Table 15 Studies examining the relationship between physical activity and colon cancer.

Hou et al 2004 [272]

To examine the effect of various forms of PA on colon cancer risk, with particular attention to commuting PA.

• n = 931 case, 1,552 control

PA assessment: Interview for the following variables

   • Number of cases: 931

Regular frequent PA over a long period of time reduces risk of CC.

China

• Sex: Men and women

Multivariate OR (95% CI) by OPA, men

   • G1 = 1.00 (referent)

Case control

• Age: 30-74 yr

OPA (kJ/min)

   • G2 = 1.23 (0.93-1.64)

D & B score = 14

• Characteristics: Case: diagnosed with CC. controls: selected randomly from residents of urban Shanghai.

G1 = <8

   • G3 = 0.81 (0.59-1.19)

G2 = 8-12

p = 0.10

G3 = >12

Commuting PA (MET hr/wk)

Multivariate OR (95% CI) by OPA, women

G1 = <48.3

   • G1 = 1.00 (referent)

G2 = 48.3-94.3

   • G2 = 0.96 (0.69-1.16)

G3 = >94.3

   • G3 = 0.64 (0.39-1.02)

p = 0.009

LTPA (MET hr/wk)

Multivariate OR (95% CI) Commuting PA, men

G1 = < 9.2

   • G1 = 1.00 (referent)

G2 = 9.2-13.6

   • G2 = 1.11 (0.31-1.23)

G3 = >13.6

   • G3 = 0.52 (0.27-0.87)

Outcome Measure: incident CC

p<0.001

Multiple logistic regression

Multivariate OR (95% CI) Commuting PA, women

   • G1 = 1.00 (referent)

   • G2 = 0.87 (0.42-1.52)

   • G3 = 0.56 (0.21-0.91)

p = 0.007

Multivariate OR (95% CI) LTPA, men

   • G1 = 1.00 (referent)

   • G2 = 1.17 (0.13-1.95)

   • G3 = 0.72 (0.41-1.07)

p = 0.06

Multivariate OR (95% CI) LTPA, women

   • G1 = 1.00 (referent)

   • G2 = 1.03 (0.41-1.59)

   • G3 = 0.84 (0.13-2.25)

p = 0.15

Boutron-Ruault et al 2001 [273]

To determine which step of the adenoma-carcinoma pathway was influenced by OPA and recreational PA.

• n = 480

PA assessment: Questionnaire and classified into 3 groups

Number of cases: 171

A sedentary lifestyle was associated with a high risk of CC.

France

• Sex: Men and women

G1 = Low

Age and gender adjusted OR (95% CI), OPA

Case control

• Age: 30-79 years

G2 = Medium

• G1 = 1.00 (referent)

D & B score = 13

• Characteristics: Cases had 1^stdiagnosis of colorectal adenoma, controls were polyp free.

G3 = High

• G2 = 1.3 (0.8-2.0)

• G3 = 0.5 (0.3-0.9)

p = 0.005

Outcome Measure: Incident CC

Multiple logistic regression

Age and gender adjusted OR (95% CI), LTPA

• G1 = 1.00 (referent)

• G2 = 0.7 (0.4-1.1)

• G3 = 0.3 (0.2-0.5)

p = <0.0001

Age and gender adjusted OR (95% CI), Global PA

• G1 = 1.00 (referent)

• G2 = 0.8 (0.5-1.2)

• G3 = 0.3 (0.2-0.6)

p = 0.0003

Brownson et al 1991 [274]

To investigate the risks of 16 cancer types in relation to OPA.

• n = 17,147

PA assessment: Medical records and classified into 3 groups:

Number of cases: 1,838

OPA is inversely related to risk of CC.

• Sex: Men

Multivariate OR (95% CI)

USA

• Age: ≥ 20 yr

OPA

G1 = 1.00 (referent)

• Characteristics: White, working

G1 = Low - Activity required <20% of time

G2 = 1.2 (1.0-1.5)

Case controll

G2 = Moderate - Activity required 20-80% of time

G3 = 1.1 (1.0-1.3)

D & B score = 15

G3 = High - Activity required >80% of time

p = 0.05

Outcome Measure: CC

Maximum likelihood estimates

Calton et al 2006 [275]

To examine the relationship between PA and colon cancer risk in women.

• n = 31,783

11 year follow up

Number of cases: 243

Results do not support the hypothesis that PA is related to a lower incidence of CC in women.

USA

• Sex: Women

PA Assessment: Questionnaire / Phone interviews for the following variables, divided into 4 or 5 groups

Prospective cohort

• Age: 61.1 yr

Multivariate RR (95% CI), TPA

D & B score = 12

• Characteristics: Free from cancer at baseline

   • G1 = 1.00 (referent)

   • G2 = 1.45 (0.98-2.15)

   • G3 = 1.16 (0.77-1.75)

   • G4 = 1.27 (0.84-1.91)

   • G5 = 1.15 (0.76-1.75)

p = 0.77

TPA (MET h/d)

G1 = 34.0-48.5

Multivariate RR (95% CI), MPA

G2 = 48.51-54.3

   • G1 = 1.00 (referent)

G3 = 54.31-59.0

   • G2 = 1.23 (0.82-1.83)

G4 = 59.1-64.9

   • G3 = 1.47 (0.99-2.21)

G5 = 65.0-98.1

   • G4 = 0.94 (0.61-1.46)

   • G5 = 1.07 (0.70-1.62)

MPA (h/d)

p = 0.80

G1 = 0-3.0

G2 = 3.01-5.0

G3 = 5.01-6.70

Multivariate RR (95% CI), VPA

G4 = 6.71-8.14

   • Q1 = 1.00 (referent)

G5 = 8.15-18.0

   • Q2 = 1.19 (0.85-1.66)

   • Q3 = 0.87 (0.59-1.29)

VPA (h/d)

   • Q4 = 1.10 (0.78-1.55)

Q1 = 0

p = 0.80

Q2 = 0.1-1.0

Q3 = 1.1-2.0

Q4 = 2.1-14.0

Outcome Measure: Incidence of CC

Cox proportional HR

Chao et al 2004 [276]

To examine how the characteristics of recreational PA affect its association with colon cancer incidence among older.

• n = 151,174 (70,403 men; 80,771 women)

7 year follow up

Number of cases: 940

Increased amounts of time spent in recreational PA is associated with substantially lower risk of CC.

