Even modest increases in leisure-time physical activity after cancer diagnosis are associated with lower mortality among survivors of multiple tumour types, including less commonly studied malignancies, according to a large, pooled cohort analysis.

The study analysed data from 17,141 adults diagnosed with bladder, endometrial, kidney, lung, oral cavity, ovarian or rectal cancer from six prospective cohorts: the Cancer Prevention Study-II Nutrition Cohort, Health Professionals Follow-Up Study, NIH-AARP Diet and Health Study, Nurses’ Health Study, Nurses’ Health Study II, and Women’s Health Study.

Participants had a mean age of 67 years, 60% were female and they were followed for a mean of 10.9 years. Physical activity was assessed before diagnosis and at a mean of 2.8 years post-diagnosis using metabolic equivalent task hours per week (MET-h/wk). During the study period 4,872 cancer deaths occurred.

The primary aim was to evaluate associations between post-diagnostic moderate-to-vigorous physical activity (MVPA) and cancer mortality, as well as changes in activity levels from before and after diagnosis.

MVPA and cancer mortality findings

Published in JAMA Network Open, the findings showed that any level of post-diagnostic MVPA, even below current guideline thresholds, was associated with improved survival outcomes in several cancer types.

Compared with inactivity, low levels of MVPA (>0 to <7.5 MET-h/wk) were associated with reduced mortality in bladder (hazard ratio [HR] 0.67), endometrial (HR 0.62) and lung cancer survivors (HR 0.56).

Greater reductions were observed with increasing activity levels, particularly among endometrial and lung cancer survivors who met or exceeded guideline recommendations (≥7.5 MET-h/wk).

Notably, higher activity volumes (≥15 MET-h/wk) were associated with reduced mortality in oral and rectal cancers. In addition, patients who became physically active after diagnosis demonstrated lower mortality risk in lung (HR 0.58) and rectal cancer (HR 0.51) even if they were inactive beforehand, reinforcing the clinical relevance of post-diagnostic behavioural change.

For kidney, oral and rectal cancers, associations were directionally consistent but not statistically definitive, which suggest a protective effect but reflects wider confidence intervals.

Counselling and survivorship care

The authors noted that reverse causality remains a concern, as reduced activity may reflect declining health status rather than causally influence outcomes, and residual confounding, particularly from smoking, could not be fully excluded.

What’s more, as physical activity was self-reported and assessed at a single post-diagnostic time point, introducing possible measurement bias, and selection bias may have arisen because participants needed to survive long enough to complete follow-up surveys.

Nevertheless, these findings support the routine incorporation of physical activity counselling into survivorship care, even for patients with cancers not traditionally included in exercise-oncology evidence.

Importantly, benefits were observed at activity levels below guideline targets, suggesting that incremental increases in activity may be both achievable and clinically meaningful, the authors said.

They added that further research is required to define optimal activity thresholds and to clarify tumour-specific effects, but the current evidence reinforces physical activity as a modifiable factor that can be promoted across a broad range of cancer survivorship settings.

Reference
Rees-Punia E et al. Leisure-time physical activity and cancer mortality among cancer survivors. JAMA Netw Open 2026;9(2):e2556971.