Table of Contents Author Guidelines Submit a Manuscript
Journal of Obesity
Volume 2019, Article ID 6561726, 8 pages
Review Article

Exercise-Induced Irisin, the Fat Browning Myokine, as a Potential Anticancer Agent

Department of Sciences, Notre Dame University-Louaize, P.O. Box 72, Zouk Mikael, Lebanon

Correspondence should be addressed to Diala El Khoury; bl.ude.udn@yruohkled

Received 15 November 2018; Accepted 14 March 2019; Published 1 April 2019

Academic Editor: Mario Musella

Copyright © 2019 George-Emmanuel Maalouf and Diala El Khoury. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Irisin is a recently discovered myokine that plays an important role in fat metabolism through the browning of white adipose tissue. This myokine is usually secreted after exercise by improving energy balance and has shown great potential as a possible treatment for some metabolic diseases such as obesity, insulin resistance, and inflammation. Obesity has been linked to a higher incidence of some cancers. Furthermore, some studies have shown irisin to have direct positive effects on different types of cancers. Although it is hard to relay conclusions from in vitro to in vivo studies, the majority of the available data favor irisin as a potential substance for cancer regression through reducing proinflammatory markers linked to obesity. However, some controversies remain on the exact benefits of irisin on cancer with some studies showing no or even a negative effect of irisin on cancer. This review summarizes these 2 differing viewpoints and synthesizes them to form a clearer picture of exercise-induced irisin’s effects on cancer.

1. Introduction

Obesity, along with the metabolic diseases it causes, has become an increasingly growing problem that has devastating economic, health, and societal effects. From insulin resistance and hyperlipidemia to cardiovascular diseases and cancer, obesity has been associated with many of the leading causes of death worldwide [1, 2]. Despite its prevalence, excess weight can be greatly reduced by following a healthy diet and a good exercise routine [1]. In fact, exercise is known to exert beneficial effects on all body systems. Studies have repeatedly proven the positive effects exercise has on the cardiovascular, respiratory, and skeletomuscular systems [3]. Exercise induces these changes by the release of hormones and myokines from the skeletomuscular system in the body [4]. Some of these myokines include BDNF, FGF-21, IL-15, and irisin [4, 5]. Indeed, one of these myokines, irisin, which was only recently discovered, has been shown to have numerous benefits not only in fighting metabolic diseases but also in combating cancer [4]. Recent reviews in the literature link irisin and exercise, concluding that irisin increases after exercise, however only transiently [6]; irisin, obesity, and metabolic diseases have also been linked [7], but no review summarizes the studies that show the effect of irisin on cancer or cancer biology. An investigation into the available literature shows that irisin has direct effects on different types of cancers. However, some controversies remain on the exact benefits of irisin on cancer with some studies showing no or even a negative effect of irisin on cancer. This review summarizes these 2 differing viewpoints and synthesizes them to form a clearer picture of irisin’s effects on cancer and questions if irisin is the missing link between obesity, exercise, and cancer.

2. Methods

The articles listed in Section 3.4 were selected based on relevancy from PubMed and Google Scholar databases. Initial results yielded 56 articles on PubMed and 9280 articles on Google Scholar where “Irisin” and “Cancer” were used as keywords. After reading all the abstracts to refine the selection, only 17 articles were found to directly link irisin with cancer as these articles mentioned the direct effect of irisin on cancer cell lines in vitro and the effects of serum irisin in cancer patients in vivo.

3. Results

From the 17 articles selected and reviewed for the “irisin and cancer,”(i)Thirteen articles (Table 1) favoured irisin as a myokine with a role in carcinogenesis or cancer therapeutics (7 studies were conducted in vitro, and 6 studies were performed in vivo)(ii)Four articles considered that irisin has no or adverse effect on cancer progression

Table 1: Studies that show the promising effects of irisin on different types of cancer.
3.1. Irisin

Irisin is released through the cleavage of FNDC5, a polypeptide protein containing 212 amino acids. This protein is cleaved at the N-terminal releasing irisin, originally named after the Greek goddess Iris, into the blood [21]. This cleavage is initiated by muscle contraction through an unknown proteasome [21]. Irisin levels are increased after acute exercise and bind to an unidentified receptor on the adipose tissue, which leads to significant weight loss and decrease in total body energy [21].