USA

• Sex: Men and women

PA assessment: Questionnaire for the following variables

Multivariate RR (95% CI) by recreational PA, men

Prospective cohort

• Age: mean 63 yr

   • G1 = 1.00 (referent)

D & B score = 12

• Cancer prevention study II Nutrition Cohort

   • G2 = 0.91 (0.69-1.19)

Recreational PA (h/wk)

   • G3 = 0.72 (0.52-1.01)

G1 = None

   • G4 = 0.86 (0.64-1.15)

G2 = <2

   • G5 = 0.77 (0.54-1.08)

G3 = 2-3

   • G6 = 0.58 (0.39- 0.87)

G4 = 4-6

p = 0.007

G5 = 7

G6 = ≥ 8

Multivariate RR (95% CI) by recreational PA, women

Recreational (MET h/wk)

   • G1 = 1.00 (referent)

G1 = None

   • G2 = 1.01 (0.70-1.44)

G2 = <7, 7-13

   • G3 = 1.01 (0.68-1.49)

G3 = 14-23

   • G4 = 0.97 (0.66-1.43)

G4 = 24-29

   • G5 = 1.03 (0.65-1.65)

G5 = ≥ 30

   • G6 = 0.65 (0.39-1.11)

p = 0.14

Walking (h/wk)

Q1 = None

Q2 = <4

Q3 = 4-6

   • G1 = 1.00 (referent)

Q4 = ≥ 7

   • G2 = 0.94 (0.75-1.16)

   • G3 = 0.83 (0.65-1.07)

Walking plus other

   • G4 = 0.89 (0.71-1.12)

activities (h/wk)

   • G5 = 0.85 (0.64-1.12)

Q1 = None

   • G6 = 0.60 (0.44-0.83)

Q2 = <4

p = 0.002

Q3 = 4-6

Q4 = ≥ 7

Multivariate RR (95% CI) by MET h/wk men

Outcome Measure: Incidence of CC

   • G1 = 1.00 (referent)

   • G2 = 0.90 (0.68-1.18)

Cox proportional HR

   • G3 = 0.83 (0.59-1.16)

   • G4 = 0.75 (0.55-1.01)

   • G5 = 0.86 (0.63-1.19)

   • G6 = 0.60 (0.41-0.87)

p = 0.005

Multivariate RR (95% CI) by MET h/wk women

   • G1 = 1.00 (referent)

   • G2 = 1.02 (0.71-1.46)

   • G3 = 0.98 (0.65-1.47)

   • G4 = 1.0 (0.68-1.47)

   • G5 = 0.94 (0.60-1.48)

   • G6 = 0.77 (0.48-1.24)

p = 0.15

Multivariate RR (95% CI) by MET h/wk men and women

   • G1 = 1.00 (referent)

   • G2 = 0.93 (0.75-1.16)

   • G3 = 0.88 (0.68-1.13)

   • G4 = 0.84 (0.66-1.06)

   • G5 = 0.89 (0.68-1.15)

   • G6 = 0.65 (0.49-0.87)

p = 0.002

Multivariate RR (95% CI) by walking, Men

   • Q1 = 1.00 (referent)

   • Q2 = 0.87 (0.66-1.15)

   • Q3 = 0.83 (0.60-1.16)

   • Q4 = 0.88 (0.61-1.25)

p = 0.34

Multivariate RR (95% CI) by walking, women

   • Q1 = 1.00 (referent)

   • Q2 = 1.00 (0.70-1.44)

   • Q3 = 1.08 (0.71-1.63)

   • Q4 = 1.18 (0.71-1.95)

p = 0.41

Multivariate RR (95% CI) by walking plus other activities, men

   • Q1 = 1.00 (referent)

   • Q2 = 0.73 (0.53-1.02)

   • Q3 = 0.85 (0.58-1.24)

   • Q4 = 0.53 (0.36-0.78)

p = 0.02

Multivariate RR (95% CI) by walking plus other activities, women

   • Q1 = 1.00 (referent)

   • Q2 = 0.99 (0.67-1.47)

   • Q3 = 0.72 (0.43-1.19)

   • Q4 = 0.59 (0.36-0.98)

p = 0.07

Colbert et al 2001 [277]

To examine the association between OPA and LTPA and colon cancer in male smokers.

• n = 29,133

12 year follow-up

Number of cases: 152

OPA is protective against CC in a dose-response manner.

USA

• Sex: Men

Prospective cohort

• Age: 50-69 yr

PA assessment: Interview for OPA and LTPA

Multivariate RR (95% CI) by OPA

D & B score = 13

• Characteristics: Smokers

   • G1 = 0.61 (0.39-0.98)

• Alpha- Tocopherol, Beta-Carotene Cancer Prevention Study

   • G2 = 1.00 (referent)

   • G3 = 0.60 (0.34-1.04)

OPA

   • G4 = 0.45 (0.26-0.78)

G1 = Non-worker

p = 0.003

G2 = Sedentary

G3 = Light

Multivariate RR (95% CI), by LTPA

G4 = Moderate

   • G1 = 1.00 (referent)

   • G2 = 0.82 (0.59-1.13)

LTPA

G1 = Sedentary

G2 = Active

Outcome Measure: incident CC

Cox proportional HR

Dosemeci et al 1993 [278]

To examine associations between PA and cancer sites among workers in Turkey.

• n = 6,236 (3,486 cases in men and 379 cases in women; 2,127 control men and 244 control women)

PA assessment: Stanford Occupational Classification code system.

Number of cases: 93

Occupational EE is inversely related to risk of CC.

Turkey

• 93 cases for CC

Multivariate OR (95% CI) by total occupational EE

Case control

• Sex: Men and women

   • G1 = 1.6 (0.9-2.8)

• Age: not indicated

   • G2 = 1.1 (0.6-2.0)

D & B score = 13

• Characteristics: All hospitalized Cases: Diagnosed with CC. Controls: included subjects diagnosed as non-cancers and cancers which there is no suggestion of an association with PA.

G1 = <8

   • G3 = 1.0 (referent)

G2 = 8-12

p = 0.04

G3 = >12

Sitting time at work (h/d) Levels:

Multivariate OR (95% CI) by sitting time at work

G1 = <2

   • G1 = 1.00 (referent)

G2 = 2-6

   • G2 = 1.5 (0.9-2.5)

G3 = >6

   • G3 = 1.5 (0.8-3.0)

p = 0.03

Outcome Measure: Incident CC

When adjusted for socioeconomic status p = 0.03

Maximum likelihood estimates

Friedenreich et al 2006 [279]

To investigate the role of PA in the development of colon cancer.

• n = 413,044

4 year follow-up

Multivariate RR (95% CI), TPA

Inverse association between PA and risk of CC, particularly for right sided tumours.

• Sex: Men and women

PA assessment: modified Baecke Questionnaire

   • Q1 = 1.00 (referent)

UK

• Age: 35-70 yr

   • Q2 = 0.92 (0.76-1.12)

• Characteristics: Free of cancer at baseline

   • Q3 = 0.86 (0.70-1.04)

Prospective cohort

• European Prospective Investigation into Nutrition and Cancer. (EPIC)

TPA

   • Q4 = 0.78 (0.59-1.03)

Q1 = Inactive

p = 0.04

D & B score = 14

Q2 = Moderately inactive

Multivariate RR (95% CI), TPA and right sided CC

Q3 = Moderately active

   • Q1 = 1.00 (referent)

Q4 = Active

   • Q2 = 1.79 (0.59-1.06)

Household PA (MET-h/wk)

   • Q3 = 0.64 (0.47-0.86)

Q1 = <19.5

   • Q4 = 0.65 (0.43-1.00)

Q2 = 19.5-39.6

p = 0.004

Q3 = 39.6-73.9

Q4 = ≥ 73.9

Multivariate RR (95% CI), household PA and right sided CC

   • Q1 = 1.00 (referent)

   • Q2 = 0.97 (0.75-1.27)

Outcome Measure: Incident CC

   • Q3 = 0.84 (0.64-1.12)

   • Q4 = 0.74 (0.54-1.02)

p = 0.05

Cox proportional HR

Giovannucci et al 1995 [280]

To examine the association between PA and colon cancer.

• n = 47,723

6 year follow-up

Multivariate RR (95% CI)

A moderate level of PA was related to a substantially lower risk of CC in this cohort of middle age to elderly men.

