The effect of vigorous physical activity on the incidence of kidney cancer

Kidney cancer incidence is increasing. While physical activity can reduce the risk of several cancers, the role of vigorous physical activity (VPA) in kidney cancer prevention remains unclear. We examined associations between physical activity intensity and kidney cancer incidence in a large Australian cohort. Data were obtained from 267,357 adults aged ≥ 45 years in the New South Wales 45 and Up Study. Physical activity, including walking, moderate physical activity (MPA), and VPA, was self-reported at baseline using the validated Active Australia Survey and categorised according to WHO guidelines. Multivariable Cox proportional hazards models estimated hazard ratios and 95% confidence intervals, adjusting for sex, body mass index, smoking, and hypertension. Over a mean follow-up of 10.9 years, 1010 kidney cancer cases were identified. Compared to no MPA, participants engaging in 150-< 300 min per week demonstrated a modest reduction in kidney cancer risk (Hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.63–0.95), with a curvilinear dose-response relationship that plateaued at 150–200 min per week. VPA was also associated with a lower risk of kidney cancer. Compared to no VPA, those performing < 75 min per week had lower risk (HR 0.70, 95% CI 0.58–0.84). However, the dose-response relationship for VPA was less consistent across higher exposure levels. Moderate and vigorous physical activity were associated with lower kidney cancer risk. MPA demonstrated a consistent, guideline-aligned protective association, while VPA showed evidence of benefit, particularly at lower volumes. These findings support the role of physical activity in kidney cancer prevention, although the dose-response relationship for VPA warrants further investigation. • Our prospective cohort study examined associations between physical activity intensity and kidney cancer incidence. • Both moderate and vigorous physical activity were associated with a lower risk of incident kidney cancer. • Vigorous physical activity was associated with reduced risk, particularly at lower activity levels. • Protective associations for vigorous activity were observed below current guideline thresholds. • MPA showed a curvilinear association, plateauing at 150-200 min/week, while VPA patterns were less consistent.