Abstract
This paper reviews the consistency of the relation between increasedphysical activity and reduced risk of colon cancer, estimates the potentialprevention benefit from increasing population levels of physical activity,and considers social strategies to increase activity levels. The publishedliterature was reviewed systematically and supplemented by MEDLINE searchesthrough March 1997. Studies that reported a measure of physical activity andoutcomes of colon cancer or colorectal cancer were included. We excluded thefirst report of a study that was expanded subsequently by extended follow-up,and any study that did not report the methods for measurement of physicalactivity. Data were extracted including details on study size, methods ofclassifying physical activity, and outcomes. A consistent inverse relationwas observed such that increased physical activity was associated withreduced risk of colon cancer. About a 50 percent reduction in incidence wasobserved among thos e with the highest level of activity across numerousstudies that used different measures of activity (occupational orleisure-time activity). This association persisted in studies usingmultivariate analyses to control for diet and other known or suspected riskfactors for colon cancer. Risk reduction was attenuated in those studies thatcombined colon and rectal cancer. This review indicates that greaterattention should be placed on social strategies to increase physical activityas a means of preventing colon cancer.
This is a preview of subscription content, access via your institution.
References
Macfarlane G, Lowenfels A. Physical activity and colon cancer. Eur J Cancer Prev 1994; 3: 393–8.
US Department of Health and Human Services. Physical Activity and Health. Atlanta, GA (USA): US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.
American Cancer Society. Cancer Facts & Figures-1996. Atlanta, GA (USA): American Cancer Society, 1996.
Miller B, Reis L, Hankey B. SEER Cancer Statistics Review. 1973-1990. Bethesda, MD (USA): National Cancer Institute, 1993; NIH Pub. No. 93–2789.
Anderson L, May D. Has the use of cervical, breast, and colorectal cancer screening increased in the United States? Am J Public Health 1995; 85: 840–2.
Muir C, Waterhouse J, Mack T, Powell J, Whelan S, eds. Cancer Incidence in Five Continents. Lyon, France: International Agency for Research on Cancer, 1987; IARC Sci. Pub. No. 88, Vol. 5.
Potter JD, Slattery ML, Bostick RM, Gapstur SM. Colon cancer: a review of the epidemiology. Epidemiol Rev 1993; 15: 499–545.
McMichael A, Giles G. Colorectal cancer. In: Doll R, Fraumeni J, Muir C, eds. Trends in Cancer Incidence. Cold Spring Harbor, NY (USA): Cold Spring Harbor Laboratory Press, 1994; Vol. 19/20: 77–98.
Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Speizer FE. Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women. N Engl J Med 1990; 323: 1664–72.
Giovannucci E, Stampfer MJ, Colditz GA, Rimm EB, Speizer FE, Willett WC. Relationship of diet to risk of colorectal adenoma in men. JNCI 1992; 84: 91–8.
Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Willett WC. Intake of fat, meat, and fiber in relation to risk of colon cancer in men. Cancer Res 1994; 54: 2390–7.
Goldbohm RA, van den Brandt PA, van 't Veer P, et al. A prospective cohort study on the relation between meat consumption and the risk of colon cancer. Cancer Res 1994; 54: 718–23.
Giovannucci E, Stampfer MJ, Colditz GA, et al. Folate, methionine and alcohol intake and risk of colorectal adenoma. JNCI 1993; 85: 875–84.
Freudenheim JL, Graham S, Marshall JR. Folate intake and carcinogenesis of the colon and rectum. Int J Epidemiol 1991; 20: 368–74.
Giovannucci E, Rimm EB, Stampfer MJ, et al. A prospective study of cigarette smoking and risk of colorectal adenoma and colorectal cancer in U.S. men. JNCI 1994; 86: 183–91.
Giovannucci E, Colditz GA, Stampfer MJ, et al. A prospective study of cigarette smoking and risk of colorectal adenoma and colorectal cancer in U.S. women. JNCI 1994; 86: 192–199.