• Sex: Men

   • G1 = 1.00 (referent)

• Age: 40-75 yr

PA assessment: Questionnaire

   • G2 = 0.73 (0.48-1.10)

USA

• Characteristics: Health professionals

   • G3 = 0.94 (0.63-1.39)

   • G4 = 0.78 (0.51-1.20)

Prospective cohort

• Health Professionals Follow-up Study

Outcome Measure: Incidence of colon cancer

   • G5 = 0.53 (0.32-0.88)

p = 0.03

D & B score = 12

Mantel-Haeszel estimator and logistic regression

Isomura et al 2006 [281]

To examine the relationship of OPA, LTPA, commuting, housework and shopping with colorectal cancer risk.

• n = 1545 (778 cases, 767 controls)

PA assessment: Questionnaire and interview for the following variables

   • Number of cases: 778

Adds to the evidence that PA confers decreased risk of CC, especially of distal CC in both men and women.

Japan

• Sex: Men and women

Multivariate OR (95% CI) for all CC by OPA, men

   • G1 = 1.00 (referent)

Case control

• Age: 20-74 yr

OPA, men

   • G2 = 0.9 (0.6-1.4)

• Characteristics: Free from cancer at baseline

G1 = Sedentary

   • G3 = 0.7 (0.4-1.0)

D & B score = 12

G2 = Moderate

p = 0.06

.

G3 = Hard

• Fukuoka colorectal cancer study

Multivariate OR (95% CI) for proximal

OPA, women

CC by OPA, men

G1 = Sedentary

   • G1 = 1.00 (referent)

G2 = Active

   • G2 = 1.2 (0.6-2.2)

   • G3 = 0.7 (0.4-1.4)

Total non-OPA, men (MET-h/wk)

p = 0.45

G1 = 0.0

Multivariate OR (95% CI) for distal CC by OPA, men

G2 = 0.1-15.9

   • G1 = 1.00 (referent)

G3 = 16.0

   • G2 = 0.8 (0.4-1.4)

   • G3 = 0.6 (0.4-1.0)

p = 0.047

Total non-OPA women (MET hr/wk)

G1 = 0.0

G2 = 0.1-15.9

G3 = 16.0

Multivariate OR (95% CI) for all CC by non-OPA, men

Moderate or hard non-OPA, men (MET hr/wk)

   • G1 = 1.00 (referent)

G1 = 0.0

   • G2 = 0.9 (0.6-1.4)

G2 = 0.1-14.9

   • G3 = 0.8 (0.5-1.2)

G3 = ≥15.0

p = 0.22

Multivariate OR (95% CI) for proximal CC by non-OPA, men

Moderate or hard non-OPA, women (MET hr/wk)

   • G1 = 1.00 (referent)

G1 = 0.0

   • G2 = 1.2 (0.6-2.1)

G2 = 0.1-14.9

   • G3 = 0.9 (0.5-1.7)

G3 = 15.0

p = 0.69

Outcome Measure: Incident CC

Multivariate OR (95% CI) for distal CC by non-OPA, men

   • G1 = 1.00 (referent)

Multiple logistic regression analysis

   • G2 = 0.8 (0.5-1.3)

   • G3 = 0.7 (0.4-1.1)

p = 0.19

Multivariate OR (95% CI) for all CC by non-OPA, women

   • G1 = 1.00 (referent)

   • G2 = 0.9 (0.5-1.5)

   • G3 = 0.8 (0.5-1.4)

p = 0.45

Multivariate OR (95% CI) for proximal CC by non-OPA, women

   • G1 = 1.00 (referent)

   • G2 = 1.5 (0.7-3.3)

   • G3 = 1.6 (0.7-3.6)

p = 0.41

Multivariate OR (95% CI) for distal CC by non-OPA, women

   • G1 = 1.00 (referent)

   • G2 = 0.7 (0.4-1.3)

   • G3 = 0.6 (0.3-1.1)

p = 0.12

Multivariate OR (95% CI) for all CC by moderate or hard non-OPA, men

   • G1 = 1.00 (referent)

   • G2 = 0.8 (0.6-1.2)

   • G3 = 0.8 (0.5-1.1)

p = 0.24

Multivariate OR (95% CI) for proximal CC by moderate or hard non-OPA, men

   • G1 = 1.00 (referent)

   • G2 = 1.1 (0.6-2.1)

   • G3 = 1.0 (0.6-1.8)

p = 0.99

Multivariate OR (95% CI) for distal CC by moderate or hard non-OPA, men

   • G1 = 1.00 (referent)

   • G2 = 0.7 (0.4-1.1)

   • G3 = 0.7 (0.4-1.0)

p = 0.12

Multivariate OR (95% CI) for all CC by moderate or hard non-OPA, women

   • G1 = 1.00 (referent)

   • G2 = 1.0 (0.6-1.6),

   • G3 = 0.8 (0.5-1.4)

p = 0.35

Multivariate OR (95% CI) for proximal CC by moderate or hard non-OPA, women

   • G1 = 1.00 (referent)

   • G2 = 1.3 (0.6-2.5)

   • G3 = 1.3 (0.6-2.7)

p = 0.59

Multivariate OR (95% CI) for distal CC by moderate or hard non-OPA, women

   • G1 = 1.00 (referent)

   • G2 = 0.8 (0.5-1.5)

   • G3 = 0.5 (0.3-1.1)

p = 0.41

Johnsen at el 2006 [282]

To investigate the effects of OPA on colon cancer incidence.

• n = 54,478 (28,356 men, 26,122 women)

7.6 year follow-up

   • Number of cases: 140 women, 157 men

No support for the hypothesis that OPA measured by MET-score may be associated with a lower risk of CC.

PA assessment: Questionnaire for OPA by MET score, 4 groups

   • Number of dropouts: <0.8%

Denmark

• Age: 50-64 yr

Multivariate RR (95% CI), men

Prospective cohort

• Characteristics: Free of Cancer at baseline

Q1 = Sitting

   • Q1 = 1.00 (referent)

• Diet, Cancer and Health Study

Q2 = Standing

   • Q2 = 1.11 (0.69-1.77)

Q3 = Manual

   • Q3 = 1.17 (0.77-1.79)

D & B score = 13

Q4 = Not working

   • Q4 = 0.95 (0.58-1.55)

Outcome Measure: Incidence of colon cancer

Multivariate RR (95% CI), women

   • Q1 = 1.00 (referent)

   • Q2 = 1.15 (0.68-1.93)

   • Q3 = 1.34 (0.83-2.16)

Cox proportional HR

   • Q4 = 0.96 (0.60-1.53)

Larsen et al 2006 [283]

To examine the relationship between PA and colorectal cancer.

• n = 6,961

PA assessment: Questionnaire (scored from 2-12), divided into quartiles:

Number of cases: 108

Inactivity was not a significant risk factor for advanced colonic neoplasia.

• Sex: Men and women

RR (95% CI)

Norway

• Age: 50-64

   • Q1 = 1.00 (referent)

• Characteristics: No history of colorectal surgery, radiotherapy, cardiopulmonary disease, anticoagulant therapy, coronary episode.