Recent studies of its function have determined that its beneficial effects derive from its ability of browning white adipose cells. The molecular cascade that ties irisin and the browning of white fat is the following: first, exercise increases the expression of PGC-1α or peroxisome proliferator-activated receptor (PPAR-γ) coactivator. This in turn increases the expression of FNDC5, which, as stated before, releases irisin. Irisin then increases the mRNA expression of UCP1, a transmembrane protein that decreases the proton gradient generated by oxidative phosphorylation [21].

3.2. Irisin and Exercise

Since irisin was linked with muscle contraction, studies were conducted to measure irisin levels after exercise. Several studies were conducted to measure the levels of irisin after exercise especially in overweight individuals. The selected articles of this section are based on recent studies conducted between 2014 and 2017 showing the relationship of irisin and exercise; the studies were performed on individuals of various body types and on mice. A murine study concluded that a significant increase in irisin levels and UCP1, which leads to increased thermogenesis in the white adipose tissue, was seen after rats were subjected to resistance exercise [22]. Another study conducted on humans indicated a significant increase in irisin levels among obese youth after exercise. However, this increase was observed directly after aerobic exercise while no change was observed after resistance exercise [23]. Other studies linked irisin levels with BMI, obesity, and leptin, where obese children who had undergone a physical activity program showed a significant increase in levels of irisin and leptin. This suggests that irisin could possibly link the skeletomuscular system with the adipose tissue [24]. A murine study conducted on high-fat diet-induced obese mice concluded that mice exposed to intravenous irisin gained similar benefits as those who had exercised. This study also showed that these two groups had improved insulin resistance and levels of reproductive hormones and improved ovarian follicle health [25]. Irisin was also found to induce muscular hypertrophy when injected into mice after activation of satellite cells and increase protein synthesis [26]. Lastly, in a study conducted on healthy human subjects, irisin and lactate levels were positively correlated and both increased with higher exercise workload, confirming the researchers’ hypothesis that irisin is tied to muscle energy demands [27]. This correlation could suggest that the increased strain on the muscles and low ATP may signal irisin release. Interestingly, individuals who were able to reach a higher VO2max and thus work at a higher exercise workload produced higher levels of irisin after exercise [27]. These studies show a clear pattern between irisin and exercise where exercise induced a significant increase in irisin secretion.

3.3. Irisin and Obesity

Irisin, originating from the white adipose tissue in mice, is thought to form around 30% of total body irisin, while in humans, muscle FNDC5/irisin expression is 100–200 times higher than in the white adipose tissue [28]. Another interspecies difference irisin shows is that its browning effects in humans may be different than those in rodents. Indeed, irisin decreases browning-related genes in human preadipocytes but increases said genes in mature human adipocytes [6, 21].

Since irisin increases energy expenditure through its aforementioned effects on UCP1, it is expected that it should reduce body weight. Hence, it is paradoxical that obese individuals show increased irisin levels as compared to normal weight individuals. In fact, anorexic patients show as much as 30% reduced irisin levels compared to morbidly obese individuals. It is surmised then that while increased fat deposits increase the production of irisin, irisin itself can no longer exert its effects in a meaningful manner; thus, obese individuals may have irisin resistance, a condition not too different from leptin resistance, where increased leptin levels fail to enact their beneficial effects. In turn, leptin is also positively correlated with obesity and irisin itself [29]. Many studies revealed a link between irisin and obesity due to its secretion by the adipose tissue and have found a positive correlation between BMI and irisin [7].

