Sports Medicine

, Volume 15, Issue 4, pp 258–280 | Cite as

Exercise in the Prevention and Treatment of Cancer

An Update
  • Roy J. Shephard
Review Article

Summary

Physical activity potentially encourages a healthy lifestyle and it could have a more direct preventive effect on certain forms of carcinogenesis (for instance, by speeding gastrointestinal transit, or by moderating sex hormone levels). However, there are also potential negative effects, particularly an excessive exposure to ultraviolet light in certain water sports. The many types of neoplasm and the equally varied sources of physical activity militate against finding any simple relationship between the risk of malignancy and the individual’s physical activity history. Nevertheless, evidence that physical activity protects against certain forms of cancer can be deduced from studies of experimental animals, former athletes, people employed in active occupations, and those with an active recreational lifestyle. Many occupational surveys and a number of studies of recreational activity show an association between sedentary living and a risk of colon cancer, both in men and in women. Moreover, an application of Bradford Hill’s criteria gives some support to the causal nature of the association. More limited data suggest that a history of active leisure is associated with a reduced risk of all-cause cancer and in women of breast and reproductive system cancers. The last observation must still be reconciled with an apparent increase in the risk of prostatic cancer in active men. Since moderate exercise elevates mood and helps to conserve lean tissue, it may finally be a helpful component of treatment after a neoplasm has been diagnosed.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams R, Victor M. Asthenia. In Adams & Victor (Eds) Principles of neurology, pp. 341–345, McGraw Hill, New York, 1981Google Scholar
  2. Albanes D, Blair A, Taylor PR. Physical activity and risk of cancer in the NHANES I population. American Journal of Public Health 79: 744–750, 1989PubMedGoogle Scholar
  3. American College of Sports Medicine. Guidelines for exercise testing and prescription, 4th ed., Lea & Febiger, Philadelphia, 1991Google Scholar
  4. Andrianpopulos G, Nelson RL, Bombeck CT, Souza G. The influence of physical activity in 1–2 dimethylhydrazine induced colon carcinogenesis in the rat. Anticancer Research 7: 849–852, 1987Google Scholar
  5. Armstrong B, Doll R. Environmental factors and cancer incidence and mortality in different countries with special reference to dietary practices. International Journal of Cancer 15: 617–631, 1975Google Scholar
  6. Ballard-Barbash R, Schatzkin A, Albanes D, Schiffman MH, Kreger BE, et al. Physical activity and risk of large bowel cancer in the Framingham study. Cancer Research 50: 3610–3613, 1990PubMedGoogle Scholar
  7. Baracos VE. Exercise inhibits progressive growth of the Morris hepatoma 7777 in male and female rats. Canadian Journal of Physiology and Pharmacology 67: 864–870, 1989PubMedGoogle Scholar
  8. Bartram HP, Wynder EL. Physical activity and colon cancer risk? Physiological considerations. American Journal of Gastroenterology 84: 109–112, 1989PubMedGoogle Scholar
  9. Benninck MR, Palmer HJ, Messina MJ. Exercise and caloric restriction modify rat mammary carcinogenesis. Abstract. Federation Proceedings 45: 1087, 1987Google Scholar
  10. Berg JW, Howell MA. Occupation and bowel cancer. Journal of Toxicology and Environmental Health 1: 75–89, 1975PubMedGoogle Scholar
  11. Beyer RE. The role of coenzyme Q in endurance-trained acquired resistance to free radical damage. In Folkers et al. (Eds) Biomedical and clinical aspects of coenzyme O, Elsevier, Amsterdam, 1991Google Scholar
  12. Bingham SA, Cummings JH. Effect of exercise and physical fitness on large intestinal function. Gastroenterology 97: 1389–1399, 1989PubMedGoogle Scholar
  13. Blair SN, Jacobs DR, Powell KE. Relationships between exercise or physical activity and other health behaviors. Public Health Reports 100: 172–179, 1985PubMedGoogle Scholar
