
Hermann et al, 2009
Wallace et al, 2005
Sandler, 1995
Larsen et al, 2006
Giovannucci et al, 1995
0.87 (0.83, 0.9
1.20 (0.80, 1.8
0.69 (0.43, 1.1
0.96 (0.74, 1.2
0.84 (0.77, 0.9
0.72 (0.57, 0.9
1.30 (0.70, 2.4
0.83 (0.76, 0.9
0.63 (0.34, 1.1
1.05 (0.72, 1.5
0.44 (0.22, 0.8
0.60 (0.30, 1.2
1.21 (0.36, 4.0
0.60 (0.30, 1.2
0.60 (0.40, 0.9
ES (95% CI)
0.94 (0.86, 1.0
1.00 (0.70, 1.4
0.64 (0.35, 1.1
0.46 (0.17, 1.2
0.80 (0.40, 1.6
1.30 (0.70, 2.4
0.58 (0.40, 0.8
1.20 (0.90, 1.6
0.90 (0.78, 1.0
1.02 (0.74, 1.4
0.35 (0.17, 0.7
0.92 (0.36, 2.3
0.56 (0.34, 0.9
0.79 (0.57, 1.0
10.2 5

8. lifetime activity & breast
Dallal et al 2007
RELATIVERISK
HOURS/WEEK P FOR TREND
STRENUOUS = 0.02
MODERATE = 0.29
0.5$
0.6$
0.7$
0.8$
0.9$
1$
1.1$
0*0.5$ 0.51*2.0$ 2.01*3.5$ 3.51*5.00$ >$5.0$

9. what we think we know

10. just 30 minutes/day of
walking is enough

11. colon cancer
Wolin et al 2007
RELATIVERISK
MET HRS/WEEK
0.75%
0.8%
0.85%
0.9%
0.95%
1%
1.05%
<2% 2.1+4.5% 4.6+10.3% 10.4+21.4% 21.5+%

12. walking & colon
Wolin et al 2007
0.5$
0.6$
0.7$
0.8$
0.9$
1$
1.1$
0$ <1$ 1+1.9$ 2+3.9$ 4+$
RELATIVERISK
HOURS/WEEK

13. colon cancer survival
Meyerhardt et al 2006

14. Measurement

15. breast cancer survival
Ibrahim et al 2010

16. breast cancer survival
Holmes et al 2005
ll num-
catego-
ses was
MET-
no sub-
usal sta-
neficial
both es-
ors (RR,
not to
d hor-
5% CI,
ing was
aths.
icial to
ase, but
cial to
women
ngaged
week of
essthan
was 0.36
hese re-
men and
was no
ercise in categories of MET-hours per
week (TABLE 5). Both walking and vig-
CI, 0.38-0.95) for 24 or more MET-
hours per week.
Figure. Kaplan-Meier Survival Curves
0.25
0.10
0.05
Physical Activity, MET-h/wk
No. at Risk
0.15
0.20
0
0 2 6 8 10 12 14 16 184
<3 959 957 573 407 286 222 83 43809
3-8.9 862 862 569 489 372 184 84 31767
≥9 1166 1166 773 692 449 290 164 861066
Follow-up, y
ProbabilityofMortality
MET-h/wk
≥9
3-8.9
<3
MET indicates metabolic equivalent task.

17. colon cancer survival
Meyerhardt et al 2006

18. resistance training & colon
Boyle et al 2012
RELATIVERISK
0.4$
0.5$
0.6$
0.7$
0.8$
0.9$
1$
1.1$
1.2$
never$ definite$ possible$ definite$or$possible$

19. physical activity matters
for everyone

20. breast by BMI
Friedenreich & Cust 2008
RELATIVERISK
0.7$
0.8$
0.9$
1$
1.1$
<22$ 22*25$ >=25$ >=30$

21. lifetime activity & endometrial
Patel et al 2008
MULTIVARIABLE MULTIVARIABLE WITH BMI
*
*
*
RELATIVERISK
0.5$
0.6$
0.7$
0.8$
0.9$
1$
1.1$
None/Low$
Low$1982,$High$1992$
High$1982,$Low$1992$
High$

22. endometrial by bmi
Patel et al 2008
*
* SIGNIFICANT
** TREND
**
RELATIVERISK
0.5$
0.6$
0.7$
0.8$
0.9$
1$
1.1$
BMI<%25%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%BMI%25+%
none$
>0$.$<7$
7$.$<17.5$
17.5+$