Q1 = 2-4

   • Q2 = 0.61 (0.32-1.16)

Cross-sectional evaluation within a randomized controlled trial

Q2 = 5

   • Q3 = 0.75 (0.45-1.26)

Q3 = 6

   • Q4 = 0.56 (0.34-0.92)

Q4 = 7-12

p = 0.04

Outcome Measure: Positive test for colonic neoplasia

Multivariate RR (95% CI)

D & B score = 13

   • Q1 = 1.00 (referent)

   • Q2 = 0.64 (0.33-1.25)

   • Q3 = 0.82 (0.47-1.43)

Multivariate logistic regression analysis

   • Q4 = 0.67 (0.39-1.16)

p = 0.23

Larsson et al 2006 [284]

To investigate the association between PA and colorectal cancer.

• n = 45,906

7.1 year follow-up

Number of cases: 309 (133 proximal, 138 distal)

Results support a role of PA in reducing the risk of CC.

• Sex: Men

• Age: 45-79 yr

PA assessment: Questionnaire for the following variables

Sweden

• Characteristics: Free of cancer at baseline

Multivariate HR (95% CI) by LTPA

   • Q1 = 1.00 (referent)

Prospective cohort

   • Q2 = 0.66 (0.43-1.02)

LTPA (min/day)

   • Q3 = 0.68 (0.46-1.01)

Q1 = <10

   • Q4 = 0.56 (0.37-0.83)

D & B score = 14

Q2 = 10-29

p = 0.01

Q3 = 30-59

Q4 = ≥ 60

Multivariate HR (95% CI) by home/housework PA

Home/housework PA (h/day)

   • Q1 = 1.00 (referent)

   • Q2 = 0.75 (0.58-0.97)

Q1 = none

   • Q3 = 0.75 (0.58-0.97)

Q2 = <1

   • Q4 = 0.68 (0.48-0.96)

Q3 = 1-2

p = 0.01

Q4 = ≥ 3

Incidence of Proximal CC(h/day)

Multivariate HR (95% CI) for distal CC by LTPA

G1 = <1

   • Q1 = 1.00 (referent)

G2 = 1-2

G3 = ≥ 3

   • Q2 = 0.51 (0.28-0.93)

   • Q3 = 0.50 (0.29-0.87)

   • Q4 = 0.40 (0.22-0.70)

p = 0.01

Outcome Measure: Incident CC

Multivariate HR (95% CI) for proximal CC by home/housework PA

Cox proportional HR

   • G1 = 1.00 (referent)

   • G2 = 0.78 (0.53-1.14)

   • G3 = 0.50 (0.29-0.89)

p = 0.02

Lee and Paffenbarger 1994 [285]

To predict cancer risk using prospective assessments of PA.

• n = 17,607

26 year follow-up

• Number of cases: 280

Found a trend, of borderline statistical significance toward decreasing CC risk with increasing PA.

• Sex: Men

• Number of dropouts: 14%

• Age: 30-79 yr

PA assessment: Questionnaire for PA level (kcal/wk)

USA

• Characteristics: Healthy at baseline

Multivariate RR (95% CI), Model A: PA in 1962/1966 and updated in 1977

   • G1 = 1.00 (referent)

Prospective cohort

G1 = <1000

   • G2 = 1.07 (0.81-1.42)

G2 = 1000-2499

   • G3 = 1.08 (0.81-1.46)

G3 = ≥ 2500

p = 0.58

D & B score = 13

Outcome Measure: Incidence of fatal and non fatal CC

Multivariate RR (95% CI), Model B: PA in both 1962/1966 and 1977

   • G1 = 1.00 (referent)

   • G2 = 0.75 (0.42-1.35)

Cox proportional HR

   • G3 = 0.94 (0.54-1.64)

p = 0.76

Lee et al 1997 [286]

To investigate whether PA alters the risk of developing CC in men.

• n = 20,614

10.9 year follow-up

Number of cases: 217

Data does not support the hypothesis that PA is related inversely to risk of developing CC.

• Sex: Men

• Age: 40-84 yrs

PA assessment: Questionnaire for the following variables

Multivariate RR (95% CI), frequency of

USA

• Characteristics: Physicians, free of cancer at baseline

PA at baseline

   • G1 = 1.00 (referent)

Prospective cohort

   • G2 = 1.1 (0.7-1.7)

Frequency of PA at baseline (times/week)

   • G3 = 1.2 (0.8-1.6)

Physicians Health Study

   • G4 = 1.1 (0.7-1.6)

D & B score = 15

G1 = <1

p = 0.6

G2 = 1

G3 = 2-4

RR (95% CI), frequency of PA at baseline and 36 months

G4 = 5+

   • G1 = 1.00 (referent)

Frequency of PA at baseline and 36 months

   • G2 = 1.2 (0.5-2.7)

G1 = 1/<1

   • G3 = 1.4 (0.9-2.3)

G2 = <1/1+

   • G4 = 1.3 (0.9-2.0)

G3 = 1+/< 1

G4 = 1+/1+

Outcome Measure: Incidence of fatal and non-fatal CC

Cox proportional HR

Lee et al 2007 [287]

To examine the association between PA and the risk of developing CRC in Japanese men and women.

• n = 65,022

6 year follow-up

Number of cases: 154 proximal CC, 166 distal CC

PA may prevent CC among Japanese men.

• Sex: Men and women

Japan

• Age: 40-69 yr

Multivariate RR (95% CI) for CC men

• Characteristics

   • Q1 = 1.00 (referent)

Prospective cohort

• Ethnicity: Japanese

Q1 = 28.25

   • Q2 = 0.87 (0.61-1.26)

Q2 = 33.25

   • Q3 = 0.62 (0.41-0.95)

Q3 = 35.25

   • Q4 = 0.58 (0.39-0.87)

D & B score = 13

Q4 = 43.75

p = 0.006

Outcome Measure: Incidence of CC

Multivariate RR (95% CI) for proximal CC men

Cox proportional HR

   • Q1 = 1.00 (referent)

   • Q2 = 0.89 (0.52-1.51)

   • Q3 = 0.44 (0.22-0.86)

   • Q4 = 0.29 (0.14-0.60)

p < 0.001

Multivariate RR (95% CI) for distal CC Men

   • Q1 = 1.00 (referent)

   • Q2 = 0.92 (0.54-1.54)

   • Q3 = 0.75 (0.42-1.33)

   • Q4 = 0.89 (0.53-1.51)

p = 0.685

PA level and incidence of CC women

Total CC

   • Q1 = 1.00 (referent)

   • Q2 = 1.03 (0.65-1.64)

   • Q3 = 0.91 (0.57-1.47)

   • Q4 = 0.89 (0.54-1.49)

p = 0.610

Proximal CC women

   • Q1 = 1.00 (referent)

   • Q2 = 1.14 (0.61-2.12)

   • Q3 = 1.01 (0.53-1.89)

   • Q4 = 0.55 (0.24-1.26)

p = 0.151

Distal CC women

   • Q1 = 1.00 (referent)

   • Q2 = 1.09 (0.52-2.29)

   • Q3 = 0.77 (0.34-1.74)

   • Q4 = 1.37 (0.66-2.85)

p = 0.401

Longnecker et al 1995 [288]

To examine the relationship between OPA and vigorous LTPA and the risk of cancer of the right colon and rectum.

• n = 242 rectal cancer and 703 controls

PA assessment: Interview for vigorous LTPA and OPA (coded and self-reported), divided into groups:

Number of cases: 163

The amount of time spent at vigorous LTPA was associated with a decreased risk of cancer of the right colon.