  14. Blair SN, Kohl HW, Paffenbarger RS, Clark DG, Cooper KH, et al. Physical fitness and all-cause mortality: a prospective study of healthy men and women. Journal of the American Medical Association 262: 2395–2401, 1989PubMedGoogle Scholar
  15. Bloom JL. Body size and lung-tumor susceptibility in outbred mice. Journal of the National Cancer Institute 33: 599–606, 1964PubMedGoogle Scholar
  16. Boulard M, Tuchweber B, LeDoux M. The effects of physical exercise on NMU-induced mammary tumors in rats. Proceedings of the International Conference on Exercise, Fitness and Health, Toronto, p. 36, 1988Google Scholar
  17. Bradford Hill, A. Principles of medical statistics, 8th ed., University Press, New York, 1971Google Scholar
  18. Brenner I, Severs Y, Shek P, Shephard RJ. The impact of combined exercise and thermal stress upon immune function. European Journal of Applied Physiology, in press, 1993Google Scholar
  19. Brill PA, Burkhalter HA, Kohl HW, Goodyear NN, Blair SN. The effect of previous athleticism on exercise habits, physical fitness, and coronary heart disease risk factors in middle-aged men. Research Quarterly 60: 209–215, 1989Google Scholar
  20. Brownson RC, Zahm SH, Chang JC, Blair A. Occupational risk of colon cancer: an analysis by anatomic subsite. American Journal of Epidemiology 130: 675–687, 1989PubMedGoogle Scholar
  21. Bruera E, Brenneis C, Michaud M, Chadwick S, MacDonald RN. Association between involuntary muscle function and asthenia, nutritional status, lean body mass, psychometric assessment and tumor mass in patients with advanced cancer. Proceedings of the American Society of Clinical Oncology 6: 261, 1987Google Scholar
  22. Bruera E, Carraro S, Roca E, Cedaro L, Chacon R. Association between malnutrition and calorie intake, emesis, psychological depression, glucose taste and tumor mass. Cancer Treatment Reports 68: 873–876, 1984PubMedGoogle Scholar
  23. Burkitt DP. Colonic-rectal cancer: fiber and other dietary factors. American Journal of Clinical Nutrition 31: 558–564, 1978Google Scholar
  24. Burkitt DP, Walker ARP, Painter NS. Effect of dietary fibre on stools and transit times, and its role in the causation of disease. Lancet 2: 1408–1411, 1972PubMedGoogle Scholar
  25. Calabrese LH. Exercise, immunity, cancer and infection. In Bouchard et al. (Eds) Exercise, fitness and health, pp. 567–579, Human Kinetics Publishers, Champaign, 1990Google Scholar
  26. Calabrese LH, Kleiner SM, Barna BP, Skibinski CI, Kirkendall DT, et al. The effects of anabolic steroids and strength training on the human immune response. Medicine and Science in Sports and Exercise 21: 386–392, 1989PubMedGoogle Scholar
  27. Cohen LA, Choi K, Wang C-X. Influence of dietary fat, caloric restriction, and voluntary exercise on N-nitrosomethyl-urea-induced mammary tumorigenesis in rats. Cancer Research 48: 4276–4283, 1988PubMedGoogle Scholar
  28. Coldman AJ, Elmwood JM, Gallagher RP. Sports activities and risk of testicular cancer. British Journal of Cancer 46: 749–756, 1982PubMedGoogle Scholar
  29. Cordain L, Latin RW, Behnke JJ. The effects of an aerobic running program on bowel transit time. Journal of Sports Medicine 26: 101–104, 1986Google Scholar
  30. Cramer DW, Welch WR, Hutchison GB, Willett W, Scully RE. Dietary animal fat in relation to ovarian cancer risk. Obstetrics and Gynecology 63: 833–838, 1984PubMedGoogle Scholar
  31. Creagh TM, Rubin A, Evans DJ. Hepatic tumours induced by anabolic steroids in an athlete. Journal of Clinical Pathology 41: 441–443, 1988PubMedGoogle Scholar
  32. Damon A. Host factors in cancer of the breast and uterine cervix and corpus. Journal of the National Cancer Institute 24: 483–516, 1960PubMedGoogle Scholar
  33. Demers LM, Harrison TS, Halbert DR, Santen RJ. Effect of prolonged exercise on plasma prostaglandin levels. Prostaglandins and Medicine 6: 413–418, 1981PubMedGoogle Scholar
  34. Devesa SS. Cancer mortality, incidence and patient survival among American women. Women and Health 11: 7–22, 1986Google Scholar
  35. Dewys W, Kisner D. Principles of nutritional care of the cancer patient. In Carter et al. (Eds) Principles of cancer treatment, pp. 252–259, Lippincott, Philadelphia, 1982Google Scholar
  36. Dietz JH. Rehabilitation oncology, Wiley, New York, 1981Google Scholar
