Regular moderate-intensity or greater physical activity is associated with a reduced risk of several types of cancer, including cancers of the breast, colon and endometrium. For several cancers, engaging in longer exercise sessions, or exercising with greater intensity or for more years, produces greater reductions in cancer risk.
Recent findings indicate that women with a history of breast cancer who engage in more than 9 metabolic equivalent (MET)·h/week of recreational physical activity after breast cancer diagnosis, which corresponds to approximately 2–3 h/week of brisk walking, had a significantly lower risk of death or breast cancer recurrence than women who were inactive. Similarly, men or women who are active after a diagnosis of colon cancer appear to have improved prognosis compared with sedentary individuals.
Physical activity effects on menstrual function and sex hormones might explain a link between increased physical activity and reduced risk for breast and endometrial cancers. Athletes and physically active premenopausal women have delayed onset of menses, fewer ovulatory cycles and lower circulating levels of oestrogen and progesterone, all factors that are related to breast or endometrial cancer risk.
Studies in postmenopausal women indicate that physical activity might affect postmenopausal breast cancer and endometrial cancer risk by reducing body fat, thereby lowering circulating levels of oestrogens and androgens.
Insulin resistance, hyperinsulinaemia, hyperglycaemia and type 2 diabetes have been linked to increased risk of breast, colon, pancreas and endometrial cancers. Physical activity improves insulin resistance, reduces hyperinsulinaemia and reduces risk for diabetes, which could explain the link between increased physical activity and reduced risk for these cancers.
Increased levels of pro-inflammatory factors and decreased levels of anti-inflammatory factors have been linked with increased cancer risk. Physical activity might reduce systemic inflammation alone or in combination with reduction in body weight or composition through reducing inflammatory cytokines in adipose tissue.
Support for an effect of physical activity on the cancer process comes from smaller randomized clinical trials. If definitive evidence from larger clinical trials is obtained to show that increased physical activity can prevent certain cancers, or can improve prognosis, it would be an excellent public-health intervention for reducing the impact of cancer at relatively low cost and risk.
About 25% of cancer cases globally are due to excess weight and a sedentary lifestyle. Physical activity may decrease risk for various cancers by several mechanisms, including decreasing sex hormones, metabolic hormones and inflammation, and improving immune function. The level of physical activity might also be associated with prognosis among individuals with cancer. Randomized clinical trials have shown that physical activity interventions can change biomarkers of cancer risk. Observational studies can also provide useful information on mechanisms that might link physical activity to cancer.
This is a preview of subscription content
Subscribe to Journal
Get full journal access for 1 year
only $4.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Vainio, H. & Bianchin, I. F. in International Agency for Research on Cancer Handbooks of Cancer Prevention 249–250 (International Agency for Research on Cancer, Lyon, 2002).
Thune, I. & Furberg, A. S. Physical activity and cancer risk: dose–response and cancer, all sites and site-specific. Med. Sci. Sports Exerc. 33, S530–S550 (2001).
Friedenreich, C. M. & Orenstein, M. R. Physical activity and cancer prevention: etiologic evidence and biological mechanisms. J. Nutr. 132, 3456S–3464S (2002).
Bernstein, L. et al. Lifetime recreational exercise activity and breast cancer risk among black women and white women. J. Natl Cancer Inst. 97, 1671–1679 (2005).
Dallal, C. M. et al. Long-term recreational physical activity and risk of invasive and in situ breast cancer: the California teachers study. Arch. Intern. Med. 167, 408–415 (2007).
McTiernan, A. et al. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women's Health Initiative Cohort Study. JAMA 290, 1331–1336 (2003).
Holmes, M. D., Chen, W. Y., Feskanich, D., Kroenke, C. H. & Colditz, G. A. Physical activity and survival after breast cancer diagnosis. JAMA 293, 2479–2486 (2005).
Pierce, J. P. et al. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J. Clin. Oncol. 25, 2345–2351 (2007).
Meyerhardt, J. A. et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J. Clin. Oncol. 24, 3535–3541 (2006).
Meyerhardt, J. A. et al. Physical activity and survival after colorectal cancer diagnosis. J. Clin. Oncol. 24, 3527–3534 (2006).
McTiernan, A. Physical activity after cancer: physiologic outcomes. Cancer Invest. 22, 68–81 (2004).
Frank, L. L. et al. Effects of exercise on metabolic risk variables in overweight postmenopausal women: a randomized clinical trial. Obes. Res. 13, 615–625 (2005).