3.4. Irisin and Cancer

A large body of evidence has linked obesity to cancer because obesity leads to an increase in inflammatory markers (IL-6 and TNF‐α) [30], insulin resistance [31], and adipokine secretions [32], all of which favor tumor survival and proliferation [33], while exercise has also shown to have potential anti-inflammatory effects by reducing of TNF‐α expression [34]. Thus, since irisin is linked to obesity, it follows to hypothesize that irisin could be associated with cancer as well (Figure 1). Tying together obesity, irisin, and cancer, exercise, which helps combat obesity, also increases irisin levels [23]. Exercise‐induced irisin could be used as a determinant of the metabolic response to exercise in obese individuals to track any decrease in cancer risk linked to obesity [35]. To study irisin’s effects on cancer, a study was conducted on human nonmalignant breast epithelial cells (MCF-10a), malignant breast epithelial cells (MCF-7), and malignant aggressive breast epithelial cells (MDA-MB-231). Upon exposure to irisin, the malignant breast tumor cell number significantly decreased as a result of increased caspase-3/7 activity and suppression of NF-κB activity. This shows that irisin could possibly reverse the cancer hallmark of resisting cell death [36, 37] by promoting caspase 3 activity and thus apoptosis. A significant decrease in cell migration compared to the control was also noted. Moreover, the malignant breast cells were exposed to doxorubicin, a chemotherapy agent, and irisin. When exposed to irisin, these cells showed a significant increase in doxorubicin sensitivity and a significant decrease in malignant cell viability and number. In fact, this increased doxorubicin sensitivity meant that less doses of doxorubicin were even more effective at producing the desired chemotherapy effects. Thus, irisin could play an important role in cancer therapy [10]. Another study on irisin and breast cancer showed that there was a negative correlation between serum levels of irisin and spinal metastasis of breast cancer. Irisin was found to have a protective effect on the bone, and these favorable bone qualities protected from metastasis of breast cancer [19]. This shows that irisin’s effects also could reduce the metastatic and invasive hallmarks of cancer [36].

Figure 1: Diagram representing the putative relationship between exercise-induced release of irisin, obesity, and cancer. A possible anti-inflammatory role of irisin could also be inferred by its ability of browning fat cells, reducing obesity and thus reducing the inflammatory microenvironment. Irisin may also have a direct effect on other cancer hallmarks.

Yet another study suggested that increased levels of serum irisin reduced the risk of breast cancer development by 90%, and patients that had developed breast cancer had a significantly lower irisin serum levels than healthy individuals [9].

Aiming to uncover irisin’s relation to other types of cancers, two studies conducted on lung cancer cells concluded that an increase in irisin levels led to a decrease in lung cancer cell proliferation, viability, and invasiveness by affecting the epithelial-mesenchymal transition (EMT), significantly decreasing the EMT markers N-cadherin and vimentin and increasing the expression of E-cadherin. This inhibition in EMT was related to the inhibition of the Snail pathway which is mediated by the PI3K/Akt pathway [8]. Irisin’s effect on the PI3K pathway may also suggest an inhibitive role and a reason for the reduction in cancer cell proliferation. The second study conducted on osteocarcinoma cells also confirmed these findings and deduced that irisin was able to reverse IL-6-induced EMT by inhibition of the STAT3 pathway [18]. Another recent study conducted on pancreatic cancer cell lines also showed irisin’s ability to inhibit EMT, viability, and proliferation of these cells by activation of the AMPK pathway. Irisin inhibits pancreatic cancer cell growth via the AMPK-mTOR pathway [20]. This ability of irisin to target the AMPK pathway may also suggest its role in reducing proliferation and altering cancer energy metabolism [37, 38]. A study conducted on prostate cancer cells subjected to different concentrations of irisin showed reduced prostate cancer cell viability [13]. Furthermore, a study on renal cell cancer suggested that irisin can be used as a biomarker for renal cancer diagnosis as irisin levels were significantly increased in patients with renal tumors; irisin too had higher specificity and sensitivity than other investigated biomarkers [11]. In a recent study conducted, patients with colorectal cancer showed low serum irisin levels compared to healthy individuals while individuals with high levels of irisin showed a 78% reduced risk of developing colorectal cancer (CRC). These findings could show that irisin could have protective qualities against development of CRC [14].

3.5. Controversies

Despite what appears to be a positive correlation between irisin and cancer, two studies conducted on hepatocellular carcinomas have suggested that irisin stimulated the proliferation and invasion of hepatocellular carcinoma tumors via activation of the PI3K/AKT pathway. This study also showed a reduction in doxorubicin cytotoxicity in the presence of irisin [16].The second study showed a significant increase in expression of hepatic irisin mRNA in individuals with hepatic carcinoma [12].