  37. Dinarello CA, Mier JW. Current concepts: lymphokines, New England Journal of Medicine 317: 440–496, 1987Google Scholar
  38. Draugsvold OG. Recreational beach use and ultraviolet exposure: implications for health-educators and recreationists. Australian Journal of Health, Physical Education and Recreation 90 (December): 8–13, 1980Google Scholar
  39. Dubin CL. Commission of Inquiry into the Use of Drugs and Banned Practices Intended to Increase Athletic Performance, Ottawa: Supply and Services, Canada, 1990Google Scholar
  40. Dyer AR, Stamler J, Berkson DM, Lindberg HA. Relationship of relative weight and body mass index to 14-year mortality in the Chicago Peoples Gas Company study. Journal of Chronic Diseases 28: 109–123, 1975PubMedGoogle Scholar
  41. Eichner ER. Exercise, lymphokines, calories and cancer. Physician and Sportsmedicine 15 (6): 109–116, 1987Google Scholar
  42. Epstein JH. How I manage sunburn. Physician and Sportsmedicine 13(8): 81–85, 1985Google Scholar
  43. Farrell GC, Joshua DE, Uren RF, Baird PJ, Perkins KW, et al. Androgen-induced hepatoma. Lancet 1: 430–432, 1975PubMedGoogle Scholar
  44. Ferry A. Influences de l’exercice musculaire sur le système immunitaire: exemples d’immunomodulation. Science and Sports 4: 25–40, 1989Google Scholar
  45. Fishran J, Boyar RM, Hellman L. Influence of body weight on estradiol metabolism in young women. Journal of Clinical Endocrinology and Metabolism 41: 989–991, 1975Google Scholar
  46. Forney JP, Milewich L, Chen GT, Garlock JL, Schwarz BE, et al. Aromatization of androstenedione to estrone by human adipose tissue in vitro. Correlation with adipose tissue mass, age and endometrial neoplasia. Journal of Clinical Endocrinology and Metabolism 53: 192–199, 1981Google Scholar
  47. Frisch RE, Wyshak G, Albright NL, Albright TE, Schiff I, et al. Lower prevalence of breast cancer and cancers of the reproductive system among former college athletes compared to non-athletes. British Journal of Cancer 52: 885–891, 1985PubMedGoogle Scholar
  48. Frisch RE, Wyshak G, Albright NL, Albright TE, Schiff I. Lower prevalence of non-reproductive system cancers among female former college athletes. Medicine and Science in Sports and Exercise 21: 250–253, 1989PubMedGoogle Scholar
  49. Garabrant DH, Peters JM, Mack TM, Bernstein L. Job activity and colon cancer risk. American Journal of Epidemiology 119: 1005–1014, 1984PubMedGoogle Scholar
  50. Garland CF, Comstock GW, Garland FC, Helsing K, Shaw EK, et al. Serum 25-hydroxyvitamin D and colon cancer: eight year prospective study. Lancet 2: 1176–1178, 1990Google Scholar
  51. Gauthier MM. Can exercise reduce the risk of cancer? Physician and Sportsmedicine 14 (10): 171–178, 1986Google Scholar
  52. Gerhardsson M, Floderus BE, Niorell SE. Physical activity and colon cancer risk. International Journal of Epidemiology 17: 743–746, 1988PubMedGoogle Scholar
  53. Gerhardsson M, Norell SE, Kiviranta H, Pedersen NL, Ahlbom A. Sedentary jobs and colon cancer. American Journal of Epidemiology 123: 775–780, 1986PubMedGoogle Scholar
  54. Glober GA, Nomura A, Xamiyama S, Shinada A, Abba BC. Bowel transit time and stool weight in populations with different colon cancer risks. Lancet 2: 110–11, 1977PubMedGoogle Scholar
  55. Godin G, Shephard RJ. Activity patterns of the Canadian Eskimo. In Edholm & Gunderson (Eds) Human polar biology, Heinemann, Cambridge, 1973Google Scholar
  56. Godin G, Valois P, Shephard RJ, Desharnais R. Prediction of leisure-time behaviour: a path analysis (Lisrel V) model. Journal of Behavioral Medicine 10: 145–158, 1987PubMedGoogle Scholar
  57. Good RA, Fernandes G. Enhancement of immunologic function and resistance to tumor growth in Balb/c mice by exercise. Federation Proceedings 40: 1040, 1981Google Scholar
  58. Goodman RA, Baker DB, Powell KE, Sayre JW. Estimating the prevalence of leisure-time physical activity. Journal of Sports Medicine and Physical Fitness 28: 360–366, 1988PubMedGoogle Scholar
  59. Graham S, Dayal H, Swanson M, Mittelman A, Wilkinson G. Diet in the epidemiology of cancer of the colon and rectum. Journal of the National Cancer Institute 61: 709–714, 1978PubMedGoogle Scholar