RR (95% CI) by vigorous LTPA

USA

• Age: ≥ 31 yr

   • G1 = 1.00 (referent)

• Characteristics: Case: Diagnosed with adenocarcinoma of the right colon or rectum. Controls: Both community and hospital. No history of large bowel cancer.

   • G2 = 0.73 (0.23-2.29)

Case control

   • G3 = 0.47 (0.16-1.36)

Vigorous LTPA (h/wk)

   • G4 = 0.60 (0.35-1.00)

D & B score = 14

G1 = 0

p = 0.03

G2 = ≤ 0.5

G3 = 1

Multivariate OR (95% CI) by vigorous

G4 = >1

LTPA

   • G1 = 1.00 (referent)

Coded lifetime OPA

   • G2 = 0.81 (0.26-2.54)

G1 = Sedentary

   • G3 = 0.36 (0.11-1.14)

G2 = light work

   • G4 = 0.57 (0.33-0.97)

G3 = moderate

p = 0.06

G4 = heavy

Self reported lifetime

Multivariate OR (95% CI) by coded lifetime OPA

OPA

G1 = Sedentary

   • G1 = 1.00 (referent)

G2 = light work

   • G2 = 0.79 (0.39-1.61)

G3 = more than light work

   • G3 = 0.79 (0.36-1.74)

   • G4 = 0.99 (0.30-3.22)

p = 0.42

Outcome Measure: Diagnosed with CC

Multivariate OR (95% CI) by self reported lifetime OPA

Conditional Logistic Regression

   • G1 = 1.00 (referent)

   • G2 = 0.85 (0.41-1.76)

   • G3 = 0.68 (0.31-1.52)

p = 0.15

Mai et al 2007 [289]

To examine in detail the relationship between recreational PA and invasive CC among women.

• n = 120,147

7 year follow-up

Number of cases: 395

Modest inverse association between recreational PA and CC.

• Sex: Women

• Age: 22-84 yr

PA assessment: Questionnaire

RR (95% CI) by MPA over past 3 years

USA

• Characteristics: no prior history of CC

   • G1 = 1.00 (referent)

   • G2 = 0.95 (0.72-1.24)

Prospective cohort

MPA over past 3 yrs (h/wk/yr)

   • G3 = 0.78 (0.62-0.97)

• California Teachers Study

p = 0.02

G1 = 0-0.50

D & B score = 15

G2 = 0.51-1.99

RR (95% CI) by strenuous + moderate (lifetime) PA:

G3 = ≥ 2.00

   • G1 = 1.00 (referent)

   • G2 = 0.79 (0.56-1.11)

Strenuous + Moderate (lifetime) PA (h/wk/yr)

   • G3 = 0.64 (0.44-0.93)

p = 0.04

G1 = 0.0-0.50

G2 = 0.51-3.99

G3 = ≥ 4.00

Outcome Measure: Incidence of invasive adenocarcinoma of the colon

Cox proportional HR

Martinez et al 1997 [290]

To examine whether LTPA could significantly influence the risk of CC in women.

• n = 89,448

6 year follow-up

Number of cases: 212

Significant inverse association between LTPA and incidence of CC in women.

• Sex: Women

• Age: 30-55 yr

PA assessment: Questionnaire for LTPA

Multivariate RR (95% CI) for all CC

USA

• Characteristics: Nurses, free from cancer at baseline

   • G1 = 1.00 (referent)

G1 = <2

   • G2 = 0.71 (0.44-1.15)

Prospective

G2 = 2-4

   • G3 = 0.78 (0.50-1.20)

cohort

G3 = 5-10

   • G4 = 0.67 (0.42-1.07)

G4 = 11-21

   • G5 = 0.54 (0.33-0.90)

D & B score = 14

G5 = >21

p = 0.03

Outcome Measure: Incidence of CC

Multivariate RR (95% CI) for distal CC

   • G1 = 1.00 (referent)

   • G2 = 0.92 (0.48-1.79)

Mantel-Haenszel Estimator and logistic regression models

   • G3 = 0.81 (0.43-1.55)

   • G4 = 0.71 (0.36-1.41)

   • G5 = 0.31 (0.12-0.77)

p = 0.01

Multivariate RR (95% CI) for proximal

CC

   • G1 = 1.00 (referent)

   • G2 = 0.54 (0.23-1.22)

   • G3 = 0.79 (0.40-1.56)

   • G4 = 0.62 (0.30-1.32)

   • G5 = 0.77 (0.38-1.58)

p = 0.67

Nilsen et al 2008 [291]

To study the separate associations of recreational PA with the incidence of, and mortality from cancer in the ascending, transverse, descending and sigmoid segments of the colon.

• n = 59,369

17 year follow-up

Number of cases: 736

Strong inverse associations between recreational PA and risk of cancer morbidity and mortality of the transverse and sigmoid colon but no association for cancer in the ascending and descending colon.

• Sex: Men and women

PA assessment: Questionnaire for frequency and duration of recreational PA

HR (95% CI) by frequency of recreational PA, men

Norway

• Age: not indicated

   • G1 = 1.00 (referent)

Prospective cohort

• Characteristics: Free from cancer at baseline

   • G2 = 0.84 (0.60-1.19)

   • G3 = 0.82 (0.58-1.17)

   • G4 = 0.81 (0.57-1.15)

D & B score = 14

Frequency of Recreational PA (times per week)

   • G5 = 0.77 (0.54-1.09)

G1 = none

p = 0.18

G2 = <1

HR (95% CI) by frequency of

G3 = 1

recreational PA, women

G4 = 2-3

   • G1 = 1.00 (referent)

G5 = ≥ 4

   • G2 = 0.91 (0.66-1.25)

   • G3 = 0.79 (0.57-1.09)

Duration of recreational PA (min per exercise)

   • G4 = 0.66 (0.47-0.92)

   • G5 = 0.99 (0.72-1.36)

G1 = none

p = 0.35

G2 = <15

G3 = 15-30

HR (95% CI) by duration of recreational

G4 = 31-60

PA, men

G5 = >60

   • G1 = 1.00 (referent)

   • G2 = 1.07 (0.71-1.60)

Intensity of recreational PA

   • G3 = 0.80 (0.57-1.12)

   • G4 = 0.68 (0.48-0.97)

G1 = none

   • G5 = 0.74 (0.50-1.08)

G2 = Low

p = 0.02

G3 = Moderate/High

HR (95% CI) by duration of recreational PA, women

Summary score for recreational PA

   • G1 = 1.00 (referent)

G1 = None

   • G2 = 0.85 (0.59-1.23)

G2 = Low

   • G3 = 0.81 (0.60-1.09)

G3 = High

   • G4 = 0.73 (0.53-1.01)

By subsite-specific (transverse colon, decending colon, sigmoid colon) CC

   • G5 = 0.84 (0.53-1.34)

p = 0.10

HR (95% CI) by intensity of recreational PA, men

Levels of REC PA:

G1 = None

   • G1 = 1.00 (referent)

G2 = < 1 x/wk

   • G2 = 0.83 (0.62-1.12)

G3 = low score

   • G3 = 0.74 (0.52-1.06)

G4 = high score

p = 0.11

Outcome Measure: incidence of fatal and non fatal CC

HR (95% CI) by intensity of recreational PA, women

Cox proportional HR

   • G1 = 1.00 (referent)

   • G2 = 0.77 (0.59-1.01)