Furthermore, a murine study conducted to assess the relationship between cachectic factors and irisin in gastric cancer showed no significant difference in the expression of FNDC5 in gastric cancer tissues. However, FNDC5 expression was increased in the subcutaneous adipose tissue, and an overall increase in irisin serum levels was noted. Nevertheless, these increased serum irisin levels seen in this study failed to increase UCP1 expression in the white fat tissue, while increased irisin levels due to exercise do increase UCP1 expression [17]. Therefore, this shows that the increased irisin levels due to exercise operate differently than those seen in gastric cancer and possibly other types of cancer.

Moreover, a study conducted on several cancer cell lines where adhesion activity and colony numbers were measured failed to show any effects of irisin on the proliferation and malignant potential of these cell lines [15]. Indeed, these studies showed that perhaps the beneficial effects of irisin are cell- or tissue-specific and may not be observable in all cancer types.

4. Discussion

Exercise has shown its positive influence in numerous chronic diseases, especially obesity, but the direct path that causes these positive changes remained elusive [39]. Exercise has also shown its effect on several hallmarks of cancer [38]. No study has yet revealed the exact type and duration of exercise that should be performed to decrease cancer risk. In our present review, we shed the light on irisin as an exercise-secreted myokine, and we summarize the studies that show the effect of irisin on some of the hallmarks of cancer. Indeed, the studies conducted showed that cancer cells exposed to irisin presented an increase caspase activity, a suppression of NF-κB activity, thus a reduction of the “resisting cell death” hallmark [36]. Other studies showed a role of irisin in suppressing other hallmarks of cancer such as “sustaining proliferative signaling” [36] by targeting the PI3K/Akt pathway [16] or “evading growth suppressors” [36] via targeting the AMPK-mTOR pathway [20] or “activating invasion and metastasis” [36] by decreasing cell migration and inhibiting the epithelial-mesenchymal transition [18]. Irisin belongs indeed to the emerging group of myokines that are hypothesized to reduce cancer risk by lowering the basal systemic levels of cancer risk factors such as proinflammatory cytokines and adipokines [37, 40].

5. Conclusion

Further mechanistic studies are necessary to determine how irisin induced fat browning and obesity reduction may reduce carcinogenesis or cancer risk. As for the potential role of irisin in cancer therapeutics, more studies should be performed in order to determine the mode of administration of irisin for each cancer type. Nevertheless, obesity has become a worldwide epidemic disease, and many diseases related to obesity also present a steady rising, including insulin resistance, metabolic syndrome, type II diabetes, hypertension, chronic kidney disease, cardiovascular disease, heart failure, and cancer. Therefore, exercise-induced irisin deserves a closer inspection to further understand its direct role in reducing obesity and to elucidate its part in cancer prevention and therapeutics.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.


This work was supported by a grant from the National Council for Scientific Research (CNRS)-Lebanon (grant 739/S).


