Association between physical activity and gynecological cancers: a meta-analysis of prospective cohort studies

Previous evidence has unveiled that physical activity (PA) may affect gynecologic cancer (GC). However, existing research findings remain inconsistent. Hence, this comprehensive meta-analysis was to quantify updated evidence on the association between PA and GC risk.

A meta-analysis of prospective cohort studies was conducted to evaluate the association between PA and GC risk, including endometrial cancer (EC), ovarian cancer (OC), and cervical cancer (CC). PubMed, Web of Science, and Embase were searched for relevant studies until May 13, 2025. Case-control and cross-sectional studies were excluded to reduce bias and improve causal inference. Study quality was appraised via the Newcastle-Ottawa Scale. The relative risks (RRs) along with 95% confidence intervals (CIs) were pooled through a random-effects model. Heterogeneity was judged with the Q and I² statistics, and publication bias was tested through funnel plot analysis and Egger's regression test.

71 risk estimates were summarized in 36 studies. Individuals participating in moderate PA had a lower risk of EC than those in low PA (RR = 0.94, 95% CI: 0.89-0.99, P = 0.024), while those in high PA exhibited an even lower EC risk (RR = 0.82, 95% CI: 0.76-0.89, P < 0.001). Besides, moderate PA (RR = 1.04, 95% CI: 0.97-1.10, P = 0.263) and high PA levels (RR = 1.04, 95% CI: 0.92-1.18, P = 0.488) were not associated with OC risk. For CC, only two studies were available; one assessed moderate PA and the other assessed high PA. Moderate PA was not associated with CC risk (RR = 1.06, 95% CI: 0.90-1.25), and high PA also showed no significant association with CC risk (RR = 0.77, 95% CI: 0.50-1.18).

High PA is associated with a reduced risk of EC, while no significant association was found for OC. Evidence for CC remains limited and inconsistent. These findings support current PA guidelines for cancer prevention but should be interpreted with caution due to study heterogeneity and limited data. Further prospective studies are needed to clarify these associations, particularly for OC and CC.