Heineman E, Zahm S, McLaughlin J, Vaught J. Increased risk of colorectal cancer among smokers: results of a 26-year follow-up of US veterans and a review. Int J Cancer 1995; 59: 728–38.
Giovannucci E, Martinez M. Tobacco, colorectal cancer, and adenomas: a review of the evidence. JNCI 1996; 88: 1717–30.
Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Speizer FE, Willett WC. A prospective study of family history, age, and diet and colorectal cancer. N Engl J Med 1994; 331: 1669–74.
Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 1990; 132: 612–28.
Garabrant DH, Peters JM, Mack TM, Bernstein L. Job activity and colon cancer risk. Am J Epidemiol1984; 119: 1005–14.
United States Bureau of Commerce. 1970 Census of Population Alphabetical Index of Industries and Occupations. Washington, DC: US Department of Commerce. US Government Printing Office, 1971.
Vena JE, Graham S, Zielezny M, Swanson MK, Barnes RE, Nolan J. Lifetime occupational exercise and colon cancer. Am J Epidemiol1985; 122: 357–65.
US Employment Service, Department of Labor, Security BoE. Estimates of Worker Trait Requirements for 4,000 Jobs as Defined in the Dictionary of Occupational Titles (An Alphabetical Index). Washington DC: US Government Printing Office, 1956.
Whittemore AS, Wu-Williams AH, Lee M, et al. Diet, physical activity and colorectal cancer among Chinese in North America and China. JNCI 1990; 82: 915–26.
Markowitz S, Morabia A, Garibaldi K, Wynder E. Effect of occupational and recreational activity on the risk of colorectal cancer among males: a case-control study. Int J Epidemiol 1992; 21: 1057–62.
Marcus P, Newcomb P, Storer B. Early adulthood physical activity and colon cancer risk among Wisconsin women. Cancer Epidemiol Biomark Prev 1994; 3: 641–4.
Longnecker M, Gerhardsson de Verdier M, Frumkin H, Carpenter C. A case-control study of physical activity in relation to risk of cancer of the right colon and rectum. Int J Epidemiol 1995; 24: 42–50.
Paffenbarger RS Jr, Hyde RT, Wing AL. Physical activity and incidence of cancer in diverse populations: a preliminary report. Am J Clin Nutr 1987; 45(Suppl): 312–7.
Gerhardsson M, Floderus B, Norell SE. Physical activity and colon cancer risk. Int J Epidemiol 1988; 17: 743–6.
Wu AH, Paganini-Hill RK, Henderson R, Henderson BE. Alcohol, physical activity and other risk factors for colorectal cancer. A prospective study. Br J Cancer 1987; 55: 687–94.
Albanes D, Blair A, Taylor PR. Physical activity and risk of cancer in the NHANES I population. Am J Public Health 1989; 79: 744–50.
Bostick R, Potter J, Kushi L, et al. Sugar, meat, fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States). Cancer Causes Control 1994; 5: 38–52.
Giovannucci E, Ascherio A, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Physical activity, obesity, and risk of colon cancer and adenoma in men. Ann Intern Med 1995; 122: 327–34.
Martinez ME, Giovannucci E, Spiegelman D, et al. Physical activity, body size, and colorectal cancer in women. Am J Epidemiol1996; 143: S73.
White E, Jacobs E, Daling J. Physical activity in relation to colon cancer in middle-aged men and women. Am J Epidemiol1996; 144: 42–50.
Lee IM, Manson J, Ajani U, Paffenbarger R, Hennekens C, Buring J. Physical activity and risk of colon cancer: The Physicians Health Study. Cancer Causes Control 1997; 8: 568–74.
Slattery ML, Schumacher MC, Smith KR, West DW, Abd-Elghany N. Physical activity, diet, and risk of colon cancer in Utah. Am J Epidemiol1988; 128: 989–99.
Kune G, Kune S, Watson L. Body weight and physical activity as predictors of colorectal cancer risk. Nutr Cancer 1990; 13: 9–17.