  60. Greenwald P, Damon A, Kirmss V, Polan AK. Physical and demographic features of men developing cancer of the prostate. Journal of the National Cancer Institute 53: 341–346, 1974PubMedGoogle Scholar
  61. Haenszel W. Cancer mortality among the foreign born in the United States. Journal of the National Cancer Institute 26: 37–132, 1961PubMedGoogle Scholar
  62. Hanke CW, Zollinger TW, O’Brian JJ, Bianco L. Skin cancer in professional and amateur female golfers. Physician and Sportsmedicine 13 (8): 51–77, 1985Google Scholar
  63. Harris S. Chicken soup and related matters, W. Kaufman, Los Altos, 1979Google Scholar
  64. Haughey BP, Graham S, Brasure J, Zielezny M, Safrin G, et al. The epidemiology of testicular cancer in upstate New York. American Journal of Epidemiology 130: 25–36, 1989PubMedGoogle Scholar
  65. Hebert JR, Barone J, Reddy MM, Backlund JY-C. Natural killer cell activity in a longitudinal dietary fat intervention trial. Clinical Immunology and Immunopathology 54: 103–116, 1990PubMedGoogle Scholar
  66. Hedfors E, Holm G, Ohnell B. Variations of blood lymphocytes during work studied by cell surface markers, DNA synthesis and cytotoxicity. Clinical and Experimental Immunology 24: 328–335, 1976PubMedGoogle Scholar
  67. Heston WE, Vlahakis G. Genetic obesity and neoplasia. Journal of the National Cancer Institute 29: 197–209, 1962PubMedGoogle Scholar
  68. Hinterbuchner C. Rehabilitation of physical disability in cancer. New York State Journal of Medicine 78: 1066–1069, 1978PubMedGoogle Scholar
  69. Hislop TG. Diet and cancer. Canadian Family Physician 36: 973–975, 1990PubMedGoogle Scholar
  70. Hislop TG, McBride ML. Changing epidemiology of cancer. Canadian Family Physician 36: 929–932, 1990PubMedGoogle Scholar
  71. Hoar SK, Blair A. Death-certificate case control study of cancers of the prostate and colon and employment in the textile industry. Archives of Environmental Health 39: 280–283, 1984PubMedGoogle Scholar
  72. Hoffman S, Paschkis KE, DeBias DA, Cantarow A, Williams TL. The influence of exercise on the growth of transplanted rat tumors. Cancer Research 22: 597–599, 1962PubMedGoogle Scholar
  73. Holdstock DJ, Misiewicz JJ, Smith T, Rowlands EN. Propulsion (mass movements) in the human colon and its relation to meals and somatic activity. Gut 11: 91–99, 1970PubMedGoogle Scholar
  74. Howell MA. Diet as an etiological factor in the development of cancers of the colon and rectum. Journal of Chronic Diseases 28: 67–80, 1975PubMedGoogle Scholar
  75. Husemann B, Neubauer MG, Duhme C. Sitzende Tatigkeit und Rektum-Sigma-Karzinom. Onkologie 3: 168–171, 1980PubMedGoogle Scholar
  76. Ishida Y, Tamura M, Kanada H, Okamoto K. Histopathologic studies of the nervous system. Tumors in rats induced by N-nitrosomethylurea. Acta Pathologica (Japan) 25: 385–401, 1975Google Scholar
  77. Jenkins RR. Free radical chemistry: relationship to exercise. Sports Medicine 5: 156–170, 1988PubMedGoogle Scholar
  78. Jick H, Watkins RN, Hunter JR, Dinan BJ, Madsen S, et al. Replacement estrogens and endometrial cancer. New England Journal of Medicine 300: 218–222, 1979PubMedGoogle Scholar
  79. Johnson FL. The association of oral androgenic-anabolic steroids and life-threatening disease. Medicine and Science in Sports 7: 284–286, 1975PubMedGoogle Scholar
  80. Kampert JB, Whittemore AS, Paffenbarger RS. Combined effect of childbearing, menstrual events, and body size on age-specific breast cancer risk. American Journal of Epidemiology 128: 962–979, 1988PubMedGoogle Scholar
  81. Karvonen MJ, Kelmola H, Virkajarvi J, Kekkonen A. Longevity of endurance skiers. Medicine and Science in Sports 6: 49–51, 1974PubMedGoogle Scholar
  82. Kavanagh T, Lindley L, Shephard RJ, Campbell R. Health and socio-demographic characteristics of the Masters competitor. Annals of Sports Medicine 4: 55–64, 1988Google Scholar
  83. Kelsey JL. A review of the epidemiology of human breast cancer. Epidemiological Reviews 1: 74–109, 1979Google Scholar
  84. Koestner A, Denlinger RH, Wechsler W. Induction of neurogenic and lymphoid neoplasms by the feeding of threshold levels of methyl and ethylnitrosurea precursors to adult rats. Food and Cosmetic Toxicology 13: 605–609, 1975Google Scholar
