Table 1.
Main characteristics of the included studies
| Publication, study name, study design, country | Sample size/ No of deaths | Follow-up | Diagnosis and mortality ascertainment | Physical activity measurement | Exposure category | Risk estimates | Confounders | Risk of bias assessment |
|---|---|---|---|---|---|---|---|---|
| Breast cancer | ||||||||
| Ammitzbøll 2016 [34], DCHS, Denmark, prospective cohort study, USA |
n = 959 144 cases |
Median (IQR), y = 10 (7) |
Cancer registry; Central Population Register. |
Questionnaire |
MET-h/week: 0 0–41 > 41–63 > 63–97 > 97–379 |
1.5 >(0.83–2.72) 1 0.75 (0.45–1.24) 0.83 (0.49–1.40) 0.75 (0.42–1.33) |
BMI, baseline alcohol, smoking status, education, comorbidity, nodal status, operation type, chemotherapy, recreational and household PA. | Serious |
| Bao 2015 [35], SBCSS, prospective cohort study, China |
n = 518 128 cases |
Median (range), y = 9.1 (0.6–11.8) | Shanghai Cancer Registry; Shanghai Vital Statistics Registry. | Questionnaire |
MET-h/week: 0 < 7.6 ≥ 7.6 |
1 0.79 (0.5–1.27) 0.61 (0.41–0.91) |
Age at diagnosis, BMI at baseline, education, marital status, menopausal status, Charlson comorbidity index, chemotherapy, radiotherapy, tumor-node metastasis stage, soy protein intake, tea consumption at baseline. | Moderate |
| Bertram 2011 [28], WHEL, follow-up study of RCT, USA |
n = 2361 195 cases |
Median (range), y = 7.1 (1.0–10.8) | Medical records and death certificates, telephone interviews, confirmation obtained for > 95% of participants. | Questionnaire |
MET-h/week: 0–2.5 2.5–7.5 7.5–14.9 14.9–24.7 24.7–107 |
1 1.01 (0.66–1.55) 0.85 (0.53- 1.35) 0.75 (0.46–1.23) 0.47 (0.26- 0.84) |
Age and BMI at randomization, race, fruit and vegetable consumption, menopausal status, tumor type, tumor grade, tumor stage, anti-estrogen use, clinical site, time from diagnosis to randomization, hot flashes, and study group. | Moderate |
| Bradshaw 2014 [36], LIBCSP, prospective cohort follow-up of case-control study, USA |
n = 1423 420 cases |
Median (range), y = 12.7 (0.23–13.42) |
Physician confirmed diagnosis; National Death Index. |
Interviewer-administered questionnaire |
0 0.1–9 > 9 |
1 0.43 (0.20–0.83) 0.32 (0.23–0.47) |
Age, pre-diagnosis BMI, chemotherapy treatment, tumor size, missing PA data. | Serious |
| Chen 2011 [37], SCR, prospective cohort study, China |
n = 4826 436 cases |
Median, y = 4.3 |
Population-based Shanghai Cancer Registry; Annual linkage with the Shanghai Vital Statistics database. |
Interview |
MET-h/week: 0 < 8.3 > 8.3 |
1 0.81 (0.63–1.05) 0.65 (0.51- 0.84) |
Date of birth, BMI at baseline, waist-to-hip ratio at baseline, menopausal status, income, education, quality of life, cruciferous vegetable intake, soy protein intake, tea consumption, chemotherapy, radiotherapy, tamoxifen use, tumor-node metastasis status, estrogen progesterone receptor status. | Moderate |
| de Glas 2014 [30], TEAM-L, prospective cohort study, Netherlands |
n = 435 58 cases |
Followed until 2012 (from 2004 to 5) | Histologically/cytologically confirmed diagnosis. | Questionnaire |
MET-h/week: 0–21 21.1–40 40.1–65.5 65.6–258 |
1 0.43 (0.19- 0.94) 0.60 (0.29- 1.24) 0.57 (0.26- 1.40) |
Age at 1 year after diagnosis, number of comorbidities, tumor stage, node stage, BMI, and chemotherapy. | Moderate |
| Holick 2008 [38], CWLS, prospective cohort follow-up of case-control study, USA |
n = 4482 412 cases |
Mean, y = 5.5 ± 1.1 |
Self-reported and state cancer registries; National Death Index. |
Questionnaire |
MET-h/week: < 2.8 2.8–7.9 8.0–20.9 ≥ 21.0 |
1 0.58 (0.45–0.76) 0.53 (0.40- 0.69) 0.44 (0.32- 0.60) |