Slattery M, Abd-Elghany N, Kerber R, Schumacher M. Physical activity and colon cancer: a comparison of various indicators of physical activity to evaluate the association. Epidemiolog y1990; 1: 481–5.
Gerhardsson de Verdier M, Steineck G, Hagman U, Rieger A, Norrell S. Physical activity and colon cancer: a case-referent study in Stockholm. Int J Cancer 1990; 46: 985–9.
Thun MJ, Calle EE, Namboodiri MM, et al. Risk factors for fatal colon cancer in a large prospective study. JNCI 1992; 84: 1491–500.
Severson RK, Nomura AMY, Grove JS, Stemmermann GN. A prospective analysis of physical activity and cancer. Am J Epidemiol1989; 130: 522–9.
Ballard-Barbash R, Schatzkin A, Albanes D, et al. Physical activity and risk of large bowel cancer in the Framingham Study. Cancer Res 1990; 50: 3610–13.
Jacobs DJ, Ainsworth B, Hartman T, Leon A. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exer1993; 25: 81–91.
Wolf AM, Hunter DJ, Colditz GA, et al. Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol 1994; 23: 991–9.
Chasan-Taber S, Rimm EB, Stampfer MJ, et al. Reproducibility and validity of a self-administered physical activity questionnaire for male health professionals. Epidemiology 1995; 7: 81–6.
Spiegelman D, Schneeweiss S, McDermott A. Measurement error correction for logistic regression models with an 'alloyed gold standard.' Am J Epidemiol1997; 145: 184–96.
Garfinkel L, Stellman SD. Mortality by relative weight and exercise. Cancer 1988; 62: 1844–50.
Vlajinac H, Jarebinski M, Adanja B. Relationship of some biosocial factors to colon cancer in Belgrade. Neoplasma 1987; 34: 503–7.
Peters RK, Garabrandt DH, Yu MC, Mack TM. A case-control study of occupational and dietary factors in colorectal cancer in young men by subsite. Cancer Res 1989; 49: 5459–68.
BrownsonRC, Zahm SH, Chang JC, Blair A. Occupational risk of colon cancer. An analysis of anatomic subsite. Am J Epidemiol1989; 130: 675–87.
Benito E, Obrador A, Stiggelbout A, et al. A population-based case-control study of colorectal cancer in Majorca. I. Dietary factors. Int J Cancer 1990; 45: 69–76.
Kato I, Tominaga S, Matsuura A, Yoshii Y, Shirai M, Kobayashi S. A comparative case-control study of colorectal cancer and adenoma. Jpn J Cancer Res 1990; 81: 1101–8.
Kato I, Tominaga S, Ikari A. A case-control study of male colorectal cancer in Aichi Prefecture, Japan: with special reference to occupational activity level, drinking habits and family history. Jpn J Cancer Res 1990; 81: 115–21.
Fredriksson M, Bengtsson NO, Hardell L, Axelson O. Colon cancer, physical activity, and occupational exposure. Cancer 1989; 63: 1838–42.
Fraser G, Pearce N. Occupational physical activity and risk of cancer of the colon and rectum in New Zealand males. Cancer Causes Control 1993; 4: 45–50.
Vetter R, Dosemeci M, Blair A, et al. Occupational physical activity and colon cancer risk in Turkey. Eur J Epidemiol 1992; 8: 845–50.
Chow WH, Dosemeci M, Zheng W, et al. Physical activity and occupational risk of colon cancer in Shanghai, China. Int J Epidemiol 1993; 22: 23–9.
Arbman G, Axelson O, Fredriksson M, Nilsson E, Sjodahl R. Do occupational factors influence the risk of colon and rectal cancer in different ways? Cancer 1993; 72: 2543–9.
Brownson RC, Chang JC, Davis JR, Smith C. Physical activity on the job and cancer in Missouri. Am J Public Health 1991; 81: 639–42.
