Association of Daily Sitting Time and Leisure-Time Physical Activity With Survival Among US Cancer Survivors

Author(s): Chao Cao, MPH1,2,3; Christine M. Friedenreich, PhD3,4; Lin Yang, PhD3,4
Source: Cao C, Friedenreich CM, Yang L. Association of Daily Sitting Time and Leisure-Time Physical Activity With Survival Among US Cancer Survivors. JAMA Oncol. Published online January 06, 2022. doi:10.1001/jamaoncol.2021.6590
Lucio Gordan MD

Dr. Gordan's Thoughts

More evidence that being physically active may enhance QOL and survival. Prospective studies are needed to show that physical activity intervention actually achieves such degree of improvements, and that the non-exercise population is not self-selected due to comorbidities.

KEY POINTS

Question  What are the independent and joint associations of daily sitting time and physical activity with mortality outcomes among cancer survivors in the US?

Findings  This prospective cohort study included 1535 cancer survivors followed up for a median of 4.5 years and found that those with a higher sitting time had an increased risk of all-cause, cancer, and noncancer mortality. The highest risk was among those who were inactive or insufficiently active, with sitting time of more than 8 hours per day.

Meaning  The findings of this cohort study suggest that the combination of prolonged sitting and lack of physical activity, highly prevalent among US cancer survivors, is associated with heightened risks of mortality outcomes.

ABSTRACT

Importance  Sedentary behaviors, particularly prolonged sitting and lack of physical activity, may influence survival after cancer.

Objective  To examine the independent and joint associations of daily sitting time and leisure-time physical activity with mortality outcomes among cancer survivors.

Design, Setting, and Participants A prospective cohort of a nationally representative sample of cancer survivors, age 40 years or older (n = 1535; weighted population, 14 002 666), from the US National Health and Nutrition Examination Survey from 2007 to 2014. Participants were linked to mortality data from their interview and physical examination date through December 31, 2015. Daily sitting time and leisure-time physical activity (LTPA) were self-reported using the Global Physical Activity Questionnaire. Data analyses were performed from January 1 to May 1, 2021.

Main Outcomes and Measures All-cause, cancer-specific, and noncancer mortality.

Results  Among 1535 cancer survivors (mean [SE] age, 65.1 [0.4] years; 828 [60.1%] females; 945 [83.1%] non-Hispanic White individuals), 950 (56.8%) reported LTPA of 0 minutes per week (min/wk) during the previous week (inactive); 226 (15.6%) reported LTPA of less than 150 min/wk (insufficiently active); 359 (27.6%) reported LTPA of 150 min/wk or more (active); 553 (35.4%) reported sitting for 6 to 8 hours per day (h/d); and 328 (24.9%) reported sitting for more than 8 h/d. Of note, 574 (35.8%) cancer survivors reported no LTPA with concurrent sitting of more than 6 h/d. During the follow-up period of up to 9 years (median, 4.5 years; 6980 person-years), there were 293 deaths (cancer, 114; heart diseases, 41; other causes, 138). Multivariable models showed that being physically active was associated with lower risks of all-cause (hazard ratio [HR], 0.34; 95% CI, 0.20-0.60) and cancer-specific (HR, 0.32; 95% CI, 0.15-0.70) mortality compared with inactivity. Sitting more than 8 h/d was associated with higher risks of all-cause (HR, 1.81; 95% CI, 1.05-3.14) and cancer-specific (HR, 2.27; 95% CI, 1.08-4.79) mortality compared with those sitting less than 4 h/d. In the joint analyses, prolonged sitting was associated with an increased risk of death among cancer survivors who were not sufficiently active. Specifically, inactive and insufficiently active survivors reported sitting more than 8 h/d had the highest overall (HR, 5.38; 95% CI, 2.99-9.67) and cancer-specific (HR, 4.71; 95% CI, 1.60-13.9) mortality risks.

Conclusions and Relevance In this cohort study of a nationally representative sample of US cancer survivors, the combination of prolonged sitting with lack of physical activity was highly prevalent and was associated with the highest risks of death from all causes and cancer.

Author Affiliations

1Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri; 2Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri; 3Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada; 4Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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