{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T08:40:19Z","timestamp":1789807219131,"version":"4.0.1"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec id=\"ab-coi250065-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Growing evidence suggests that physical activity protects against digestive system cancers (DSCs). However, it remains largely unknown whether consistently reaching the physical activity guidelines (\u22657.5 metabolic equivalent task [MET]-hours\/week) is associated with lower DSC risk or whether a much higher level is needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi250065-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the association between physical activity and DSC risk and mortality with a focus on the optimal amount and long-term consistency in performing the recommended level over a long period of time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi250065-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This population-based cohort study includes data from 3 large US prospective cohorts: Health Professionals Follow-Up Study, 1988-2020; Nurses\u2019 Health Study, 1988-2021; and Nurses\u2019 Health Study II, 1991-2021. Data analysis was performed between October 2024 and May 2025. Participants were men and women free from cancer and cardiovascular disease at baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi250065-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Total levels of leisure-time physical activity were assessed with biennial validated questionnaires and expressed in MET-hours per week. Consistency was calculated as the percentage of follow-up years meeting the recommended level (\u22657.5 MET-hours\/week).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi250065-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>DSCs included cancers of digestive tract (mouth, throat, esophagus, stomach, small intestine, colon, and rectum) and digestive accessory organs (pancreas, gallbladder, and liver).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi250065-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During up to 32 years of follow-up of 231\u202f067 men and women (median age, 43 [IQR, 36-55] years), a total of  6538 incident DSCs and 3791 DSC deaths were documented. Higher physical activity levels were associated with lower DSC risk (\u226545 vs &amp;amp;lt;3 MET-hours\/week; hazard ratio [HR], 0.83; 95% CI, 0.74-0.93;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001 for trend) and mortality (HR, 0.72; 95% CI, 0.62-0.83;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001 for trend). The inverse associations were evident for both digestive tract and accessory organ cancers: the HRs comparing greater than or equal to 45 vs 3 MET-hours\/week were 0.85 (95% CI, 0.75-0.97) for digestive tract cancer risk and 0.73 (95% CI, 0.58-0.92) for digestive accessory organ cancer risk. The traditional dose-response analysis suggested the lowest DSC risk was achieved at approximately 50 MET-hours\/week. However, when long-term consistency was considered, compared with those with minimal activity, consistently reaching the guideline at moderate levels (median, 16.9 [IQR, 13.6-20.5] MET-hours\/week) over 3 decades was associated with substantial reductions in DSC risk (HR, 0.83; 95% CI, 0.75-0.90), whereas that performing much higher amounts (median, 38.5 [IQR, 28.5-53.8] MET-hours\/week) was not associated with further benefit (HR, 0.87; 95% CI, 0.81-0.93).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi250065-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this study, traditional dose-response analysis suggested that approximately 50 MET-hours\/week was associated with optimal DSC risk reduction. After incorporating long-term consistency, maintenance of a moderate level approximately 17 MET-hours\/week over 3 decades was associated with achieving optimal benefit in reducing DSC risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoncol.2025.4185","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T15:31:39Z","timestamp":1761838299000},"page":"1488","source":"Crossref","is-referenced-by-count":8,"title":["Consistent Adherence to Physical Activity Guidelines and Digestive System Cancer Risk and Mortality"],"prefix":"10.1001","volume":"11","author":[{"given":"Yiwen","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Hoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Department of Sport Industry Studies, Yonsei University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leandro F. M.","family":"Rezende","sequence":"additional","affiliation":[{"name":"Chronic Disease Epidemiology Research Center, Department of Preventive Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil"},{"name":"Faculty of Health Sciences, Universidad Aut\u00f3noma de Chile, Providencia, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"NaNa","family":"Keum","sequence":"additional","affiliation":[{"name":"Department of Food Science and Biotechnology, Dongguk University, Goyang, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward L.","family":"Giovannucci","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"},{"name":"Department of Epidemiology, Harvard T.H. 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