  85. Kohl HW, LaPorte RE, Blair SN. Physical activity and cancer: an epidemiological perspective. Sports Medicine 6: 222–237, 1988PubMedGoogle Scholar
  86. LaPorte RE, Montoye HJ, Caspersen CJ. Assessment of physical activity in epidemiologic research: problems and prospects. Public Health Reports 100: 131–146, 1985PubMedGoogle Scholar
  87. Lee IM, Paffenbarger RS, Hsieh C-C. Physical activity and risk of colorectal cancer among college alumni. Journal of the National Cancer Institute 83: 1324–1329, 1991PubMedGoogle Scholar
  88. Lehman JF, DeLisa JA, Warren CG, deLeatur BJ, Sand-Bryant PL, et al. Cancer rehabilitation: assessment of need, development and evaluation of a model care. Archives of Physical Medicine and Rehabilitation 59: 410–419, 1978Google Scholar
  89. Liesen H, Uhlenbruck G. Sports immunology. Sports Science Review 1: 94–116, 1992Google Scholar
  90. Mackinnon LT. Exercise and natural killer cells. What is the relationship? Sports Medicine 7: 141–149, 1989PubMedGoogle Scholar
  91. Mackinnon LT. Exercise and immune function, Human Kinetics Publishers, Champaign, 1992Google Scholar
  92. MacVicar MG, Winningham ML, Nickel JL. Effects of aerobic interval training on cancer patients’ functional capacity. Nursing Research 38: 348–351, 1989PubMedGoogle Scholar
  93. Marti B, Minder CE. Physische Berufsactivität und Kolonkarzi-nomamortalität bei Schweizer Männer. Soziale Präventivmedizin 34: 30–37, 1989Google Scholar
  94. Menotti A, Seccareccia F. Physical activity at work and job responsibility as risk factors for fatal coronary heart disease and other causes of death. Journal of Epidemiology and Community Health 39: 325–329, 1985PubMedGoogle Scholar
  95. Mohle-Boetani J, Grosser S, Whittemore AS, Malec M, Kampert JB, et al. Body size, reproductive factors and breast cancer survival. Preventive Medicine 17: 634–642, 1988PubMedGoogle Scholar
  96. Montoye HJ. Risk indicators for cardiovascular disease in relation to physical activity in youth. In Binkhorst et al. (Eds) Children and exercise XI, pp. 3–25, Human Kinetics Publishers, Champaign, 1985Google Scholar
  97. Montoye HJ, Van Huss WD, Olson H, Pierson WR, Hudec AJ. The longevity and morbidity of college athletes. Phi Epsilon Kappa Fraternity, Michigan State University, Lansing, Michigan, 1957Google Scholar
  98. Moore C, Tittle PW. Muscle activity, body fat, and induced rat mammary tumours. Surgery 73: 329–332, 1973PubMedGoogle Scholar
  99. Moore JL, LaMont JT. Colorectal cancer: risk factors and screening strategies. Archives of Internal Medicine 144: 1819–1823, 1984PubMedGoogle Scholar
  100. Morgan P, Gildiner M, Wright GR. Smoking reduction in adults who take up exercise: a survey of a running club for adults. Canadian Association for Health. Physical Education and Recreation Journal 43: 39–43, 1976Google Scholar
  101. Morris JN, Heady JA, Raffle PAB. Physique of London busmen; epidemiology of uniforms. Lancet 2: 569–570, 1956Google Scholar
  102. Mottram DR. Drugs in sport, E & F Spon, London, 1988Google Scholar
  103. National Center for Health Statistics. Annual summary of births, marriages, divorces and deaths, United States, 1985. Monthly Vital Statistics. Report 34. DHHS Publ. No. (PHS) 86-1120. US Public Health Service, Hyattsville, 1986Google Scholar
  104. National Research Council Committee on Diet, Nutrition and Cancer. National Academy Press, Washington, 1982Google Scholar
  105. Nauss KN, Jacobs LR, Newperne RM. Dieting, fat and fiber relationship to caloric intake, body growth and colon tumorigenesis. American Journal of Clinical Nutrition 45: 243–251, 1987PubMedGoogle Scholar
  106. Nieman DC, Nehlsen-Cannarella SL. Effects of endurance exercise on the immune response. In Shephard & Åstrand (Eds) Endurance in sport, pp. 487–504, Blackwell Scientific Publications, Oxford, 1992Google Scholar
  107. Niinimaa V, Cole P, Mintz S, Shephard RJ. The switching point from nasal to oronasal breathing. Respiratory Physiology 42: 61–71, 1980Google Scholar
  108. Paffenbarger RS, Hyde RT, Wing AL. Physical activity and incidence of cancer in diverse populations: a preliminary report. American Journal of Clinical Nutrition 45: 312–317, 1987PubMedGoogle Scholar
