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Meta-Analysis
. 2016 Aug 9:354:i3857.
doi: 10.1136/bmj.i3857.

Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013

Hmwe H Kyu  1 , Victoria F Bachman  2 , Lily T Alexander  1 , John Everett Mumford  1 , Ashkan Afshin  1 , Kara Estep  1 , J Lennert Veerman  3 , Kristen Delwiche  4 , Marissa L Iannarone  1 , Madeline L Moyer  1 , Kelly Cercy  1 , Theo Vos  1 , Christopher J L Murray  1 , Mohammad H Forouzanfar  5
Affiliations
Meta-Analysis

Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013

Hmwe H Kyu et al. BMJ. .

Abstract

Objective: To quantify the dose-response associations between total physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events.

Design: Systematic review and Bayesian dose-response meta-analysis.

Data sources: PubMed and Embase from 1980 to 27 February 2016, and references from relevant systematic reviews. Data from the Study on Global AGEing and Adult Health conducted in China, Ghana, India, Mexico, Russia, and South Africa from 2007 to 2010 and the US National Health and Nutrition Examination Surveys from 1999 to 2011 were used to map domain specific physical activity (reported in included studies) to total activity.

Eligibility criteria for selecting studies: Prospective cohort studies examining the associations between physical activity (any domain) and at least one of the five diseases studied.

Results: 174 articles were identified: 35 for breast cancer, 19 for colon cancer, 55 for diabetes, 43 for ischemic heart disease, and 26 for ischemic stroke (some articles included multiple outcomes). Although higher levels of total physical activity were significantly associated with lower risk for all outcomes, major gains occurred at lower levels of activity (up to 3000-4000 metabolic equivalent (MET) minutes/week). For example, individuals with a total activity level of 600 MET minutes/week (the minimum recommended level) had a 2% lower risk of diabetes compared with those reporting no physical activity. An increase from 600 to 3600 MET minutes/week reduced the risk by an additional 19%. The same amount of increase yielded much smaller returns at higher levels of activity: an increase of total activity from 9000 to 12 000 MET minutes/week reduced the risk of diabetes by only 0.6%. Compared with insufficiently active individuals (total activity <600 MET minutes/week), the risk reduction for those in the highly active category (≥8000 MET minutes/week) was 14% (relative risk 0.863, 95% uncertainty interval 0.829 to 0.900) for breast cancer; 21% (0.789, 0.735 to 0.850) for colon cancer; 28% (0.722, 0.678 to 0.768) for diabetes; 25% (0.754, 0.704 to 0.809) for ischemic heart disease; and 26% (0.736, 0.659 to 0.811) for ischemic stroke.

Conclusions: People who achieve total physical activity levels several times higher than the current recommended minimum level have a significant reduction in the risk of the five diseases studied. More studies with detailed quantification of total physical activity will help to find more precise relative risk estimates for different levels of activity.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow chart of selecting studies for inclusion in dose-response meta-analysis of effect of physical activity on five diseases
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Fig 2 Continuous risk curve for association between physical activity and breast cancer. For each datapoint in included studies, which are represented by different colors, length of horizontal bar refers to total physical activity interval in MET-minutes/week and vertical bar refers to confidence interval of relative risks
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Fig 3 Continuous risk curve for association between physical activity and colon cancer. For each datapoint in included studies, which are represented by different colors, length of horizontal bar refers to total physical activity interval in MET-minutes/week and vertical bar refers to confidence interval of relative risks
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Fig 4 Continuous risk curve for association between physical activity and diabetes. For each datapoint in included studies, which are represented by different colors, length of horizontal bar refers to total physical activity interval in MET-minutes/week and vertical bar refers to confidence interval of relative risks
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Fig 5 Continuous risk curve for association between physical activity and ischemic heart disease. For each datapoint in included studies, which are represented by different colors, length of horizontal bar refers to total physical activity interval in MET-minutes/week and vertical bar refers to confidence interval of relative risks
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Fig 6 Continuous risk curve for association between physical activity and ischemic stroke. For each datapoint in included studies, which are represented by different colors, length of horizontal bar refers to total physical activity interval in MET-minutes/week and vertical bar refers to confidence interval of relative risks
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Fig 7 Continuous risk curves for association between physical activity and breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke
See this image and copyright information in PMC

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