Association between cardiorespiratory fitness and colorectal cancer in the UK Biobank


Increased cardiorespiratory fitness is related to decreased risk of major chronic illnesses, including cardiovascular disease, type 2 diabetes, and cancer, but its association with colorectal cancer specifically has received very little attention. We examined the relation of cardiorespiratory fitness to colorectal cancer in 59,191 UK Biobank participants aged 39–70 years without prevalent cancer at baseline, followed from 2009 to 2014. Submaximal bicycle ergometry was conducted at study entry, and cardiorespiratory fitness was defined as physical work capacity at 75% of the maximum heart rate, standardised to body mass (PWC75%). Multivariable Cox proportional hazards regression was performed to obtain hazard ratios (HR) and corresponding 95% confidence intervals (CI). During a mean follow-up of 4.6 years, 232 participants developed colorectal cancer (151 colon cancers; 79 rectal cancers). When comparing the 75th to the 25th percentiles of PWC75%, the multivariable-adjusted HR of colorectal cancer was 0.78 (95% CI 0.62–0.97). That relation was largely driven by an inverse association with colon cancer (HR 0.74, 95% CI 0.56–0.97) and less so with rectal cancer (HR 0.88, 95% CI 0.62–1.26; p value for difference by colorectal cancer endpoint = 0.056). The inverse relation of cardiorespiratory fitness with colorectal cancer was more evident in men (HR 0.72, 95% CI 0.55–0.94) than women (HR 0.99, 95% CI 0.71–1.38), although the gender difference was not statistically significant (p value for interaction = 0.192). Increased cardiorespiratory fitness is associated with decreased risk of colorectal cancer. Potential heterogeneity by colorectal cancer anatomic subsite and gender requires further study.

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Fig. 1
Fig. 2

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Body mass index


Beats per minute


Confidence interval




Hazard ratio


International classification of diseases


International Physical Activity Questionnaire


Metabolic equivalent of task


North West Multi-centre Research Ethics Committee


Nonsteroidal anti-inflammatory drug

PWC75% :

Physical work capacity at 75% of the maximum heart rate standardised to body mass


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This research has been conducted using the UK Biobank Resource under Application Number 24091. The authors thank all study participants and the study personnel.


The UK Biobank was supported by the Wellcome Trust, Medical Research Council, Department of Health, Scottish government, and Northwest Regional Development Agency. It has also had funding from the Welsh Assembly government and British Heart Foundation. The research was designed, conducted, analysed, and interpreted by the authors entirely independently of the funding sources.

Author information




AH conducted the data preparation and analysis. AH drafted the manuscript with support from ML and SB. ML and SB conceived the original idea and supervised the project. All authors directly participated in interpretation of the results, provided critical comments to the manuscript and revised the text. All authors of this research paper have read and approved the final version submitted.

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Correspondence to Andrea Hillreiner.

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All procedures performed were in accordance and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and ethical approval was obtained from North West Multi-centre Research Ethics Committee (REC reference: 11/NW/03820).

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Informed consent was obtained from all individual participants included in the study.

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Hillreiner, A., Baumeister, S.E., Sedlmeier, A.M. et al. Association between cardiorespiratory fitness and colorectal cancer in the UK Biobank. Eur J Epidemiol 35, 961–973 (2020).

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  • Cardiorespiratory fitness
  • Colorectal cancer
  • Incidence
  • UK Biobank
  • Gender-specific