23. anything is better than
nothing

24. mortality
Wijndaele et al 2011
diabete
(Model
after fu
A 1-h/d
an incr
from a
(2% m
terially
shown)
excludi
2 years
Table
derived
cation,
tion an
Consist
terms
among
were n
signific
total P
(P ¼ 0.4
the sim
tween
To ex
mediat
BMI an
The inc
results
P ¼ 0.03
95% CI
tality:
Adding
the eff
CI ¼ 0.9
(HR ¼ 1
ally no
HR ¼ 1.
No ev
0
50
100
150
200
250
300
0 - 0.99 1 - 1.99 2 - 2.99 3 - 3.99 4 - 4.99 5 - 5.99
TV time (h/day)
All-cause mortality
0
20
40
60
80
100
120
140
0 - 0.99 1 - 1.99 2 - 2.99 3 - 3.99 4 - 4.99 5 - 5.99
TV time (h/day)
Cardiovascular mortality
0
20
40
60
80
100
120
140
0 - 0.99 1 - 1.99 2 - 2.99 3 - 3.99 4 - 4.99 5 - 5.99
TV time (h/day)
Cancer mortality
Mortalityrateper10000person-yearsMortalityrateper10000person-yearsMortalityrateper10000person-years
Figure 1 Unadjusted all-cause, cardiovascular and cancer
TV TIM
MVAR HR: 1.04 (0.98-1.10)
MVAR HR: 1.08 (1.01-1.16)
MVAR HR: 1.05 (1.01-1.09)

25. mortality
Dunstan et al 2010
0
5
10
15
20
25
All−causemortalityrate
0− 1− 2− 3− 4− 5− 6−
TV viewing time (hours/day)
A
0
5
10
15
20
25
CVDmortalityrate
0− 1− 2− 3− 4− 5− 6−
TV viewing time (hours/day)
B
0
5
10
15
20
25
Cancermortalityrate
0− 1− 2− 3− 4− 5− 6−
TV viewing time (hours/day)
C
0
5
10
15
20
25
Non−CVD/non−cancermortalityrate
0− 1− 2− 3− 4− 5− 6−
TV viewing time (hours/day)
D
Figure. Unadjusted all-cause (A), CVD (B), cancer (C), and non-CVD/noncancer (D) mortality rates per 1000 person-years according to
television (TV) viewing time (h/d). Dashed line presents the linear relationship between increments of television viewing time and all-
cause, CVD, cancer, and non-CVD/noncancer mortality rates. Number of people in each television viewing category was as follows: 0
h/d, 2442; Ն1 h/d, 2528; Ն2 h/d, 2138; Ն3 h/d, 1020; Ն4 h/d, 407; Ն5 h/d, 155; and Ն6 h/d, 108.
Dunstan et al Television Viewing Time and Mortality 387
CANCERALLCAUSE
CVDNON-CVD/NON-CANCER

26. colorectal
Howard et al 2008
0.9$
1$
1.1$
1.2$
1.3$
1.4$
1.5$
<3$
3+4$
5+6$
7+8$
9+$
RELATIVERISK
H/D
MEN WOMEN
TV SITTING TV SITTING
* SIGNIFICANT
*
*
* **

27. breast
Lynch et al 2013
H/W/Y
*
**
* SIGNIFICANT
RELATIVERISK
0.5$
0.6$
0.7$
0.8$
0.9$
1$
1.1$
Premenopausal,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Postmenopausal,
0$
0.1$*$<2.2$
2.2$*$<7.3$
7.3+$

28. breast
Dallal et al 2012
COUNTS
RELATIVERISK
*
* SIGNIFICANT
*
*
1"
1.5"
2"
2.5"
3"
3.5"
4"
mvar" mvar"+"PA"
<396.6"
396.612457.74"
457.752524.1"
524.11+"

29. breast
George et al 2010
0.9$
1$
1.1$
1.2$
1.3$
1.4$
1.5$
1.6$
1.7$
1.8$
<3$
3.4$
5.6$
7.8$
9+$
H/D
TV SITTING

30. endometrial
Arem et al 2011
*
* SIGNIFICANT
RELATIVERISK
0.8$
0.9$
1$
1.1$
1.2$
1.3$
1.4$
1.5$
1.6$
0$ 4$to$<6$ 6$to$<8$ 8+$
HR/DAY

31. endometrial
Moore et al 2010
RELATIVERISK
* SIGNIFICANT
* HRS/DAY
SITTING
*
**
*
1"
1.1"
1.2"
1.3"
1.4"
1.5"
1.6"
1.7"
Ac,ve" Inac,ve" Inac,ve"+BMI"
<3"
3to4"
5to6"
7to8"
9+"

32. mechanisms
Lynch 2010
Sixty-two studies that met review criteria addressed the
association between sedentary behavior and adiposity
(see Table 2). The randomized controlled trial assessed
the effect of a 3-week television-viewing-reduction inter-
of sedentary behavior at follow-up (93). A second pro-
spective study found that baseline sedentary behavior
(assessed by individually calibrated heart rate monitor-
ing) did not predict fat mass, BMI, or waist circumference
Figure 2. Biological model of hypothesized pathways from sedentary behavior to cancer. TNF-α, tumor necrosis factor-α; IL-6, interleukin-6; CRP, C-reactive protein.

33. mechanisms
Cancer
Obesity
Insulin ↑
(insulin
resistance)
IGFBP-1 ↓
IGFBP-2 ↓
IGF-I ↑
Exercise
Vitamin D
Adipokines
Inflammation
Oxidative stress
Immune function
Hormones

34. future directions