The relationship between physical activity and lymphoma: a systematic review and meta analysis

Abstract

Background The literature suggests an increased risk between anthropometrics including higher body mass index and lymphoma incidence; however, the association with physical activity remains unclear. A systematic review/meta-analysis was therefore performed to examine this association with physical activity (total, recreational or occupational). Methods PubMed, Web of Science and Embase were reviewed from inception to October 2019 identifying relevant observational studies. Non-Hodgkin lymphoma (NHL) including subtypes diffuse large B cell lymphoma, follicular lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma, and Hodgkin lymphoma (HL) were analyzed. Included studies reported activity, lymphoma cases, effect size and variability measures, and were restricted to human subjects of any age. Data was pooled generating summary relative risk (RR) estimates with 95% confidence intervals (CI) using random-effects models with primary outcome of histologically confirmed incident lymphoma. Results One thousand four hundred studies were initially identified with 18 studies (nine cohort, nine case-control) included in final analysis. Comparing highest vs. lowest activity categories was protective for all lymphoma (RR 0.89, 95%CI 0.81–0.98). Sensitivity analysis demonstrated effect persistence within case-control studies (RR 0.82, 95% CI 0.71–0.96), but not cohort studies (RR 0.95, 95%CI 0.84–1.07). Borderline protective effect was seen for NHL (RR 0.92, 95%CI 0.84–1.00), but not HL (RR 0.72, 95%CI 0.50–1.04). Analysis by NHL subtype or gender showed no effect. Dose response analysis demonstrated a protective effect (p = 0.034) with a 1% risk reduction per 3 MET hours/week (RR 0.99, 95%CI 0.98–1.00). Conclusions Physical activity may have a protective effect against lymphoma development; further studies are required to generate recommendations regarding health policy. Trial registration This study was registered prospectively at PROSPERO: CRD42020156242.

Assessment of Subjective Well-Being in a Cohort of University Students and Staff Members: Association with Physical Activity and Outdoor Leisure Time during the COVID-19 Pandemic

“…While physical activity (PA) has long been associated with a reduced risk of mortality and morbidity from chronic and degenerative diseases [16][17][18][19][20][21], the research interest on the role of PA on mental health has emerged more recently. PA has been related to an improvement in general well-being [22], enhanced perception of quality of life [23,24] and mood, as well as to a significant reduction in anxious and depressive symptomatology [25].…”

Physical activity and the risk of non‐Hodgkin lymphoma subtypes: A pooled analysis

“…A 2016 pooled analysis of ~7000 cases from 11 cohort studies found a hazard ratio of 0.91 (95% CI = 0.83, 1.00) when comparing the 90th and 10th percentiles of cohort‐specific distributions of MVPA, 23 while a related 2019 pooled analysis of ~4000 cases from nine of those 11 cohort studies found engagement in recommended amounts of activity (7.5 to 15 MET‐hours per week) was associated with a ~ 10% lower risk of NHL 4 . Similarly, a 2020 meta‐analysis of 17 cohort and case‐control studies found that participants with the highest levels of physical activity had a 8% lower risk of NHL than those with the lowest levels of physical activity 5 . We found a larger risk reduction (~20%) in the exposure‐response analyses for NHL overall and for each NHL subtypes than in the tertile analysis, and also found that risk began to decrease with relatively low levels of activity.…”

“…4 Similarly, a 2020 meta-analysis of 17 studies (nine cohort, eight case-control) reported an overall NHL risk reduction of 8% when comparing high vs low physical activity levels. 5 Conversely, a 2019 meta-analysis of five cohort studies found no association between physical activity and NHL risk. 6 NHL includes a highly heterogeneous collection of subtypes with considerable differences in genetics, biology, aetiology and outcomes.…”

“…Two meta-analyses of relevant studies found that physical activity was not significantly associated with the risks of diffuse large B-cell lymphoma, follicular lymphoma or chronic lymphocytic lymphoma/ small lymphocytic lymphoma (CLL/SLL) 5,6 ; however, the number of included studies was small and only three NHL subtypes were examined.…”

Assessing the Effects of Physical Activity on Children and Adolescents Hodgkin’s Lymphoma Survivors: A Systematic Review

“…A recent review underlines that (a) higher level of physical activity seems to be inversely associated with lymphoma development (compared to the lower PA level); (b) female subjects appear to better benefit from higher PA levels than boys (Davies et al, 2020). At the same time, a large percentage of adolescents and young adult cancer survivors (AYACs) do not meet the lifestyle guidelines and recommendations for PA, BMI, and/or smoking, involving several late effects and/or comorbidities (Bøhn et al, 2020).…”