The relationship between physical activity and lymphoma: a systematic review and meta analysis
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RESEARCH ARTICLE
Open Access
The relationship between physical activity and lymphoma: a systematic review and meta analysis Gwynivere A. Davies1* , Christopher Strader2, Richa Chibbar3, Stefania Papatheodorou4 and Adam A. Dmytriw5
Abstract Background: The literature suggests an increased risk between anthropometrics including higher body mass index and lymphoma incidence; however, the association with physical activity remains unclear. A systematic review/meta-analysis was therefore performed to examine this association with physical activity (total, recreational or occupational). Methods: PubMed, Web of Science and Embase were reviewed from inception to October 2019 identifying relevant observational studies. Non-Hodgkin lymphoma (NHL) including subtypes diffuse large B cell lymphoma, follicular lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma, and Hodgkin lymphoma (HL) were analyzed. Included studies reported activity, lymphoma cases, effect size and variability measures, and were restricted to human subjects of any age. Data was pooled generating summary relative risk (RR) estimates with 95% confidence intervals (CI) using random-effects models with primary outcome of histologically confirmed incident lymphoma. Results: One thousand four hundred studies were initially identified with 18 studies (nine cohort, nine casecontrol) included in final analysis. Comparing highest vs. lowest activity categories was protective for all lymphoma (RR 0.89, 95%CI 0.81–0.98). Sensitivity analysis demonstrated effect persistence within case-control studies (RR 0.82, 95% CI 0.71–0.96), but not cohort studies (RR 0.95, 95%CI 0.84–1.07). Borderline protective effect was seen for NHL (RR 0.92, 95%CI 0.84–1.00), but not HL (RR 0.72, 95%CI 0.50–1.04). Analysis by NHL subtype or gender showed no effect. Dose response analysis demonstrated a protective effect (p = 0.034) with a 1% risk reduction per 3 MET hours/week (RR 0.99, 95%CI 0.98–1.00). Conclusions: Physical activity may have a protective effect against lymphoma development; further studies are required to generate recommendations regarding health policy. Trial registration: This study was registered prospectively at PROSPERO: CRD42020156242. Keywords: Lymphoma, Physical activity, Meta-analysis
* Correspondence: [email protected] 1 Department of Oncology, Juravinski Cancer Centre- Hamilton Health Sciences, Hamilton, ON, Canada Full list of author information is available at the end of the article
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