European Journal of Epidemiology

, Volume 29, Issue 6, pp 391–404 | Cite as

Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies

  • Shanliang Zhong
  • Tianchi Jiang
  • Tengfei Ma
  • Xiaohui Zhang
  • Jinhai Tang
  • Weixian Chen
  • Mengmeng Lv
  • Jianhua ZhaoEmail author


Previous studies concerning the association between physical activity (PA) and mortality in breast cancer yielded mixed results. We investigated the association by performing a meta-analysis of all available studies. Relevant studies were identified by searching PubMed and EMBASE to January 2014. We calculated the summary relative risk (RR) and 95 % confidence intervals (CIs) using random-effects models. The dose–response relationship was assessed by restricted cubic spline model and multivariate random-effect meta-regression. Sixteen cohort studies involving 42,602 patients of breast cancer were selected for meta-analysis. The analyses showed that patients who participated in any amount of PA before diagnosis had a RR of 0.82 (95 % CI 0.74–0.91) for breast cancer-specific mortality (vs. low PA). Those who participated in high PA and moderate PA before diagnosis had a RR of breast cancer-specific mortality of 0.81 (95 % CI 0.72–0.90) and 0.83 (95 % CI 0.73–0.94), respectively. Similar inverse associations of prediagnosis PA were found for all-cause mortality. Postdiagnosis PA on breast cancer-specific and all-cause mortality also showed the same results. Stratifying by body mass index (<25 vs. ≥25) or menopausal status, all the subgroups experienced benefits with PA, with a stronger mortality reduction among overweight women than normal weight women and among postmenopausal women than premenopausal women. A linear and significant dose–response association was only found for breast cancer-specific or all-cause mortality and prediagnosis PA (P for nonlinearity = 0.07 and 0.10, respectively). In conclusion, both prediagnosis and postdiagnosis PA were associated with reduced breast cancer-specific mortality and all-cause mortality.


Physical activity Exercise Breast Cancer Mortality 



This study was supported by the National Natural Science Foundation of China (81272470).

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

10654_2014_9916_MOESM1_ESM.xls (28 kb)
Supplementary material 1 (XLS 27 kb)


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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Shanliang Zhong
    • 1
  • Tianchi Jiang
    • 2
  • Tengfei Ma
    • 1
  • Xiaohui Zhang
    • 1
  • Jinhai Tang
    • 3
  • Weixian Chen
    • 4
  • Mengmeng Lv
    • 4
  • Jianhua Zhao
    • 1
    Email author
  1. 1.Center of Clinical Laboratory ScienceJiangsu Cancer Hospital Affiliated to Nanjing Medical UniversityNanjingChina
  2. 2.Clinical College of Nanjing Medical UniversityNanjingChina
  3. 3.Department of General SurgeryJiangsu Cancer Hospital Affiliated to Nanjing Medical UniversityNanjingChina
  4. 4.The Fourth Clinical College of Nanjing Medical UniversityNanjingChina

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