Age at diagnosis, stage of disease at diagnosis, state of residence, interval between diagnosis and PA assessment, BMI, post-diagnosis menopausal status, post-diagnosis hormone therapy use, total energy intake year before enrollment in the CWLS, education level at diagnosis, family history of breast cancer at diagnosis, and initial treatment modality (radiation, chemotherapy, tamoxifen). | Serious |
| Holmes 2005 [39], NHS, prospective cohort study, USA |
n = 2987 463 cases |
Median, y = 8 |
Self-reported and confirmed from medical records and pathology reports, family, postal authorities; National Death Index. |
Questionnaire |
MET-h/week: < 3 3–8.9 9–14.9 15–23.9 ≥24 |
1 0.71 (0.56- 0.89) 0.59 (0.41- 0.84) 0.56 (0.41- 0.77) 0.65 (0.48- 0.88) |
Age, interval between diagnosis and PA assessment, smoking status, BMI, menopausal status and hormone therapy use, age at first birth and parity, oral contraceptive use, energy intake, energy-adjusted protein intake, disease stage, radiation treatment, chemotherapy, and tamoxifen treatment. | Serious |
| Irwin 2008 [40], HEAL, prospective cohort study, USA |
n post-diagnosis = 688 53 cases |
Median (range), y = 6 (5–8) | Surveillance, Epidemiology, and End Results registries. | Questionnaire |
MET-h/week: 0 > 0–8.9 ≥ 9 |
1 0.36 (0.17–0.73) 0.33 (0.15–0.73) |
Age, race, disease stage, initial treatment, tamoxifen use, BMI, and fruit/vegetable servings per day. | Serious |
| Irwin 2011 [32], WHI, prospective cohort study, USA |
n = 2910 186 cases |
Mean (SD), y = 3.3 (1.8) | Physician-confirmed diagnosis, clinical center follow-up of participants and surrogates; National Death Index. | Questionnaire |
MET-h/week: 0 > 0–3.0 3.1–8.9 ≥ 9 |
1 0.42 (0.21–0.82) 0.72 (0.48- 1.07) 0.54 (0.38-0.79) |
Age, stage, estrogen receptor, progesterone receptor, grade, human epidermal growth factor receptor 2, ethnicity, study arm, previous therapy use, time from diagnosis to PA assessment, BMI, diabetes, alcohol consumption, smoking, total calories, percentage calories from fat, servings of fruit and vegetables. | Moderate |
| Maliniak 2018 [41], CPS-II NC, prospective cohort study, USA |
n = 3689 185 cases |
Median (IQR) = 7.5 (5.8) | Self-reported diagnosis of breast cancer; National Death Index. Both verified through medical records or state cancer registries. | Questionnaire |
MET-h/week: < 3.5 3.5 - < 8.75 8.75 - < 17.5 > 17.5 < 3.5 3.5 - < 8.75 8.75 - < 17.5 > 17.5 |
Age 45–64 years: 1.36 (0.89–2.07) 1 0.67 (0.44–1.02) 0.56 (0.37–0.83) Age 65–92 years: 1.34 (1.14–1.58) 1 0.81 (0.67–0.99) 0.74 (0.61–0.90) |
Age at diagnosis, race, calendar year of diagnosis, post-diagnosis BMI, Surveillance, Epidemiology, and End Results summary stage at diagnosis, post-diagnosis number of co-morbidities, post-diagnosis use of hormone replacement therapy, post-diagnosis alcohol intake, and post-diagnosis other cancer diagnosis, smoking status. | Serious |
| Sternfeld 2009 [42], LACE, prospective cohort study, USA |
n = 1970 187 cases |
Mean (SD), mo = 87 (18) | Kaiser Permanente Northern California Cancer Registry, Utah Cancer Registry; death certificates. | Questionnaire |
MET-h/week: < 29 29- < 44 44- < 62 ≥ 62 |
1 0.89 (0.59–1.33) 0.82 (0.54–1.25) 0.76 (0.48–1.19) |
Age, BMI, number of positive nodes, stage, weight at 18 years, type of treatment, type of surgery, education level, smoking status. | Serious |
| Type 2 diabetes | ||||||||
| Glenn 2015 [31], SCCS, prospective cohort study, USA |
n = 15,645/ m-f 2370 cases |
Median (range), y = 6.2 (0.01–9.8) | Self-reported diagnosis; Social Security Administration vital status service for epidemiologic researchers and the National Death Index. | Questionnaire |
MET-h/day: < 6.9 6.9–14.1 14.2–24.8 > 24.9 |
1 0.77 (0.69–0.86) 0.66 (0.58–0.74) 0.64 (0.57–0.73) |