  109. Paffenbarger RS, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality and longevity of college athletes. New England Journal of Medicine 314: 605–613, 1986PubMedGoogle Scholar
  110. Paffenbarger RS, Hyde RT, Wing AL, Jung D, Kampert J. Influence of changes in physical activity and other characteristics on all-cause mortality. Medicine and Science in Sports and Exercise 23: S82, 1991Google Scholar
  111. Paffenbarger RS, Hyde RT, Wing AL, Steinmetz CH. A natural history of athleticism and cardiovascular health. Journal of the American Medical Association 252: 491–495, 1984PubMedGoogle Scholar
  112. Pearson L. Jogging and cancer. Medicine and Sport 12: 126–127, 1978Google Scholar
  113. Penman K. A potential health hazard in physical education environment. Journal of Physical Education and Recreation 51: 24, 1980Google Scholar
  114. Perrier Company. The Perrier Study, Perrier-Great Waters of France, New York, 1979Google Scholar
  115. Persky V, Dyer AR, Leonas J, Stamler J, Berkson DM, et al. Heart rate: a risk factor for cancer?. American Journal of Epidemiology 114: 477–487, 1981PubMedGoogle Scholar
  116. Perusse L, Tremblay A, LeBlanc C, Bouchard C. Genetic and familial environmental influences on level of habitual physical activity. American Journal of Epidemiology 129: 1012–1022, 1989PubMedGoogle Scholar
  117. Peters RK, Garabrant DH, Yu MC, Mack TM. A case-control study of occupational and dietary factors in colorectal cancer in young men by subsite. Cancer Research 49: 5459–5468, 1989PubMedGoogle Scholar
  118. Polednak AP. College athletics, body size and cancer mortality. Cancer 38: 382–387, 1976PubMedGoogle Scholar
  119. Powell KE, Caspersen CJ, Koplan JP, Ford ES. Physical activity and chronic diseases. American Journal of Clinical Nutrition 49: 999–1006, 1989PubMedGoogle Scholar
  120. Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and the incidence of coronary heart disease. Annual Reviews of Public Health 8: 253–287, 1987Google Scholar
  121. Prener A, Hojgaard-Nielsen N, Storm HH, Hansen JPH, Jensen OM. Cancer in Greenland, 1953–1985. Acta Pathologica Mi-crobiologica et Immunologica Scandinavica 99 (Suppl. 20): 1–79, 1991Google Scholar
  122. Preston-Martin S, Paganini-Hill A, Henderson BE, Pike MC, Wood C. Case control study of intracranial meningiomas in women in Los Angeles County, California. Journal of the National Cancer Institute 65: 67–73, 1980PubMedGoogle Scholar
  123. Preston-Martin S, Yu MC, Henderson BE, Roberts C. Risk factors for meningiomas in men in Los Angeles County. Journal of the National Cancer Institute 70: 863–866, 1983PubMedGoogle Scholar
  124. Prior JC. Reversible reproductive changes with endurance training. In Shephard & Åstrand (Eds) Endurance in sport, pp. 365–376, Blackwell Scientific Publications, Oxford, 1992Google Scholar
  125. Rashkis HA. Systemic stress as an inhibitor of experimental tumors in Swiss mice. Science 116: 169–171, 1952PubMedGoogle Scholar
  126. Roitt I, Brostoff J, Male D. Immunology, Gower Medical Publishing, London, 1989Google Scholar
  127. Rook A. An investigation into the longevity of Cambridge sportsmen. British Medical Journal 1: 773–777, 1954PubMedGoogle Scholar
  128. Rusch HP, Kline BE. Exercise effects on growth of mouse tumour. Cancer Research 4: 116–118, 1944Google Scholar
  129. Schlueter LA. Knowledge and beliefs about breast cancer and breast self-examination among athletic and non-athletic women. Nursing Research 31: 348–353, 1982PubMedGoogle Scholar
  130. Schmid L. Malignant tumours as causes of death of former athletes. In Howald & Poortmans (Eds) Metabolic adaptations to prolonged exercise, pp. 85–91, Birkhauser Verlag, Basel, 1975Google Scholar
  131. Severson RK, Nomura AMY, Grove JS, Stemmermann GN. A prospective analysis of physical activity and cancer. American Journal of Epidemiology 130: 522–529, 1989PubMedGoogle Scholar
  132. Shephard RJ. Ischemic heart disease and exercise, Croom Helm, London, 1981Google Scholar
  133. Shephard RJ. Physical activity and the healthy mind. Canadian Medical Association Journal 128: 525–530, 1983PubMedGoogle Scholar
  134. Shephard RJ. Exercise and malignancy. Sports Medicine 3: 235–241, 1986PubMedGoogle Scholar
