Epithelial ovarian cancer and recreational physical activity: A review of the epidemiological literature and implications for exercise prescription

Abstract

Despite the publication of two dozen observational epidemiological studies investigating the association between recreational physical activity (RPA) and epithelial ovarian cancer (EOC) risk and survival over the past two decades, taken collectively, data from retrospective and prospective studies are mixed and remain inconclusive.

Objective: Our primary purpose was to conduct a careful review and summary of the epidemiological literature depicting the association between EOC and RPA in the framework of identifying factors which may be impeding our ability to observe consistent associations in the literature. Secondly, in the backdrop of the more broad scientific evidence regarding the benefits of RPA, we provide a summary of guidelines for practitioners to utilize in the context of exercise prescription for cancer patients, including a discussion of special considerations and contraindications to exercise which are unique to EOC patients and survivors.

Methods: We performed a comprehensive literature search via PubMed to identify epidemiologic investigations focused on the association between RPA and EOC. To be included in the review, studies had to assess RPA independently of occupational or household activities.

Results: In total, 26 studies were identified for inclusion. Evidence of a protective effect of RPA relative to EOC risk is more consistent among-case control studies, with the majority of studies demonstrating significant risk reductions between 30 and 60% among the most active women. Among cohort studies, half yielded no significant associations, while the remaining studies provided mixed evidence of an association.

Conclusions: Given the limitations identified in the current body of literature, practitioners should not rely on inconclusive evidence to dissuade women from participating in moderate or vigorous RPA. Rather, emphasis should be placed on the greater body of scientific evidence which has demonstrated that RPA results in a plethora of health benefits that can be achieved in all populations, including those with cancer.

Keywords: Ovarian cancer risk; Ovarian cancer survival; Physical activity benefits; Physical activity guidelines.

Figure 1

Flowchart of criteria for inclusion in the review of epidemiological literature assessing the association between recreational physical activity and ovarian cancer risk and survival.

Figure 2

Epithelial Ovarian Cancer Risk and Total Recreational Physical Activity

Figure 3

Epithelial Ovarian Cancer Risk and Moderate Intensity Recreational Physical Activity

Figure 4

Epithelial Ovarian Cancer Risk and Vigorous-Intensity Recreational Physical Activity