   • G3 = 0.89 (0.60-1.32)

p = 0.33

HR (95% CI) by summary score for recreational PA, men

   • G1 = 1.00 (referent)

   • G2 = 0.85 (0.62-1.16)

   • G3 = 0.69 (0.48-0.98)

p = 0.06

HR (95% CI) by summary score for recreational PA, women

   • G1 = 1.00 (referent)

   • G2 = 0.86 (0.64-1.01)

   • G3 = 0.72 (0.53-0.98)

p = 0.03

HR (95% CI) by total CC and recreational PA, incidence

   • G1 = 1.00 (referent)

   • G2 = 0.88 (0.70-1.12)

   • G3 = 0.87 (0.70-*1.08)

   • G4 = 0.73 (0.58-0.92)

p = 0.009

HR (95% CI) by subsite specific CC and recreational PA, death

   • G1 = 1.00 (referent)

   • G2 = 0.87 (0.64-1.18)

   • G3 = 0.79 (0.59-1.04)

   • G4 = 0.56 (0.41-0.78)

p <0.001

HR (95% CI) for transverse CC incidence and recreational PA

   • G1 = 1.00 (referent)

   • G2 = 0.75 (0.44-1.28)

   • G3 = 0.66 (0.41-1.08)

   • G4 = 0.44 (0.25-0.78)

p = 0.004

HR (95% CI) for transverse CC death and recreational PA

   • G1 = 1.00 (referent)

   • G2 = 0.73 (0.36-1.49)

   • G3 = 0.40 (0.19-0.82)

   • G4 = 0.33 (0.14-0.76)

p = 0.002

HR (95% CI) for sigmoid CC incidence and recreational PA

   • G1 = 1.00 (referent)

   • G2 = 0.88 (0.59-1.32)

   • G3 = 0.68 (0.46-1.01)

   • G4 = 0.48 (0.31-0.75)

p <0.001

HR (95% CI) for sigmoid CC death and recreational PA

   • G1 = 1.00 (referent)

   • G2 = 0.78 (0.45-1.35)

   • G3 = 0.51 (0.30-0.87)

   • G4 = 0.29 (0.15-0.56)

p <0.001

Schnohr et al 2005 [292]

To assess the association between LTPA and incidence of cancer in the general population.

• n = 28,259 (15,043 men,13,216 women)

14 year follow-up

   • Number of cases: 215 men, 108 women

For the most active men, VPA was associated with a non-significant lower risk of CC.

Denmark

Multivariate RR (95% CI), men

• Sex: Men and women

G1 = Low

   • G1 = 1.00 (referent)

Prospective cohort

G2 = Moderate

   • G2 = 1.08 (0.74-1.57)

• Age: 20-93 yr

G3 = Vigorous

   • G3 = 0.72 (0.47-1.11)

D & B score = 13

• Characteristics: Free from cancer at baseline

Outcome Measure: Incidence of CC

p =0.06

Multivariate RR (95% CI), women

• Copenhagen Heart Study, The Copenhagen County Centre of Preventive Medicine and the Copenhagen Male Study

   • G1 = 1.00 (referent)

Cox proportional HR

   • G2 = 1.02 (0.70-1.50)

   • G3 = 0.90 (0.56-1.46)

p = 0.68

Slattery et al 1988 [293]

To assess the relationship of PA and diet with the development of CC in Utah.

• n = 229 cases, 384 controls

PA assessment: Interview for the following variables

• Number of cases: 229

PA shows an inverse relationship with incidence of CC.

USA

• Sex: Men and women

Multivariate OR (95% CI) by TPA, men

Case control

   • Q1 = 1.00 (referent)

• Characteristics: Case: Diagnosed with CC Controls: no history of cancer

TPA

   • Q2 = 1.19 (0.67-2.13)

Q1 = Low

   • Q3 = 0.88 (0.48-1.69)

Q2

   • Q4 = .70 (0.38-1.29)

D & B score = 13

Q3

Q4 = high

Multivariate OR (95% CI) by TPA, women

Intense PA

   • Q1 = 1.00 (referent)

G1 = none

   • Q2 = 0.97 (0.56-1.69)

G2 = low

   • Q3 = 0.91 (0.52-1.60)

G3 = high

   • Q4 = 0.48 (0.27-0.87)

Non-intense PA

Multivariate OR (95% CI) by intense PA, men

Q1 = Low

Q2

   • G1 = 1.00 (referent)

Q3

   • G2 = 0.83 (0.40-1.75)

Q4 = high

   • G3 = 0.27 (0.11-0.65)

Outcome Measure: Diagnosed with CC

Multivariate OR (95% CI) by intense PA, women

Multiple logistic regression analysis

   • G1 = 1.00 (referent)

   • G2 = 0.55 (0.23-1.34)

Multivariate OR (95% CI) by non-intense PA, men

   • Q1 = 1.00 (referent)

   • Q2 = 1.40 (0.76-2.57)

   • Q3 = 0.93 (0.51-1.72)

   • Q4 = 1.25 (0.68-2.29)

Multivariate OR (95% CI) by non-intense PA, women

   • Q1 = 1.00 (referent)

   • Q2 = 1.09 (0.62-1.90)

   • Q3 = 0.94 (0.53-1.66)

   • Q4 = 0.53 (0.29-0.95)

Slattery et al 1997 [294]

To examine the relationship between weekly PA patterns (source, duration and frequency) and CC.

• n = 1,993 cases, 2,410 controls

PA Assessment: Interview, adapted CARDIA PA history

Number of cases: 1,993

High level of leisure time VPA during the past 20 yrs was associated with a reduced risk of CC in both men and women. The same associations were not observed with leisure time MPA.

USA

• Sex: Men and women

Multivariate OR (95% CI) by recent leisure time VPA, men

• Age: 30-79 yr

Recent leisure time

   • Q1 = 1.00 (referent)

• Characteristics: Cases: diagnosed with first primary CC. Controls: no history of CC

VPA

   • Q2 = 0.80 (0.64-1.01)

Q1 = None

   • Q3 = 0.84 (0.66-1.05)

D & B score = 14

Q2

   • Q4 = 0.69 (0.55-0.87)

Q3

Q4 = High

Multivariate OR (95% CI) by recent leisure time VPA, women

The greatest inverse association was observed when activities were performed for longer periods of time per session.

