Associations of leisure time physical activity volume, frequency, and intensity with all-cause mortality among cancer survivors.

PURPOSE: To investigate whether the survival benefits of Leisure-Time Physical Activity (LTPA) among cancer survivors depend on total weekly volume, frequency of sessions, or proportion of vigorous-intensity activity. METHODS: We analysed data from 3362 cancer survivors aged ≥ 20-years in the National Health and Nutrition Examination Survey (NHANES) 2007-2018, linked to mortality data through December 2019. LTPA was self-reported via the Global Physical Activity Questionnaire and categorized as inactive (< 150 min/week) or active (≥ 150 min/week). The active group was further stratified by session frequency (1‒2, 3‒4, ≥ 5 week) and vigorous-intensity proportion, defined as doubled vigorous minutes divided by total equivalent LTPA minutes (< 50%, ≥ 50%). Weighted Cox proportional hazards models estimated Hazard Ratios (HRs) for all-cause mortality, adjusting for sociodemographic, lifestyle, and clinical covariates. RESULTS: Over a mean follow-up of 6.0-years, 856 deaths occurred. Meeting activity guidelines was associated with a 45% lower risk of all-cause mortality (HR = 0.55; 95% CI 0.43‒0.71). Among active participants, exploratory analyses suggested similar inverse associations across activity frequency categories and proportions of vigorous-intensity activity. Associations did not differ by age, sex, or marital status. CONCLUSION: Adherence to physical activity guidelines was associated with lower all-cause mortality among cancer survivors. Exploratory findings suggest that survival benefits may be achieved through a range of activity frequency and intensity patterns, supporting flexible approaches to physical activity promotion in survivorship care.