McTiernan, A., Ulrich, C., Slate, S. & Potter, J. Physical activity and cancer etiology: associations and mechanisms. Cancer Causes Control 9, 487–509 (1998).
Martinez, M. E. et al. Physical activity, body mass index, and prostaglandin E2 levels in rectal mucose. J. Natl Cancer Inst. 91, 950–951 (1999).
Meijer, E. P., Goris, A. H., van Dongen, J. L., Bast, A. & Westerterp, K. R. Exercise-induced oxidative stress in older adults as a function of habitual activity level. J. Am. Geriatr. Soc. 50, 349–353 (2002).
Endogenous Hormones and Breast Cancer Collaborative Group. Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J. Natl Cancer Inst. 94, 606–616 (2002).
Kaaks, R., Lukanova, A. and Kurzer, M. S. Obesity, endogenous hormones and endometrial cancer risk: a synthetic review. Cancer Epidemiol. Biomarkers Prev. 11, 1531–1543 (2002).
Tammela, T. Endocrine treatment of prostate cancer. J. Steroid Biochem. Mol. Biol. 92, 287–295 (2004).
Thompson, I. M. et al. The influence of finasteride on the development of prostate cancer. N. Engl. J. Med. 349, 215–224 (2003).
Loucks, A. B. Energy availability, not body fatness, regulates reproductive function in women. Exerc. Sport Sci. Rev. 31, 144–148 (2003).
Loucks, A. B. & Redman, L. M. The effect of stress on menstrual function. Trends Endocrinol. Metab. 15, 466–471 (2004).
Williams, N. I., Helmreich, D. L., Parfitt, D. B., Caston-Balderrama, A. & Cameron, J. L. Evidence for a causal role of low energy availability in the induction of menstrual cycle disturbances during strenuous exercise training. J. Clin. Endocrinol. Metab. 86, 5184–5193 (2001).
Bonen, A. Recreational exercise does not impair menstrual cycles: a prospective study. Int. J. Sports Med. 13, 110–120 (1992).
Rogol, A. D. et al. Durability of the reproductive axis in eumenorrheic women during 1 yr of endurance training. J. Appl. Physiol. 72, 1571–1580 (1992).
Bullen, B. A. et al. Endurance training effects on plasma hormonal responsiveness and sex hormone excretion. J. Appl. Physiol. 56, 1453–1463 (1984).
Keizer, H. A. et al. Effect of a 3-month endurance training program on metabolic and multiple hormonal responses to exercise. Int. J. Sports Med. 8 (Suppl. 3), 154–160 (1987).
Bullen, B. A. et al. Induction of menstrual disorders by strenuous exercise in untrained women. N. Engl. J. Med. 312, 1349–1353 (1985).
Chan, M. F. et al. Usual physical activity and endogenous sex hormones in postmenopausal women: the European prospective investigation into cancer — Norfolk population study. Cancer Epidemiol. Biomarkers Prev. 16, 900–905 (2007).
McTiernan, A. et al. Relation of BMI and physical activity to sex hormones in postmenopausal women. Obesity (Silver Spring) 14, 1662–1677 (2006).
Verkasalo, P. K., Thomas, H. V., Appleby, P. N., Davey, G. K. & Key, T. J. Circulating levels of sex hormones and their relation to risk factors for breast cancer: a cross-sectional study in 1092 pre- and postmenopausal women (United Kingdom). Cancer Causes Control 12, 47–59 (2001).
McTiernan, A. et al. Effect of exercise on serum estrogen in postmenopausal women: a 12-month randomized controlled trial. Cancer Res. 64, 2923–2928. (2004).
McTiernan, A. et al. Effect of exercise on serum androgens in postmenopausal women: a 12-month randomized clinical trial. Cancer Epidemiol. Biomarkers Prev. 13, 1–7 (2004).
De Souza, M. J. & Miller, B. E. The effect of endurance training on reproductive function in male runners. A 'volume threshold' hypothesis. Sports Med. 23, 357–374 (1997).
Abate, N., Haffner, S. M., Garg, A., Peshock, R. M. & Grundy, S. M. Sex steroid hormones, upper body obesity, and insulin resistance. J. Clin. Endocrinol. Metab. 87, 4522–4527 (2002).
Hawkins, V. N. et al. Effect of exercise on serum sex hormones in men: a 12-month randomized clinical trial. Med. Sci. Sports Exerc. 40, 223–233 (2008).
