title: Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review.
abstract: BACKGROUND
  Cancer survivors often seek information about how lifestyle factors, such as physical activity, may influence their prognosis. We systematically reviewed studies that examined relationships between physical activity and mortality (cancer-specific and all-cause) and/or cancer biomarkers.
  
  
  METHODS
  We identified 45 articles published from January 1950 to August 2011 through MEDLINE database searches that were related to physical activity, cancer survival, and biomarkers potentially relevant to cancer survival. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement to guide this review. Study characteristics, mortality outcomes, and biomarker-relevant and subgroup results were abstracted for each article that met the inclusion criteria (ie, research articles that included participants with a cancer diagnosis, mortality outcomes, and an assessment of physical activity).
  
  
  RESULTS
  There was consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancer-specific, and colon cancer-specific mortality. There is currently insufficient evidence regarding the association between physical activity and mortality for survivors of other cancers. Randomized controlled trials of exercise that included biomarker endpoints suggest that exercise may result in beneficial changes in the circulating level of insulin, insulin-related pathways, inflammation, and, possibly, immunity; however, the evidence is still preliminary.
  
  
  CONCLUSIONS
  Future research directions identified include the need for more observational studies on additional types of cancer with larger sample sizes; the need to examine whether the association between physical activity and mortality varies by tumor, clinical, or risk factor characteristics; and the need for research on the biological mechanisms involved in the association between physical activity and survival after a cancer diagnosis. Future randomized controlled trials of exercise with biomarker and cancer-specific disease endpoints, such as recurrence, new primary cancers, and cancer-specific mortality in cancer survivors, are warranted.
authors.affiliation: Applied Research Program, Department of Health and Human Services, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7344, USA. barbashr@mail.nih.gov
authors.forename: Rachel
authors.initials: R
authors.lastname: Ballard-Barbash
authors.forename: Christine M
authors.initials: CM
authors.lastname: Friedenreich
authors.forename: Kerry S
authors.initials: KS
authors.lastname: Courneya
authors.forename: Sameer M
authors.initials: SM
authors.lastname: Siddiqi
authors.forename: Anne
authors.initials: A
authors.lastname: McTiernan
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Alfano
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D001943:Breast Neoplasms / Q000401:mortality; D015986:Confounding Factors, Epidemiologic; D015444:Exercise; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D007328:Insulin / Q000097:blood*; D009043:Motor Activity; D009369:Neoplasms / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D005082:Physical Exertion; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D017741:Survivors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D007328:Insulin