Age, sex, race, BMI, income, education, comorbidities (hypertension, high cholesterol, myocardial infarction, stroke), smoking, insulin use, time since diagnosis, sedentary time. | Serious |
| Gregg 2003 [43], NHIS, prospective cohort study, USA |
n = 2896/ m-f 671 cases |
y = 8 | Self-reported diagnosis; National Death Index. | Interview |
h/week: 0 > 0–1.9 ≥ 2 |
1 0.95 (0.77-1.17). 0.71 (0.59-0.87) |
Age, BMI, sex, race, self-rated health, smoking, weight loss approaches, hospitalizations, hypertension, use of antihypertensive medications, physician visits, limitations caused by cancer and CVD, functional limitations. | Serious |
| Hu 2004 [33], six independent population surveys, prospective cohort study, Finland |
n = 3316/ m-f 1410 cases |
Mean, y = 18.5 | Self-reported, hospital discharge diagnosis, or drug-treated cases in the Drug Registry; Statistics Finland. | Questionnaire |
Low Moderate High |
1 0.95 (0.81- 1.12) 0.96 (0.80- 1.15) |
Age, sex and study year, BMI, systolic blood pressure, cholesterol, smoking, occupational PA, commuting PA; individuals with comorbidities, severe disease or disability at baseline, and who died the first two years of follow-up were excluded. | Serious |
| Sluik 2012 [44], EPIC, prospective cohort study, 10 European Countries |
n = 5859/ m-f 755 case |
Median, y = 9.4 | Self-reported diabetes confirmed from a physician, or use of medication, or self-reported confirmation during follow-up, or diabetes registries, or HbA1c level > 6% at baseline; Linkages with local, regional, or central cancer registries, boards of health, or death indices. | Questionnaire |
MET-h/week: < 45 45–74 75–113 > 113 |
1 0.85 (0.70–1.04) 0.80 (0.64–0.99) 0.73 (0.57–0.93) |
Age, sex, study center, diabetes medication, disease duration, myocardial infarction, stroke, cancer, alcohol consumption, smoking behavior, education, energy intake, scores for dietary patterns. | Serious |
| Sone 2013 [45], JDCS, prospective cohort study, Japan |
n = 1702/ m-f 69 cases |
Median, y = 8.05 | HbA1c levels ≥ 6.5% (51 mmol/mol) referring to the Japan Diabetes Society; annual reports form. | Questionnaire |
MET-h/week: ≤ 3.7 3.8–15.3 ≥ 15.4 |
1 0.88 (0.47–1.64) 0.47 (0.22–0.99) |
Age, sex, BMI, diabetes duration, smoking, energy/ethanol intake, dietary fiber, saturated fatty acid, type of occupation, HbA1c, systolic blood pressure, LDL-cholesterol, HDL-cholesterol, triacylglycerol, treatment (insulin, oral hypoglycaemic agents, antihypertensive agents or lipid-lowering agents). | Serious |
| Tanasescu 2003 [46], HPFS, prospective cohort study, USA |
n = 2803/ m 355 cases |
y = 14 | Self-reported physician’s diagnosis confirmed from diagnostic criteria from the National Diabetes Data Group; next of kin, work associates, postal authorities, and National Death Index. | Questionnaire |
MET-h/week: 0–5.1 5.2–12.0 12.1–21.7 21.8–37.1 ≥37.2 |
1 0.88 (0.64–1.21) 0.64 (0.45–0.91) 0.64 (0.45–0.90) 0.65 (0.45–0.93) |
BMI, alcohol intake, smoking status, family history of myocardial infarction, use of vitamin E supplements, diabetes duration, diabetes medication, dietary intake of trans fat, saturated fat, fiber, and folate, history of angina and coronary artery bypass graft (CABG), hypertension at baseline, high serum cholesterol at baseline. | Moderate |
| Chronic obstructive pulmonary disease | ||||||||
| Cheng 2018 [14], HSE and SES, prospective cohort study, England and Scotland |
n = 2398/ m-f 571 cases |
Mean (SD), y = 8.5 (3.9) | Confirmed by spirometry according to GOLD criteria; National Health Service mortality data. | Questionnaire |
MET-h/week: 0 < 3.75 3.75- < 7.5 ≥ 7.5 |
1 0.86 (0.67–1.10) 0.75 (0.56–1) 0.56 (0.45–0.69) |