  1. M. Nocon, T. Hiemann, F. Müller-Riemenschneider, F. Thalau, S. Roll, and S. N. Willich, “Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis,” European Journal of Cardiovascular Prevention & Rehabilitation, vol. 15, no. 3, pp. 239–246, 2008. View at Publisher · View at Google Scholar · View at Scopus
  2. M. Tanasescu, M. F. Leitzmann, E. B. Rimm, W. C. Willett, M. J. Stampfer, and F. B. Hu, “Exercise type and intensity in relation to coronary heart disease in men,” JAMA, vol. 288, no. 16, pp. 1994–2000, 2002. View at Publisher · View at Google Scholar · View at Scopus
  3. J. Vina, F. Sanchis-Gomar, V. Martinez-Bello, and M. Gomez-Cabrera, “Exercise acts as a drug; the pharmacological benefits of exercise,” British Journal of Pharmacology, vol. 167, no. 1, pp. 1–12, 2012. View at Publisher · View at Google Scholar · View at Scopus
  4. B. So, H.-J. Kim, J. Kim, and W. Song, “Exercise-induced myokines in health and metabolic diseases,” Integrative Medicine Research, vol. 3, no. 4, pp. 172–179, 2014. View at Publisher · View at Google Scholar · View at Scopus
  5. B. K. Pedersen, “Exercise-induced myokines and their role in chronic diseases,” Brain, Behavior, and Immunity, vol. 25, no. 5, pp. 811–816, 2011. View at Publisher · View at Google Scholar · View at Scopus
  6. P. A. Andrade, B. K. S. Silveira, A. C. Rodrigues, F. M. O. D. Silva, C. O. B. Rosa, and R. C. G. Alfenas, “Effect of exercise on concentrations of irisin in overweight individuals: a systematic review,” Science & Sports, vol. 33, no. 2, pp. 80–89, 2018. View at Publisher · View at Google Scholar · View at Scopus
  7. S. A. Polyzos, A. D. Anastasilakis, Z. A. Efstathiadou et al., “Irisin in metabolic diseases,” Endocrine, vol. 58, no. 2, pp. 1–15, 2017. View at Google Scholar
  8. L. Shao, H. Li, J. Chen et al., “Irisin suppresses the migration, proliferation, and invasion of lung cancer cells via inhibition of epithelial-to-mesenchymal transition,” Biochemical and Biophysical Research Communications, vol. 485, no. 3, pp. 598–605, 2017. View at Publisher · View at Google Scholar · View at Scopus
  9. X. Provatopoulou, G. P. Georgiou, E. Kalogera et al., “Serum irisin levels are lower in patients with breast cancer: association with disease diagnosis and tumor characteristics,” BMC Cancer, vol. 15, no. 1, p. 898, 2015. View at Publisher · View at Google Scholar · View at Scopus
  10. N. P. Gannon, R. A. Vaughan, R. Garcia-Smith, M. Bisoffi, and K. A. Trujillo, “Effects of the exercise-inducible myokine irisin on malignant and non-malignant breast epithelial cell behaviorin vitro,” International Journal of Cancer, vol. 136, no. 4, pp. E197–E202, 2015. View at Publisher · View at Google Scholar · View at Scopus
  11. D. U. Altay, E. E. Keha, E. Karagüzel, A. Menteşe, S. O. Yaman, and A. Alver, “The diagnostic value of FNDC5/irisin in renal cell cancer,” International Brazilian Journal of Urology, vol. 44, pp. 734–739, 2018. View at Publisher · View at Google Scholar · View at Scopus
  12. M. Gaggini, M. Cabiati, S. Del Turco et al., “Increased FNDC5/irisin expression in human hepatocellular carcinoma,” Peptides, vol. 88, pp. 62–66, 2017. View at Publisher · View at Google Scholar · View at Scopus
  13. S. Tekin, Y. Erden, S. Sandal, and B. Yilmaz, “Is irisin an anticarcinogenic peptide?” Medicine Science, vol. 4, no. 2, pp. 2172–2180, 2015. View at Publisher · View at Google Scholar
  14. H. Zhu, M. Liu, N. Zhang et al., “Serum and adipose tissue mRNA levels of ATF3 and FNDC5/irisin in colorectal cancer patients with or without obesity,” Frontiers in Physiology, vol. 9, 2018. View at Publisher · View at Google Scholar · View at Scopus
  15. H.-S. Moon and C. S. Mantzoros, “Regulation of cell proliferation and malignant potential by irisin in endometrial, colon, thyroid and esophageal cancer cell lines,” Metabolism, vol. 63, no. 2, pp. 188–193, 2014. View at Publisher · View at Google Scholar · View at Scopus
  16. G. Shi, N. Tang, J. Qiu et al., “Irisin stimulates cell proliferation and invasion by targeting the PI3K/AKT pathway in human hepatocellular carcinoma,” Biochemical and Biophysical Research Communications, vol. 493, no. 1, pp. 585–591, 2017. View at Publisher · View at Google Scholar · View at Scopus
