Physically Active Lifestyles Reduce Cancer Risk
A physically active lifestyle can reduce the risk for several cancer types, particularly colorectal, postmenopausal breast, and endometrial cancer. Further suggestive evidence exists for associations for lung, pancreatic, and prostate cancer.
The risk of colon cancer, for example, is estimated to be reduced by 30 percent through physical activity. Therefore, among other factors (such as cigarette smoking, diet, or body weight), physical activity is considered an important modifiable risk factor that has been linked to cancer development.
Research on Physical Activity and Cancer Can Improve Cancer Survivorship
We increasingly know that exercise in cancer patients and survivors improves quality of life, reduces therapy- and cancer-related side effects, and might reduce the risk of recurrence and cancer mortality, so that exercise is more and more seen as an effective supportive cancer therapy.
The Ulrich group investigates the protective effects of physical activity and these related concepts:
- Associations between physical activity, body composition including sarcopenia (muscle mass loss) and cancer treatment and prognosis
- Effects of physical activity and body composition on cancer-related biomarkers including inflammation and the gut microbiome
- Interactions between adipose tissue and tumor microenvironment
- Molecular mechanisms (see below)
Dr. Ulrich’s interdisciplinary teams at her prior institutions, the Fred Hutchinson Cancer Research Center in Seattle and the German Cancer Research Center in Heidelberg, have worked actively on increasing scientific and public knowledge about the relevance of physical activity and obesity-prevention in reducing cancer burden.
She and her team have conducted both randomized controlled trials and observational studies, established a network of physicians, and organized several conferences on the topic of exercise, energy balance, and cancer.
At Huntsman Cancer Institute (HCI), an interdisciplinary team including Dr. Ulrich’s team, medical doctors, nurses, physical therapist, and interdisciplinary researchers designed the Precision Exercise Prescription (PEP) Study and is currently actively recruiting patients. Results of this randomized, controlled trial seek to provide information on how a patient-tailored exercise program can improve long-term outcomes after lung cancer surgery. Recruitment is nearly completed.
Discovery of Biological Mechanisms Linking Physical Activity to Cancer
Several biological mechanisms have been proposed to explain the association between physical activity and specific cancers:
- Reduced levels of hormones (insulin, estrogen, growth factors, and others)
- Reduced inflammation
- Prevention of obesity
- Improved immune function
- Altered bile acid metabolism
- Improved food digestion
The Ulrich group has published extensively on biomarkers of cancer risk that can be impacted by exercise and diet, including adipose-tissue gene expression, inflammation, insulin/IGF, and many more. For cancer patients, goals are now to establish a safe, evidence-based and individually optimized training program and further strengthen the evidence base in terms of biologic underpinnings, quality of life, and clinically relevant endpoints.
The Ulrich group’s research at HCI focuses on studies on biomarkers of exercise and cancer as well as intervention studies among cancer patients. The studies are under development with local investigators and in collaboration with the NIH TREC initiative.
Key reviews from the group related to this topic:
Ulrich CM, Himbert C, Holowatyj AN, Hursting SD. Energy balance and gastrointestinal cancer: risk, interventions, mechanisms, and outcomes. Nature Reviews Gastroenterology & Hepatology. 2018. 15(11):683-698.
Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K, International Agency for Research on Cancer Handbook Working Group. Body fatness and cancer – Viewpoint of the IARC Working Group. New England Journal of Medicine. 2019. 375(8): 794-798.
Himbert C, Delphan M, Bowers LW, Habermann N, Hursting S, Ulrich CM. Signals from the adipose microenvironment and the obesity-cancer link – a systematic review. Cancer Prevention Research. 2017. 10(9):494-506. PMID: 28864539. PMCID: PMC: PMC5898450.
Himbert C, Durham N, Coletta AM, Barnes CA, Wiskemann J, LaStayo PC, Varghese TK, Ulrich CM. Exercise and lung cancer surgery: a systematic review of randomized-controlled trials. Critical Reviews in Oncology and Haematology. 2020. 156:103086.
Neli Ulrich, MS, PhD
Comprehensive Cancer Center,