Age, gender, BMI, COPD severity, history of CVD, cancer and diabetes, self-reported longstanding illness, smoking status, alcohol consumption, education. | Serious |
| Garcia-Aymerich 2006 [47], CCHS, prospective cohort study, Denmark |
n = 2386/ m-f 1425 cases |
Mean (SD) = 12 (5.9) | Confirmed by a fixed FEV1/FVC ratio test; Danish National Board of Health. | Questionnaire |
Very low Low Moderate High |
1 1.04 (0.84–1.27) 0.73 (0.61–0.86) 0.72 (0.59–0.86) |
Age, gender, BMI, income, smoking status, glucose, systolic blood pressure FEV1, IHD, myocardial infarction, stroke, asthma, sputum, asthma and smoking interaction. | Serious |
| Ischemic heart diseases | ||||||||
| Gerber 2011 [48], ISFAMI, prospective cohort study, Israel |
n = 1521/ m-f 427 cases |
Median (IQR), y = 13.2 (12.0–13.5) | Index hospitalization; Israeli Population Registry, death certificates, hospital charts, family physicians and members. | Questionnaire |
None Irregularly Regularly |
1 0.71 (0.54–0.95) 0.56 (0.42–0.74) |
Age, gender, hypertension, diabetes, dyslipidemia, smoking, obesity, chronic IHD, comorbidity index, Killip class, self-rated health, thrombolytic therapy, CABG, PTCA within 45 days, education, income, pre-MI employment, living with a steady partner, recurrent MI (and unstable angina pectoris, heart failure, CABG and PTCA) and cardiac rehabilitation during follow-up. | Moderate |
| Janssen 2006 [49], CHS, prospective cohort study, USA |
n = 1045/ m-f 489 cases |
y = 9 | Self-reported IHD confirmed from medications, medical records, clinical examinations; reviews of obituaries, medical records, death certificates, and the U.S. Health Care Financing Administration health care utilization database. | Interview |
EE (kcal/week) < 500 500–999 1000–1999 2000–2999 ≥ 3000 |
1 0.87 (0.68–1.26) 0.77 (0.59–0.99) 0.54 (0.36–0.81) 0.63 (0.44–0.91) |
Age, sex, race, smoking, alcohol, socioeconomic status, adiposity, prevalent disease (diabetes, lung disease, cancer, hypertension, stroke, congestive heart failure), and type of IHD (angina, MI, coronary revascularization). | Moderate |
| Lahtinen 2017 [13], ARTEMIS, follow-up study of RCT, Finland |
n = 1746/ m-f 147 cases |
Median (IQR), mo = 54 (41–69) | Angiographically confirmed IHD with coronary stenosis > 50% of ≥ 1 coronary arteries; national death registries, mailing, telephone calls to family, electronic patient records. | Questionnaire |
Inactive Irregularly active Active Highly active |
4.6 (2.1–10.0) 2.4 (1.1–5.3) 2.0 (0.9–4.3) 1 |
Age, gender, BMI at baseline, diabetes mellitus, history of MI, left ventricular ejection fraction, Canadian Cardiovascular Society grading for angina pectoris, cardiovascular event at 2-years follow-up, smoking status and alcohol consumption at 2 years. | Moderate |
| Moholdt 2017 [50], HUNT, prospective cohort study, Norway |
n = 6493/ m-f 3818 cases |
Median (IQR), y = 12.5 (14.1) | Self-reported IHD; National Cause of Death Registry in Norway. | Questionnaire |
Inactive Low Recommended High |
1 0.85 (0.79–0.92) 0.81 (0.72–0.90) 0.82 (0.70–0.95) |
Age, examination year, smoking status, diabetes mellitus, alcohol consumption, hypertension, health status, PA for BMI, BMI for physical activity (stratified by sex). | Moderate |
| Mons 2014 [51], KAROLA, prospective cohort study, Germany | n = 1038/ m-f | Mean (SD), y = 8.1 (3.1) | Physician-confirmed diagnosis; death certificates. | Questionnaire |
Frequency/strenuous PA: Rarely/never 1-4x/month 2-4x/week 5-6x/week Daily |
3.81 (2.17–6.70) 1.74 (0.59–3.21) 1 1.69 (0.81–3.50) 1.77 (0.90–3.47) |