Dosemeci M, Hayes R, Vetter R, et al. Occupational physical activity, socioeconomic status, and risk of 15 cancer sites in Turkey. Cancer Causes Control 1993; 4: 313–21.
Vena JE, Graham S, Zielezny M, et al. Occupational exercise and risk of cancer. Am J Clin Nutr 1987; 45: 318–27.
Polednak AP. College athletics, body size, and cancer mortality. Cancer 1976; 38: 382–7.
Gerhardsson M, Norell S, Kiviranta H, Pedersen N, Ahlbom A. Sedentary jobs and colon cancer. Am J Epidemiol1986; 123: 775–80.
Marti B, Minder CE. Physische Berufsktivitatund Kolonkarzinommortalitat bei Schweizer Mannern 1979-1982.Soz Praventivmed 1989; 34: 30–7.
Lynge E, Thygesen L. Use of surveillance system for occupational cancer: data from the Danish national system. Int J Epidemiol 1988; 17: 493–500.
Lee I, Paffenbarger R, Hsieh C. Physical activity and risk of developing colorectal cancer among college alumni. JNCI 1991; 83: 1324–9.
Thune I, Lund E. Physical activity and risk of colorectal cancer in men and women. Br J Cancer 1996; 73: 1134–40.
Bostick RM, Potter JD, Kushi LH, et al. Sugar, meat, and fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States). Cancer Causes Control 1994; 5: 38–52.
Slattery M, Potter J, Caan B, et al. Energy balance and colon cancer-beyond physical activity. Cancer Res 1997; 57: 75–80.
Bartram H, Wynder E. Physical activity and colon cancer risk? Physiologic considerations. Am J Gastroenterology 1989; 84: 109–11.
Cordain L, Latin R, Behnke J. The effects of aerobic running program on bowel transit time. J Sports Med 1986; 26: 101–4.
Reddy BS, Wynder EL. Metabolic epidemiology of colon cancer. Fecal bile acids and neutral sterols in colon cancer patients and patients with adenomatous polyps. Cancer 1977; 39: 2533–9.
Zaridze DG. Environmental etiology of large-bowel cancer. JNCI 1983; 70: 389–400.
Kriska A, Bennett P. An epidemiologic perspective on the relationship between physical activity and NIDDM: from activity assessment to intervention. Diabetes/Metab Rev 1992; 8: 355–72.
Tran T, Medline A, Bruce W. Insulin promotion of colon tumors in rats. Cancer Epidemiol Biomark Prev 1996; 5: 1013–5.
Giovannucci E. Insulin and colon cancer. Cancer Causes Control 1995; 6: 164–79.
McKeown-Eyssen G. Epidemiology of colorectal cancer revisited: are serum triglycerides and/or plasma glucose associated with risk? Cancer Epidemiol Biomark Prev 1994; 3: 687–95.
Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Willett WC. Aspirin use and the risk of colorectal cancer and adenoma in male health professionals. Ann Intern Med 1994; 121: 241–6.
Giovannucci E, Egan KM, Hunter DJ, iet al. Aspirin use and risk of colorectal cancer in women. N Engl J Med 1995; 333: 609–14.
Stephens T. Secular trends in adult physical activity. Res Q Exerc Sport 1987; 58: 94–105.
US Department of Health and Human Services. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: Department of Health and Human Services, 1991; DHHS Pub. No. PHS-91–50212.
Powell K, Blair S. The public health burdens of sedentary living habits: theoretical but realistic estimates. Med Sci Sports Exerc 1994; 26: 851–6.
Rose G. Strategy of prevention: lessons from cardiovascular disease. Br Med J-Clin Res 1981; 282: 1847–51.
Richmond J, Kotelchuck M. Co-ordination and development of strategies and policy-the United States example. In: Holland W, ed. Textbook of Public Health. Oxford, UK: Oxford University Press, 1984.
Pate R, Pratt M, Blair S, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and American College of Sports Medicine. JAMA 1995; 273: 402–7.
