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Physical activity during adolescence and risk of colorectal adenoma later in life: results from the Nurses’ Health Study II



Physical activity during adulthood has been consistently associated with lower risk of colorectal cancers, but whether physical activity during adolescence may also play a role in colorectal carcinogenesis is unclear.


We included 28,250 women in the Nurses’ Health Study II who provided data on physical activity during adolescence (ages 12–22 years) in 1997 and underwent lower bowel endoscopy (1998–2011). We used logistic regression models for clustered data to examine the association between physical activity during adolescence and risk of adenoma later in life.


Physical activity during adolescence was inversely associated with risk of colorectal adenoma (2373 cases), independent of physical activity during adulthood. The multivariable-adjusted odds ratio (OR) of adenoma was 0.89 (95% CI 0.77–1.02; Ptrend = 0.03) comparing women with ≥ 72 metabolic equivalent of tasks-hours/week (MET-h/week) to < 21 MET-h/week. Women with high physical activity during both adolescence (≥53.3 MET-h/week) and adulthood (≥23.1 MET-h/week) had significantly lower risk of adenoma (all adenomas: OR 0.76; 95% CI 0.66–0.88; advanced adenoma: OR 0.61; 95% CI 0.45–0.82) compared to women with low physical activity during both stages of life.


Our findings suggest that physical activity during adolescence may lower the risk of colorectal adenoma later in life.

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The authors would like to thank the Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School. The authors would like to thank the participants and staff of the Nurses’ Health Study II for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA and WY. The authors assume full responsibility for analyses and interpretation of these data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

L.F.M.R., D.H.L. and N.K. had full access to all of the data and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: L.F.M.R., D.H.L., N.K., E.G., K.W. Acquisition, analysis or interpretation of data: L.F.M.R., D.H.L., N.K., E.G., K.W., K.N., M.S., I.L., J.E.N., S.O., C.F., J.M., A.T.C., W.W. Drafting of manuscript: L.F.M.R., D.H.L. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: L.F.M.R., D.H.L. and N.K. Obtained funding: W.W. and K.W. Study supervision: K.W. 

Correspondence to NaNa Keum.

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Competing interests

Dr. Fuchs reports consulting role for Agios, Bain Capital, Bayer, Celgene, Dicerna, Five Prime Therapeutics, Gilead Sciences, Eli Lilly, Entrinsic Health, Genentech, KEW, Merck, Merrimack Pharmaceuticals, Pfizer, Sanofi, Taiho, and Unum Therapeutics. He also serves as a Director for CytomX Therapeutics and owns unexercised stock options for CytomX and Entrinsic Health. Dr. Meyerhardt reports consulting role for Ignyta, COTA, Taiho Pharmaceutical (all <$5 K). All other authors declare no competing interests relevant in relation to the work described.

Ethics approval and consent to participate

The study protocol was approved by the institutional review boards of the Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, and those of participating registries as required. Completion of the questionnaire was considered to imply informed consent.

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Not applicable.

Data availability

Further information including the procedures to obtain and access data from the Nurses' Health Study and Health Professionals Follow-up Study is described at (email: and


This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).


The Nurses’ Health Study II was funded by the National Cancer Institute (NCI), National Institutes of Health (UM1 CA176726 to WW). Leandro Fórnias Machado de Rezende receives a doctoral fellowship from the Coordination for the Improvement of Higher Education Personnel (CAPES) and the Sao Paulo Research Foundation (FAPESP), grant #2016/21390–0 and #2014/25614-4. NCI grants R03 CA197879 to KW, R21 CA222940 to K.W. and Reiko Nishihara, R21 CA230873 to K.W. and S.O., R35 CA197735 to S.O., P50 CA127003 to C.S.F. The American Cancer Society (grant number MRSG-17-220-01 – NEC to M.S.). The National Institutes of Health grants K99 CA215314 and R00 CA215314 to M.S. N.K. was supported by grants from the National Research Foundation of Korea (NRF-2018R1C1B6008822; NRF-2018R1A4A1022589); the Dongguk University Research Grant of 2017. This work was also in part supported by an Investigator Initiated Grant from the American Institute for Cancer Research (AICR) to KW.

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