Age, gender, BMI, education, study site, employment status, cotinine-validated smoking status, self-reported poor health, history of MI, diabetes mellitus, hypertension, left ventricular function, number of affected vessels. | Serious |
| Stewart 2017 [29], STABILITY, follow-up study of RCT, Global (39 countries) |
n = 15,467/ m-f 1081 cases |
Median (IQR), y = 3.79 (0.31) | IHD confirmed from coronary angiography. | Questionnaire |
Median (IQR), MET-h/w: 14.0 ± 12.0 40.0 ± 14.0 90.0 ± 52.0 |
1 0.75 (0.65–0.87) 0.70 (0.60–0.82) |
Age, gender, BMI, randomized treatment, systolic blood pressure, hypertension, geographic region for final reporting, prior myocardial infarction (MI), prior coronary revascularization percutaneous coronary intervention or coronary artery bypass graft, IHD, diabetes mellitus, smoking status, polyvascular disease, significant renal dysfunction, hemoglobin, white blood cell count, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, estimated glomerular filtration rate according to the Chronic Kidney Disease-Epidemiology research group calculator, congestive heart failure. | Serious |
| Tian 2017 [52], CKB, prospective cohort study, China |
n (IHD) = 13,936 / m-f 1442 cases |
y = 7 | Physician-diagnosed hypertension or CVD (stroke, transient ischemic attack, ischemic heart disease); China CDC’s Disease Surveillance Points system, local residential and health insurance records, active confirmation from street committee or village administrators. | Interviewer-administered questionnaire |
MET-h/d: < 8.91 8.91–16.53 ≥ 16.53 |
1 (0.93 - 1.08) 0.80 (0.73–0.88) 0.59 (0.50–0.70) |
Smoking status, alcohol consumption, fruit consumption, dairy products, meat and preserved vegetables, education, income, survey season, diabetes status, family history of CVD, CVD medication, poor health status (Analysis stratified by age-at-risk, gender, region, baseline CVD status) | Serious |
| Wannamethee 2000 [53], BRHS, prospective cohort study, Great Britain |
n = 772/ m 131 cases |
Mean, y = 5 | Self-reported physician-diagnosed IHD; National Health Service registers in Southport and Edinburgh. | Interviewer-administered questionnaire |
Inactive/occasional Light Moderate Moderate to vigorous |
1 0.42 (0.25–0.71) 0.47 (0.24–0.92) 0.63 (0.39–1.03) |
Age, smoking, social class, self-rated health status, diabetes mellitus, history of MI and stroke. | Moderate |
DCHS Diet, Cancer, and Health study, IQR Interquartile range, BMI body mass index, PA physical activity, CVD cardiovasular diseases, IHD ischemic heart diseases, COPD chronic obstructive pulmonary disease, SBCSS Shanghai Breast Cancer Survival Study, WHEL Women’s Healthy Eating and Living study, LIBCSP Long Island Breast Cancer Study, LIBCSP Long Island Breast Cancer Study Project, SCR Shanghai Cancer Registry, TEAM-L Tamoxifen Exemestane Adjuvant Multicenter Lifestyle, CWLS Collaborative Women’s Longevity Study, NHS Nurses’ Health Study, HEAL Health, Eating, Activity, and Lifestyle study, WHI Women’s Health Initiative study, CPS-II NC Cancer Prevention Study-II Nutrition Cohort, LACE Life After Cancer Epidemiology study, SCCS Southern Community Cohort Study, NHIS National Health Interview Survey, EPIC European Prospective Investigation Into Cancer and Nutrition, JDCS Japan Diabetes Complications Study, HPFS Health Professionals’ Follow-up Study, HSE Health Survey for England, SES Scottish Health Survey, CCHS Copenhagen City Heart Study, ISFAMI Israel Study of First Acute Myocardial Infarction, CABG coronary artery bypass graft, PTCA percutaneous transluminal coronary angioplasty, CHS Cardiovascular Health Study, ARTEMIS Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection, HUNT Nord-Trøndelag Health study, CKB China Kadoorie Biobank study, BRHS British Regional Heart Study