US Preventive Services Task Force. Screening for Colorectal Cancer. Guide to Clinical Preventive Services. 2nd Edition. Baltimore, MD (USA): Williams and Wilkins, 1996: 89–103.
US National Cancer Institute. Measures of Progress against Cancer. Cancer Prevention. Volume IV. Significant Accomplishments 1982-1992. Bethesda, MD (USA): National Institutes of Health, 1992.
US Department of Health and Human Services. Report of the Surgeon General. Preventing Smoking among Adolescents. Washington, DC: Centers for Disease Control and Prevention, DHHS. US Public Health Service, 1994.
US Preventive Services Task Force. Guide to Clinical Preventive Services. Baltimore, MD (USA): Williams and Wilkins, 1996.
US Department of Health and Human Services. The Health Benefits of Smoking Cessation. Washington, DC: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 1990; DHHS Pub. No. (CDC)90–8416.
LaFontaine T, Dabney S, Brownson R, Smith C. The effect of physical activity on all cause mortality: a review of research and recommendations. Missouri Med 1994; 91: 188–94.
Campbell M, Browne D, Walters W. Can general practitioners influence exercise habits? Controlled trial. Br Med J 1985; 290: 1044–6.
Macera C, Croft J, Brown D, Ferguson J, Lane M. Predictors of adopting leisure time physical activity among a biracial community cohort. Am J Epidemiol1995; 142: 629–35.
British Medical Association. Cycling Towards Health and Safety. Oxford, UK: Oxford University Press, 1992.
Bhopl R, Unwin N. Cycling, physical exercise, and the Millenium fund. Br Med J 1995; 311: 344.
Penna C. Great Rail-trails of the Northeast. Amherst, MA (USA): New England Cartographics, 1995.
Anonymous. A rails-to-trails network for hikers and bikers pumps up its tourism muscle. Wall Street Journal 1996; March 14: 1.
100. Anonymous. Making cities safer. Good fences.... The Economist 1995; March 25-31: 66–7.
101. Roberts S. Who We Are. A Portrait of America. New York, NY (USA): Times Books, 1993.
102. Kunstler J. The Geography of Nowhere: The Rise and Decline of America's Man-made Landscape. New York, NY (USA): Simon & Schuster, 1994; Touchtone Edition.
103. Blamey A, Mutrrie N, Aitchison T. Health promotion by encouraged use of stairs. Br Med J 1995; 311: 289–90.
104. Manson JE, Rimm EB, Stampfer MJ, et al. A prospective study of physical activity and the incidence of non-insulin-dependent diabetes mellitus in women. Lancet 1991; 338: 774–8.
105. Jaglal SB, Kreiger N, Darlington GA. Past and recent physical activity and risk of hip fracture. Am J Epidemiol1993; 138: 107–18.
106. Byrne A, Byrne D. The effects of exercise on depression, anxiety and other mood states: a review. J Psychosomatic Res 1993; 37: 565–74.
107. Frisch RE, Wyshak G, Albright NL, et al. Lower prevalence of breast cancer and cancers of the reproductive system among former college athletes compared to nonathletes. Br J Cancer 1985; 52: 885–91.
108. Bernstein L, Henderson BE, Hanisch R, Sullivan-Halley J, Ross RK. Physical exercise and reduced risk of breast cancer in young women. JNCI 1994; 86: 1403–8.
109. Mittendorf R, Longnecker MP, Newcomb PA. Strenuous physical activity in young adulthood and risk of breast cancer (United States). Cancer Causes Control 1995; 6: 347–53.
110. Kohl H, LaPorte R, Blair S. Physical activity and cancer. An epidemiologic perspective. Sports Med 1988; 6: 222–37.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Colditz, G.A., Cannuscio, C.C. & Frazier, A.L. Physical activity and reduced risk of colon cancer: implications for prevention. Cancer Causes Control 8, 649–667 (1997). https://doi.org/10.1023/A:1018458700185
Issue Date:
DOI: https://doi.org/10.1023/A:1018458700185
- Colon cancer
- physical activity
- prevention