  135. Shephard RJ. Fitness of a nation: lessons from the Canada Fitness Survey, Karger, Basel, 1986Google Scholar
  136. Shephard RJ. Exercise as an agent of lifestyle change. British Journal of Sports Medicine 23: 11–22, 1989aPubMedGoogle Scholar
  137. Shephard RJ. Assessment of physical activity and energy needs. American Journal of Clinical Nutrition 50: 1195–1200, 1989bPubMedGoogle Scholar
  138. Shephard RJ. Physical activity and cancer. International Journal of Sports Medicine 11: 413–420, 1990PubMedGoogle Scholar
  139. Shephard RJ. Does exercise reduce all-cancer death rates?. British Journal of Sports Medicine 26: 125–128, 1992PubMedGoogle Scholar
  140. Shephard RJ, LaBarre R. Attitudes to smoking and cigarette smoke: the Toronto Survey, 1976, York-Toronto Respiratory Disease Association, Willowdale, 1976Google Scholar
  141. Shephard RJ, Verde TJ, Thomas SG, Shek P. Physical activity and the immune system. Canadian Journal of Sport Sciences 16: 163–185, 1991PubMedGoogle Scholar
  142. Shephard SE. Towards an evaluation of the health risk posed by the in vivo nitrosation of foods, Doctoral dissertation, Faculty of Natural Sciences, University of Zurich, Zurich, 1987Google Scholar
  143. Shinkai S, Shore S, Shek PN, Shephard RJ. Acute exercise and immune function. International Journal of Sports Medicine 13: 452–461, 1992PubMedGoogle Scholar
  144. Siiteri PK. Adipose tissue as a source of hormones. American Journal of Clinical Nutrition 45: 277–282, 1987PubMedGoogle Scholar
  145. Simon HB. The immunology of exercise. Journal of the American Medical Association 252: 2735–2738, 1984PubMedGoogle Scholar
  146. Simon HB. Discussion: exercise, immunity, cancer, and infection. In Bouchard et al. (Eds) Exercise, fitness and health, pp. 581–588, Human Kinetics Publishers, Champaign, 1990Google Scholar
  147. Simopoulos AP. Obesity and carcinogenesis: historical perspective. American Journal of Clinical Nutrition 45: 271–276, 1987PubMedGoogle Scholar
  148. Sivertsen I, Dahlstrom AW. Relation of muscular activity to carcinoma. Journal of Cancer Research 6: 365–378, 1921Google Scholar
  149. Slattery ML, Schumacher MC, Smith KP, West DW, Abd-Elghany N. Physical activity, diet and risk of colon cancer in Utah. American Journal of Epidemiology 128: 989–999, 1988PubMedGoogle Scholar
  150. Sorensen G, Pechacek T. Occupational and sex differences in smoking and smoking cessation. Journal of Occupational Medicine 28: 360–364, 1986PubMedGoogle Scholar
  151. Stephens T, Craig C. The well-being of Canadians: the 1988 Campbell’s Survey, Fitness and Lifestyle Research Institute, Ottawa, 1988Google Scholar
  152. Stephens T, Jacobs DR, White CC. The descriptive epidemiology of leisure time physical activity. Public Health Reports 100: 147–158, 1985PubMedGoogle Scholar
  153. Steplewski Z, Vogel WH, Ehya H, Poropatich C. Effects of restraint stress on innoculated tumour growth and immune responses in rats. Cancer Research 45: 5128–5133, 1985PubMedGoogle Scholar
  154. Surgeon General. The changing cigarette, US Department of Health and Human Services, Public Health Service, Washington, 1981Google Scholar
  155. Tannenbaum A. Relationship of body weight to cancer incidence. Archives of Pathology 30: 509–517, 1940Google Scholar
  156. Taylor H, Klepetar E, Keys A, Parlin W, Blackburn H, et al. Death rates among physically active employees of the railroad industry. American Journal of Public Health 52: 1697–1707, 1962PubMedGoogle Scholar
  157. Thompson HJ, Ronan AM, Ritacco KA, Tagliaferro AR, Meeker LD. Effects of exercise on the induction of mammary carcinogenesis. Cancer Research 48: 2720–2723, 1988PubMedGoogle Scholar
  158. Tiidus P. Dietary protein requirements for the athlete. In Torg et al. (Eds) Current therapy in sports medicine 2, pp. 99–102, BC Decker, Burlington, 1990Google Scholar
  159. Turchetta A, Calzolari A, Donfrancesco A, Drago F, Miano C, et al. Physical activity and competitive sport in youngs with leukemia ‘off therapy’. Proceedings of the World Congress on Sport for All, Tampere, Finland, 0-FR-220, 1990Google Scholar
