Association between Physical Activity and Urologic Cancer: A Comprehensive Systematic Review and Meta Analysis

Background: The aim of this study was to determine the effect of physical activity (PA) on different types of urologic cancer (UC) through a systematic review.Methods: We searched PubMed, Cochrane Library, EMBASE and Ebsco databases for published epidemiological studies on the relationship between PA and UC according to PRISMA guidelines. We selected English-language literature published before July 2022, using a random-effects model, and assessed the quality of the literature using the Newcastle Ottawa Scale.Findings: Data from 95 studies with 176 risk estimates involving 112,557,21 participants and 164,570,8 cases were finally screened and retained for the systematic review analysis. High VS. low PA levels were assessed and the risk of UC (0.91, 95%CI 0.88–0.94), bladder cancer (0.87, 95%CI: 0.80-0.95), prostate cancer (0.94, 95%CI: 0.89-0.99), renal cancer (0.89, 95%CI: 0.84-0.95), urinary tracy cancer (0.86, 95%CI: 0.74-0.99). We report the results of cohort studies (0.93, 95% CI: 0.90- 0.97) and case- control studies (0.86, 95% CI: 0.80-0.93). Our findings were comparable in men (0.93, 95% CI: 0.89-0.97) and women (0.86, 95% CI: 0.77- 0.97). For the PA domain, the results showed that occupational PA (0.84, 95% CI: 0.78-0.90) was a higher protective factor than recreational PA (0.89, 95% CI: 0.84-0.94) and total PA (0.97, 95%CI: 0.91- 1.02). A systematic review of 82 studies yielded 145 risk estimates reporting low, moderate, and high PA levels, which showed that moderate PA may reduce the risk of UC compared with low PA levels (0.94, 95%CI: 0.91- 0.97). High PA also slightly reduced the risk of UC compared with moderate PA (0.96, 95%CI: 0.92-0.99). In addition, limited evidence from 16 studies in line with international PA guidelines suggests that high VS low PA may reduce the risk of UC by 8% (0.92, 95%CI: 0.86- 1.00).Interpretation: High, moderate, and low levels of PA are an protective factor. High PA is effective for UC, the higher PA the greater protection reduces the risk of UC. UC exercise guidelines should consider the use of high PA to reduce the risk of UC. Future studies should determine the maximum dose, duration of PA.Funding: This study was supported by the National Key Technology R&D Program of China [grant numbers 2017YFC1703301], the National Natural Science Foundation of China [grant numbers 82105038,81873235, 82104736, 82104738] , Shanghai Science and Technology Commission[21010504400] and Shanghai Municipal Commission [grant numbers 201940117, 2020JQ003].Declaration of Interest: The authors declare that they have no competing interests.