Numerous epidemiological studies have examined the association between physical activity and pancreatic cancer; however, findings from individual cohorts have largely not corroborated a protective effect. Among other plausible mechanisms, physical activity may reduce abdominal fat depots inducing metabolic improvements in glucose tolerance and insulin sensitivity, thereby potentially attenuating pancreatic cancer risk. We performed a systematic review to examine associations between physical activity and pancreatic cancer. Six electronic databases were searched from their inception through July 2009, including MEDLINE and EMBASE, seeking observational studies examining any physical activity measure with pancreatic cancer incidence/mortality as an outcome. A random effects model was used to pool individual effect estimates evaluating highest vs. lowest categories of activity. Twenty-eight studies were included. Pooled estimates indicated a reduction in pancreatic cancer risk with higher levels of total (five prospective studies, RR: 0.72, 95% CI: 0.52-0.99) and occupational activity (four prospective studies, RR: 0.75, 95% CI: 0.59-0.96). Nonsignificant inverse associations were seen between risks and recreational and transport physical activity. When examining exercise intensity, moderate activity appeared more protective (RR: 0.79, 95% CI: 0.52-1.20) than vigorous activity (RR: 0.97, 95% CI: 0.85-1.11), but results were not statistically significant and the former activity variable incorporated marked heterogeneity. Despite indications of an inverse relationship with higher levels of work and total activity, there was little evidence of such associations with recreational and other activity exposures.Pancreas cancer is the thirteenth most common malignancy in Europe but is the fifth most frequent cause of cancer death. 1 Although relatively rare it grows aggressively, it metastasises early and is often detected late; consequently, 5 year survival is formidably low at only 5% in Europe and 75% of patients die within a year of their initial diagnosis. 2 Current pharmacological and radiological modalities confer little benefit to this neoplasm; a focus on methods for both its prevention and earlier detection are therefore pivotal. Despite this dismal prognosis, the etiology of pancreatic cancer remains poorly understood. Cigarette smoking is the most strongly associated risk factor for this disease; a meta-analysis of 82 articles (42 retrospective and 40 prospective studies) has shown that smoking may increase the risk of this neoplasm by as much as 75% (RR: 1.74, 95% CI: 1.61-1.87). 3 In addition, long-standing type II diabetes 4,5 and obesity 6-8 have also been associated with this multifaceted disease. Despite the potential for physical activity to ameliorate the effect of these latter risk factors, findings from observational epidemiological studies examining physical activity and pancreatic cancer risk remain ambiguous. 9,10 Physical inactivity and obesity, particularly abdominal adiposity, increase the risk ...