The Three Centered Diet, Activity and Lifestyle Colon Cancer Study

Leisure time VPA

   • Q1 = 1.00 (referent)

Q1 = Low

   • Q2 = 0.79 (0.61-1.02)

Q2

   • Q3 = 0.83 (0.64-1.07)

Q3

   • Q4 = 0.86 (0.67-1.10)

Q4 = High

Current PA (min)

Multivariate OR (95% CI) by leisure time VPA, men

G1 = <30

G2 = 30-60

   • Q1 = 1.00 (referent)

G3 = ≥ 60

   • Q2 = 0.97 (0.76-1.25)

   • Q3 = 0.86 (0.67-1.09)

LTPA (ranked by time per session)

   • Q4 = 0.61 (0.47-0.79)

Q1 = None

Multivariate OR (95% CI) by leisure time VPA, women

Q2 = Low - <30 min

Q3 = moderate - 30-60 min

   • Q1 = 1.00 (referent)

Q4 = high ->60 min

   • Q2 = 0.75 (0.59-0.95)

   • Q3 = 0.68 (0.53-0.87)

Number of activity session per week

   • Q4 = 0.63 (0.48-0.83)

G1 = None

Multivariate OR (95% CI) by current MPA time per week

G2 = 1

G3 = 2-4

   • Q1 = 1.00 (referent)

G4 = 5-7

   • Q2 = 1.00 (0.83-1.21)

G5 = >7

   • Q3 = 0.90 (0.76-1.07)

   • Q4 = 0.92 (0.77-1.10)

Outcome Measure: Diagnosed with CC

Multivariate OR (95% CI) by current VPA time per week

Unconditional regression models

   • Q1 = 1.00 (referent)

   • Q2 = 0.90 (0.73-1.12)

   • Q3 = 0.89 (0.71-1.10)

   • Q4 = 0.83 (0.69-0.98)

Multivariate OR (95% CI) by leisure time MPA time per session

   • Q1 = 1.00 (referent)

   • Q2 = 1.20 (0.91-1.59)

   • Q3 = 1.09 (0.83-1.42)

   • Q4 = 1.08 (0.82-1.42)

Multivariate OR (95% CI) by leisure time VPA time per session

   • Q1 = 1.00 (referent)

   • Q2 = 0.86 (0.74-0.99)

   • Q3 = 0.76 (0.64-0.90)

   • Q4 = 0.68 (0.52-0.87)

Multivariate OR (95% CI) by number of MPA sessions/wk

   • G1 = 1.00 (referent)

   • G2 = 1.02 (0.79-1.30)

   • G3 = 0.86 (0.72-1.02)

   • G4 = 0.91 (0.81-1.14)

   • G5 = 1.02 (0.82-1.27)

Multivariate OR (95% CI) by number of VPA sessions/wk

   • G1 = 1.00 (referent)

   • G2 = 0.72 (0.56-0.92)

   • G3 = 0.87 (0.73-1.03)

   • G4 = 1.00 (0.81-1.25)

   • G5 = 0.84 (0.61-1.15)

Slattery et al 1997 [295]

To determine how physical inactivity interacts with other components of energy balance in determining risk of CC.

• n = 1,993 cases, 2,410 controls

PA Assessment: Interview for lifetime VPA (PA index)

Number of cases: 1,993

These results support previous findings that physical inactiity is associated with an increased risk of developing CC.

USA

• Sex: Men and women

Multivariate OR (95% CI), men

Q2 = 7-9

   • Q1 = 1.00 (referent)

• Characteristics: Cases: diagnosed with first primary CC. Controls: no history of CC

Q3 = 4-6

   • Q2 = 1.60 (1.11-1.75)

Case control

• The Three Centered Diet, Activity and Lifestyle Colon Cancer Study

Q4 = <4

   • Q3 = 1.59 (1.26-2.01)

D & B score = 14

   • Q4 = 1.63 (1.26-2.12)

Outcome Measure: Diagnosed with CC

Multivariate OR (95% CI), women

   • Q1 = 1.00

   • Q2 = 1.14 (0.86-1.52)

Unconditional regression models

   • Q3 = 1.13 (0.85-1.49

   • Q4 = 1.59 (1.21-2.10)

Takahashi et al 2007 [296]

To investigate the association between time spent walking each day and the risk of CRC.

• n = 20,519 men, 21,469 women

7 year follow-up

   • Number of cases: 101

Time spent walking per day was associated with a lower risk of colon cancer in men but not in women.

• Sex: Men and women

PA assessment: Questionnaire for time spent walking (h/day)

   • Number of dropouts: 3.5%

Japan

• Age: 40-64 yr

Multivariate RR (95% CI), men

• Characteristics: Free from cancer at baseline

   • G1 = 1.00 (referent)

Prospective cohort

G1 = <0.5

   • G2 = 0.72 (0.43-1.21)

G2 = 0.5-1

   • G3 = 0.38 (0.22-0.64)

G3 = >1

p < 0.001

D & B score = 12

Outcome Measure: Incidence of CC

Time spent walking and incidence of CC

Multivariate RR (95% CI), women

Cox proportional HR

   • G1 = 1.00

   • G2 = 2.68 (0.94-7.68)

   • G3 = 1.79 (0.64-4.96)

p = 0.42

Tang et al 1999 [297]

To investigate the association between PA, water intake and risk of CRC in a hospital based case controlled study.

• n = 163 cases, 163 controls

PA assessment: Interview

   • Number of cases: 163

Found a negative association between LTPA and the risk of CC among men.

• Sex: Men and women

Multivariate RR (95% CI), men

Taiwan

LTPA METs

   • G1 = 1.00 (referent)

• Age: 33-80 yr

G1 = Sedentary

   • G2 = 2.22 (0.68-7.21)

Case control

• Characteristics: Cases: Hospital patients diagnosed with colorectal cancer Controls: Hospital patients in hospital for other reasons, free of CRC.

G2 = Moderate (< 20 MET)

   • G3 = 0.19 (0.05-0.77)

D & B score = 14

G3 = Active (≥20 MET)

p = 0.03

Multivariate RR (95% CI), women

Outcome Measure: Diagnosis of CC

   • G1 = 1.00 (referent)

   • G2 = 0.52 (0.13-2.03)

   • G3 = 0.63 (0.18-2.18)

Conditional logistic regression analysis

p = 0.48

Tavani et al 1999 [298]

To investigate the relationship between PA and risk of CC in both sexes at different ages.

• n = 5,379 (1,225 cases and 4,154 controls)

PA assessment: Questionnaire on activity at work and during leisure time

   • Number of cases: 537 women, 688 men

The study confirms that OPA is protective against CC.

Italy

• Sex: Men and women

Multivariate OR (95% CI) for CC by OPA at age 15-19 yr, men

Case control

• Age: 19-74 yr

G1 = Highest

   • G1 = 1.00 (referent)

G2

   • G2 = 0.89 (0.64-1.23)

D & B score = 13

G3

   • G3 = 0.72 (0.54-0.97)

G4

   • G4 = 0.54 (0.40-0.74)

G5 = Lowest

   • G5 = 0.47 (0.31-0.71)

p < 0.01

OPA at 30-39 yrs old

Q1 = Highest

Multivariate OR (95% CI) for CC by OPA at age 15-19 yr, women

Q2

   • G1 = 1.00 (referent)

Q3

   • G2 = 0.73 (0.55-0.96)

Q4 = Lowest

   • G3 = 0.91 (0.69-1.21)

Outcome Measure: Diagnosis of CC

   • G4 = 0.62 (0.44-0.89)

Unconditional multiple Logistic Regression

p < 0.05

Multivariate OR (95% CI) for CC by OPA at age 30-39 yr, men

   • G1 = 1.00 (referent)

   • G2 = 1.01 (0.75-1.37)

   • G3 = 0.79 (0.59-1.06)

   • G4 = 0.71 (0.52-0.97)

   • G5 = 0.64 (0.44-0.93)

p < 0.01

Multivariate OR (95% CI) for CC by OPA at age 30-39 yr, women

   • G1 = 1.00 (referent)

   • G2 = 0.65 (0.46-0.93)

   • G3 = 0.57 (0.41-0.79)

   • G4 = 0.49 (0.33-0.72)

p < 0.01

Multivariate OR (95% CI) for CC by OPA at age 50-59 yr, men

   • G1 = 1.00 (referent)

   • G2 = 1.06 (0.78-1.43)