Kjellman, A., Akre, O., Norming, U., Tornblom, M. & Gustafsson, O. Dihydrotestosterone levels and survival in screening-detected prostate cancer: a 15-yr follow-up study. Eur. Urol. 53, 106–111 (2007).
Nishiyama, T., Ikarashi, T., Hashimoto, Y., Suzuki, K. & Takahashi, K. Association between the dihydrotestosterone level in the prostate and prostate cancer aggressiveness using the Gleason score. J. Urol. 176, 1387–1391 (2006).
Kaaks, R. & Lukanova, A. Energy balance and cancer: the role of insulin and insulin-like growth factor-I. Proc. Nutr. Soc. 60, 91–106 (2001).
Wolf, I., Sadetzki, S., Catane, R., Karasik, A. & Kaufman, B. Diabetes mellitus and breast cancer. Lancet Oncol. 6, 103–111 (2005).
Boule, N. G., Haddad, E., Kenny, G. P., Wells, G. A. & Sigal, R. J. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 286, 1218–1227 (2001).
Ross, R. et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men: a randomized, controlled trial. Ann. Intern. Med. 133, 92–103 (2000).
Ross, R. et al. Exercise-induced reduction in obesity and insulin resistance in women: a randomized controlled trial. Obes Res. 12, 789–798 (2004).
Duncan, G. E. et al. Exercise training, without weight loss, increases insulin sensitivity and postheparin plasma lipase activity in previously sedentary adults. Diabetes Care 26, 557–562 (2003).
Campbell, K. L. & McTiernan, A. Exercise and biomarkers for cancer prevention studies. J. Nutr. 137, 161S–9S (2007).
Weiss, E. P. et al. Improvements in glucose tolerance and insulin action induced by increasing energy expenditure or decreasing energy intake: a randomized controlled trial. Am. J. Clin. Nutr. 84, 1033–1042 (2006).
McTiernan, A. et al. No effect of exercise on insulin-like growth factor 1 and insulin-like growth factor binding protein 3 in postmenopausal women: a 12-month randomized clinical trial. Cancer Epidemiol. Biomarkers Prev. 14, 1020–1021 (2005).
Orenstein, M. R. & Friedenreich, C. Insulin-like growth factors and exercise: review of the evidence. J. Phys. Act. Health 1, 291–320 (2004).
Il'yasova, D. et al. Circulating levels of inflammatory markers and cancer risk in the health aging and body composition cohort. Cancer Epidemiol. Biomarkers Prev. 14, 2413–2418 (2005).
Wetmore, C. M. & Ulrich, C. M. in Cancer Prevention and Management through Exercise and Weight Control (ed. McTiernan, A.) 157–175 (CRC Taylor Francis, Boca Raton, 2006).
Esposito, K. et al. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA 289, 1799–1804 (2003).
Jakobisiak, M., Lasek, W. & Golab, J. Natural mechanisms protecting against cancer. Immunol. Lett. 90, 103–122 (2003).
Nieman, D. C. Exercise immunology: practical applications. Int. J. Sports Med. 18 (Suppl. 1), S91–S100 (1997).
Ainsworth, B. E., Sternfeld, B., Slattery, M. L., Daguise, V. & Zahm, S. H. Physical activity and breast cancer: evaluation of physical activity assessment methods. Cancer 83, 611–620 (1998).
Irwin, M. L. & Ainsworth, B. E. Physical activity interventions following cancer diagnosis: methodologic challenges to delivery and assessment. Cancer Invest. 22, 30–50 (2004).
U. S. Department of Health and Human Services. Physical activity and health: a report of the Surgeon General (U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, 1996).
National Cancer Institute
National Cancer Institute Drug Dictionary
About this article
Cite this article
McTiernan, A. Mechanisms linking physical activity with cancer. Nat Rev Cancer 8, 205–211 (2008). https://doi.org/10.1038/nrc2325
Association between physical activity and infertility: a comprehensive systematic review and meta-analysis
Journal of Translational Medicine (2022)
Exercise suppresses tumor growth independent of high fat food intake and associated immune dysfunction
Scientific Reports (2022)
Therapeutic and preventive effects of exercise training on metabolic regulators/markers in mouse colorectal cancer cells
Sport Sciences for Health (2022)
Risk of Carcinogenicity Associated with Synthetic Hair Dyeing Formulations: A Biochemical View on Action Mechanisms, Genetic Variation and Prevention
Indian Journal of Clinical Biochemistry (2022)
Physical activity reduces the risk of pneumonia: systematic review and meta-analysis of 10 prospective studies involving 1,044,492 participants