Vigorous Intermittent Lifestyle Physical Activity and Cancer Incidence Among Nonexercising Adults: The UK Biobank Accelerometry Study

Abstract

Importance: Vigorous physical activity (VPA) is a time-efficient way to achieve recommended physical activity (PA) for cancer prevention, although structured longer bouts of VPA (via traditional exercise) are unappealing or inaccessible to many individuals.

Objectives: To evaluate the dose-response association of device-measured daily vigorous intermittent lifestyle physical activity (VILPA) with incident cancer, and to estimate the minimal dose required for a risk reduction of 50% of the maximum reduction.

Design, setting, and participants: This was a prospective cohort analysis of 22 398 self-reported nonexercising adults from the UK Biobank accelerometry subsample. Participants were followed up through October 30, 2021 (mortality and hospitalizations), or June 30, 2021 (cancer registrations).

Exposures: Daily VILPA of up to 1 and up to 2 minutes, assessed by accelerometers worn on participants' dominant wrist.

Main outcomes and measures: Incidence of total cancer and PA-related cancer (a composite outcome of 13 cancer sites associated with low PA levels). Hazard ratios and 95% CIs were estimated using cubic splines adjusted for age, sex, education level, smoking status, alcohol consumption, sleep duration, fruit and vegetable consumption, parental cancer history, light- and moderate-intensity PA, and VPA from bouts of more than 1 or 2 minute(s), as appropriate.

Results: The study sample comprised 22 398 participants (mean [SD] age, 62.0 [7.6] years; 10 122 [45.2%] men and 12 276 [54.8%] women; 21 509 [96.0%] White individuals). During a mean (SD) follow-up of 6.7 (1.2) years (149 650 person-years), 2356 total incident cancer events occurred, 1084 owing to PA-related cancer. Almost all (92.3%) of VILPA was accrued in bouts of up to 1 minute. Daily VILPA duration was associated with outcomes in a near-linear manner, with steeper dose-response curves for PA-related cancer than total cancer incidence. Compared with no VILPA, the median daily VILPA duration of bouts up to 1 minute (4.5 minutes per day) was associated with an HR of 0.80 (95% CI, 0.69-0.92) for total cancer and 0.69 (95% CI, 0.55-0.86) for PA-related cancer. The minimal dose was 3.4 minutes per day for total (HR, 0.83; 95% CI, 0.73-0.93) and 3.7 minutes for PA-related (HR, 0.72; 95% CI, 0.59-0.88) cancer incidence. Findings were similar for VILPA bout of up to 2 minutes.

Conclusions and relevance: The findings of this prospective cohort study indicate that small amounts of VILPA were associated with lower incident cancer risk. Daily VILPA may be a promising intervention for cancer prevention in populations not able or motivated to exercise in leisure time.

Figure 1.. Adjusted Absolute Risk Dose-Response of Vigorous Intermittent Lifestyle Physical Activity (VILPA) Daily Duration, From Bouts of Up to 1 and 2 Minutes, With Physical Activity–Related Cancer Incidence (n = 22 398; 1084 Events)

Absolute risk adjusted for age, sex, body mass index (calculated as weight in kilograms divided by height in meters squared), duration of light-intensity physical activity, duration of moderate-intensity physical activity, smoking status, alcohol consumption, accelerometer-estimated sleep duration, fruit and vegetable consumption, education level, medication use, self-reported parental history of cancer, and prevalent cardiovascular disease. All analyses were additionally adjusted for vigorous physical activity duration of more than 1 or 2 minutes, as appropriate.

Figure 2.. Dose-Response Association of Vigorous Intermittent Lifestyle Physical Activity (VILPA) Daily Duration, From Bouts of Up to 1 and 2 Minutes, With Total Cancer Incidence (n = 22 398; 2356 Events)

The diamond shape indicates the ED₅₀ value, the minimal dose defined as the daily duration of VILPA associated with 50% of the optimal risk reduction; and the circle, the effect associated with the median VILPA value (the list of values is available in eTable 7 in Supplement 1) . Analyses were adjusted for age, sex, body mass index (calculated as weight in kilograms divided by height in meters squared), duration of light-intensity physical activity, duration of moderate-intensity physical activity, smoking status, alcohol consumption, accelerometer- estimated sleep duration, fruit and vegetable consumption, education level, medication use, self-reported parental history of cancer, and prevalent cardiovascular disease. All analyses were additionally adjusted for vigorous physical activity duration of more than 1 (bouts up to 1 minute exposure) minute or more than 2 (bouts up to 2 minutes exposure) minutes. Hazard ratios were calculated using Fine-Gray models.

Figure 3.. Dose-Response Association of Vigorous Intermittent Lifestyle Physical Activity (VILPA) Daily Duration From Bouts of Up to 1 and 2 Minutes With Physical Activity–Related Cancer Incidence (n = 22 398; 1084 Events)

The diamond shape indicates the ED₅₀ value, the minimal dose defined as the daily duration of VILPA associated with 50% of the optimal risk reduction; and the circle, the effect associated with the median VILPA value (the list of values is available in eTable 7 in Supplement 1) Analyses were adjusted for age, sex, body mass index (calculated as weight in kilograms divided by height in meters squared), duration of light-intensity physical activity, duration of moderate-intensity physical activity, smoking status, alcohol consumption, accelerometer-estimated sleep duration, fruit and vegetable consumption, education, medication use, self-reported parental history of cancer, and prevalent cardiovascular. All analyses were additionally adjusted for vigorous physical activity duration of more than 1 (bouts up to 1 minute exposure) minute or more than 2 (bouts up to 2 minutes exposure) minutes. Hazard ratios were calculated using Fine-Gray models.