  160. Turnbull EM. Effects of basic preventive health practices and mass media on the practice of breast self-examination. Nursing Research 27: 98–102, 1978PubMedGoogle Scholar
  161. Uhlenbruck G, Order U. Perspektiven, Probleme und Prioritäten: Sport-immunologie — die nächsten 75 Jahre?. Deutsche Zeit-schrifte für Sportmedizin 38: 40–47, 1987Google Scholar
  162. Uhlenbruck G, Order U. Can endurance sports stimulate immune mechanisms against cancer and metastasis? International Journal of Sports Medicine 12 (Suppl. 1): 63–68, 1991Google Scholar
  163. Valaoras V, MacMahon B, Trichopoulos D, Polychronopolou A. Lactation and reproductive histories of breast cancer in Greater Athens, 1965–67. International Journal of Cancer 4: 350–363, 1969Google Scholar
  164. Vena JE, Graham S, Zielezny MK, Swanson MK, Barnes RE, et al. Lifetime occupational exercise and colon cancer. American Journal of Epidemiology 122: 357–365, 1985PubMedGoogle Scholar
  165. Vena JE, Graham S, Zielezny M, Brasure J, Swanson MK. Occupational exercise and risk of cancer. American Journal of Clinical Nutrition 45: 318–327, 1987PubMedGoogle Scholar
  166. Verde T, Thomas S, Shephard RJ. Influence of heavy training on immune response to acute exercise in elite runners. Abstract. Medicine and Science in Sports and Exercise 21: S110, 1989Google Scholar
  167. Walsh J, Gye R, Connelly TJ. Meningioma: a late complication of head injury. Medical Journal of Australia 1: 906–908, 1969PubMedGoogle Scholar
  168. Walmolts J, Peter K, Lewis R, Engel WK. Type 2 muscle fiber atrophy: an early systemic effect of cancer. Abstract. Neurology 25: 374, 1975Google Scholar
  169. Warnold I, Lundtholm K, Schersten T. Energy balance and body composition in cancer patients. Cancer Research 38: 1801–1807, 1978PubMedGoogle Scholar
  170. Washburn RA, Montoye HJ. The assessment of physical activity by questionnaire. American Journal of Epidemiology 123: 563–576, 1986PubMedGoogle Scholar
  171. Whittaker JL, Baracos VE, Haennel RG, Brown BE, Humen DP, et al. Exercise training in the post-treatment remission period of patients with limited small cell cancer. Proceedings of the Annual Meeting of the Canadian Association of Sport Sciences, Kingston, Ontario, 1991Google Scholar
  172. Whittemore AS, Wu AH, Zheng S, Gallagher RP, Wu ML, et al. Diet, physical activity and colorectal cancer among Chinese in North America and the People’s Republic of China. Journal of the National Cancer Institute 82: 915–926, 1990PubMedGoogle Scholar
  173. Williams RR, Stegens NL, Goldsmith JR. Association of cancer site and type with occupation and industry from the third National Cancer Survey Interview. Journal of the National Cancer Institute 59: 1147–1185, 1977PubMedGoogle Scholar
  174. Wilmore JH. Body composition and body energy stores. In Shephard & Åstrand (Eds) Endurance in Sport, pp. 244–255, Blackwell Scientific Publications, Oxford, 1992Google Scholar
  175. Wilson BRA, Olson HW, Sprague HA, Van Huss WD, Montoye HJ. Somatotype and longevity of former university athletes and nonathletes. Research Quarterly 61: 1–6, 1990Google Scholar
  176. Winningham ML, MacVicar MG, Burke CA. Exercise for cancer patients: guidelines and precautions. Physician and Sports-medicine 14(10): 125–134, 1986Google Scholar
  177. Wu AH, Paganini-Hill A, Ross RK, Henderson BE. Alcohol, physical activity and other risk factors for colorectal cancer: a prospective study. British Journal of Cancer 55: 687–694, 1987PubMedGoogle Scholar
  178. Wyshak G, Frisch RE, Albright N, Albright T, Schiff I. Lower prevalence of benign diseases of the breast and benign tumors of the reproductive system among former college athletes compared to non-athletes. British Journal of Cancer 54: 841–845, 1986PubMedGoogle Scholar
  179. Yu DTY, Clements J, Pearson CM. Effect of sport stress on lymphocyte transformation and antibody formation. Clinical and Experimental Immunology 28: 326–331, 1977PubMedGoogle Scholar

Copyright information

© Adis International Limited 1993

Authors and Affiliations

  • Roy J. Shephard
    • 1
  1. 1.School of Physical and Health Education and Department of Preventive Medicine and Biostatistics, Faculty of MedicineUniversity of TorontoTorontoCanada

Personalised recommendations