   • G3 = 0.85 (0.63-1.14)

   • G4 = 0.68 (0.49-0.95)

   • G5 = 0.69 (0.45-1.05)

p < 0.01

Multivariate OR (95% CI) for CC by OPA at age 50-59 yr, women

   • G1 = 1.00 (referent)

   • G2 = 0.69 (0.47-1.00)

   • G3 = 0.68 (0.46-1.00)

   • G4 = 0.75 (0.47-1.20)

p = > 0.05

Multivariate OR (95% CI) for ascending CC by OPA at age 30-39 yr No significant associations for men or women

Multivariate OR (95% CI) for transverse and descending CC by OPA at age 30-39 yr, men

   • Q1 = 1.00 (referent)

   • Q2 = 0.92 (0.51-1.67)

   • Q3 = 0.76 (0.43-1.37)

   • Q4 = 0.46 (0.24-0.87)

p < 0.05

Multivariate OR (95% CI) for transverse and descending CC by OPA at age 30-39 yr, women

   • Q1 = 1.00 (referent)

   • Q2 = 0.51 (0.23-1.10)

   • Q3 = 0.39 (0.19-0.80)

   • Q4 = 0.29 (0.12-0.71)

p < 0.01

Multivariate OR (95% CI) for sigmoid CC by OPA at age 30-39 yr, men

   • Q1 = 1.00 (referent)

   • Q2 = 1.02 (0.65-1.57)

   • Q3 = 0.78 (0.51-1.20)

   • Q4 = 0.54 (0.34-0.85)

p < 0.01

Multivariate OR (95% CI) for sigmoid CC by OPA at age 30-39 yr, women

   • Q1 = 1.00 (referent)

   • Q2 = 0.62 (0.36-1.05)

   • Q3 = 0.71 (0.44-1.15)

   • Q4 = 0.58 (0.32-1.03)

p > 0.05

Thune et al 1996 [299]

To examine the association between self-reported OPA and LTPA and the subsequent risk of CC.

• n = 81,516 (53,242 men, 28,274 women)

16.3 year follow up

Number of cases: 236 men, 99 women

An inverse dose-response relationship between TPA and risk of CC was observed in women. In men this inverse dose-response was found only for those 45 yrs or older at study entry.

PA assessment: Questionnaire for TPA (OPA plus recreational PA (combined)

Multivariate RR (95% CI) for total CC, men

Norway

• Sex: Men and women

   • G1 = 1.00 (referent)

Prospective cohort

• Age: 20-49 yr

   • G2 = 1.18 (0.76-1.82)

• Characteristics: Free from cancer at baseline

G3 = Active

   • G3 = 0.97 (0.63-1.50)

D & B score = 14

p = 0.49

Multivariate RR (95% CI) for total CC, women

Outcome Measure: Incidence of CC

   • G1 = 1.00 (referent)

Cox proportional HR

   • G2 = 0.97 (0.33-2.77)

   • G3 = 0.63 (0.39-1.04)

p = 0.04

Multivariate RR (95% CI) for proximal CC, men

   • G1 = 1.00 (referent)

   • G2 = 1.16 (0.57-2.34)

   • G3 = 0.96 (0.47-1.93)

p = 0.64

Multivariate RR (95% CI) for proximal CC, women

   • G1 = 1.00 (referent)

   • G2 = 1.22 (0.51-2.94)

   • G3 = 0.62 (0.30-1.28)

p = 0.10

Multivariate RR (95% CI) for distal CC, men

   • G1 = 1.00 (referent)

   • G2 = 1.29 (0.72-2.33)

   • G3 = 0.99 (0.55-1.80)

p = 0.53

Multivariate RR (95% CI) for distal CC, women

   • G1 = 1.00 (referent)

   • G2 = 0.84 (0.32-2.17)

   • G3 = 0.61 (0.30-1.23)

p = 0.15

Multivariate RR (95% CI) for total CC, men < 45 yrs at entry

   • G1 = 1.00 (referent)

   • G2 = 2.02 (0.78-5.21)

   • G3 = 2.23 (0.88-5.66)

p = 0.13

Multivariate RR (95% CI) for total CC, women < 45 yrs at entry

   • G1 = 1.00 (referent)

   • G2 = 0.96 (0.39-2.40)

   • G3 = 0.62 (0.31-1.23)

p = 0.13

Multivariate RR (95% CI) for total CC, men ≥ 45 yrs at entry

   • G1 = 1.00 (referent)

   • G2 = 0.96 (0.59-1.58)

   • G3 = 0.66 (0.40-1.10)

p = 0.04

Multivariate RR (95% CI) for total CC, women ≥ 45 yrs at entry

   • G1 = 1.00 (referent)

   • G2 = 0.99 (0.41-2.39)

   • G3 = 0.66 (0.33-1.33)

p = 0.19

Vena et al 1985 [300]

To assess the relationship between lifetime OPA and the risk of CC.

• n = 1,641 (210 cases, 1,431 control)

PA assessment: Questionnaire

• Number of cases: 210

CC risk increased with increasing amount and proportion of time in jobs involving only sedentary or light work.

USA

• Sex: Men

Number of work years in jobs with sedentary or light work (yr)

OR (95% CI) by number of work years in jobs with sedentary or light work

Case control

• Age: 30-79 yr

G1 = None

   • G1 = 1.00 (referent)

• Characteristics: Cases: admitted to hospital. Diagnosis of CC Controls: Admitted to hospital. Diagnosed with non-neoplastic non-digestive diseases

   • G2 = 1.49

D & B score = 15

G3 = >20

   • G3 = 1.97

OR (95% CI) by proportion of years in jobs with sedentary or light work

Proportion of years in jobs with sedentary or light work

   • G1 = 1.00 (referent)

   • G2 = 1.53

   • G3 = 1.58

G1 = None

   • G4 = 2.10

G2 = 0.01-0.50

G3 = 0.41-0.99

OR (95% CI) by proportion of life in jobs with sedentary or light work

G4 = 1.00 (referent)

   • G1 = 1.00 (referent)

Proportion of life in jobs with sedentary or light work

   • G2 = 1.66

   • G3 = 1.83

G1 = None

G2 = 0.01-0.40

G3 = 0.41-1.00

Outcome Measure: diagnosed with CC

Multiple logistic regression

Vetter et al 1992 [301]

To investigate the influence of OPA on the risk of CC in a developing country.

• n = 87 men cases, 13 women cases, 371 controls

PA assessment: Questionnaire Job title and industry names

Number of cases: 87 men, 13 women

This study presents a weak inverse association between CC and PA.

USA

• Sex: Men and women

OR (95% CI) Sitting time and CC

Only 2 of the 4 measures of activity showed evidence of an increased CC risk for sedentary jobs (time spent sitting and occupational EE) though neither was statistically significant.

Case control

• Age: 14-97 yr

Levels (Sitting time, energy expenditure

   • G1 = 1.00 (referent)

D & B score = 11

• Characteristics: Cases: Diagnosed with CC Controls: cancer cases other then colon, rectum and lung cancer.

G1 = High

   • G2 = 1.0 (0.5-2.0)

G2 = Moderate

   • G3 = 1.5 (0.7-2.9)

G3 = Sedentary

p = 0.145

Outcome Measure: Diagnosed with CC

OR (95% CI) Energy Expenditure and CC

   • G1 = 1.00 (referent)