  17. D. U. Altay, E. E. Keha, S. Ozer Yaman et al., “Investigation of the expression of irisin and some cachectic factors in mice with experimentally induced gastric cancer,” QJM, vol. 109, no. 12, pp. 785–790, 2016. View at Publisher · View at Google Scholar · View at Scopus
  18. G. Kong, Y. Jiang, X. Sun et al., “Irisin reverses the IL-6 induced epithelial-mesenchymal transition in osteosarcoma cell migration and invasion through the STAT3/snail signaling pathway,” Oncology Reports, vol. 38, no. 5, pp. 2647–2656, 2017. View at Publisher · View at Google Scholar · View at Scopus
  19. Z.-P. Zhang, X.-F. Zhang, H. Li et al., “Serum irisin associates with breast cancer to spinal metastasis,” Medicine, vol. 97, no. 17, Article ID e0524, 2018. View at Publisher · View at Google Scholar · View at Scopus
  20. J. Liu, N. Song, Y. Huang, and Y. Chen, “Irisin inhibits pancreatic cancer cell growth via the AMPK-mTOR pathway,” Scientific Reports, vol. 8, no. 1, Article ID 15247, 2018. View at Publisher · View at Google Scholar · View at Scopus
  21. P. Boström, J. Wu, M. P. Jedrychowski et al., “A PGC1-α-dependent myokine that drives brown-fat-like development of white fat and thermogenesis,” Nature, vol. 481, no. 7382, pp. 463–468, 2012. View at Publisher · View at Google Scholar · View at Scopus
  22. J. Reisi, K. Ghaedi, H. Rajabi, and S. M. Marandi, “Can resistance exercise alter irisin levels and expression profiles of FNDC5 and UCP1 in rats?” Asian Journal of Sports Medicine, vol. 7, no. 4, 2016. View at Publisher · View at Google Scholar · View at Scopus
  23. D. R. Blizzard LeBlanc, B. V. Rioux, and C. Pelech, “Exercise‐induced irisin release as a determinant of the metabolic response to exercise training in obese youth: the EXIT trial,” Physiological Reports, vol. 5, no. 23, Article ID e13539, 2017. View at Publisher · View at Google Scholar · View at Scopus
  24. B. Palacios‐González, F. Vadillo-Ortega, E. Polo-Oteyza et al., “Irisin levels before and after physical activity among school‐age children with different BMI: a direct relation with leptin,” Obesity, vol. 23, no. 4, pp. 729–732, 2015. View at Google Scholar
  25. E. Bastu, U. Zeybek, E. Gurel Gurevin et al., “Effects of irisin and exercise on metabolic parameters and reproductive hormone levels in high-fat diet-induced obese female mice,” Reproductive Sciences, vol. 25, no. 2, pp. 281–291, 2018. View at Publisher · View at Google Scholar · View at Scopus
  26. M. M. Reza, N. Subramaniyam, C. M. Sim et al., “Irisin is a pro-myogenic factor that induces skeletal muscle hypertrophy and rescues denervation-induced atrophy,” Nature Communications, vol. 8, no. 1, p. 1104, 2017. View at Publisher · View at Google Scholar · View at Scopus
  27. S. S. Daskalopoulou, A. B. Cooke, Y.-H. Gomez et al., “Plasma irisin levels progressively increase in response to increasing exercise workloads in young, healthy, active subjects,” European Journal of Endocrinology, vol. 171, no. 3, pp. 343–352, 2014. View at Publisher · View at Google Scholar · View at Scopus
  28. J. Y. Huh, G. Panagiotou, V. Mougios et al., “FNDC5 and irisin in humans: I. Predictors of circulating concentrations in serum and plasma and II. mRNA expression and circulating concentrations in response to weight loss and exercise,” Metabolism, vol. 61, no. 12, pp. 1725–1738, 2012. View at Publisher · View at Google Scholar · View at Scopus
  29. S. A. Polyzos, J. Kountouras, K. Shields, and C. S. Mantzoros, “Irisin: a renaissance in metabolism?” Metabolism, vol. 62, no. 8, pp. 1037–1044, 2013. View at Publisher · View at Google Scholar · View at Scopus
  30. C. H. Lee, Y. C. Woo, Y. Wang, C. Y. Yeung, A. Xu, and K. S. L. Lam, “Obesity, adipokines and cancer: an update,” Clinical Endocrinology, vol. 83, no. 2, pp. 147–156, 2015. View at Publisher · View at Google Scholar · View at Scopus
  31. S. Tsugane and M. Inoue, “Insulin resistance and cancer: epidemiological evidence,” Cancer Science, vol. 101, no. 5, pp. 1073–1079, 2010. View at Publisher · View at Google Scholar · View at Scopus
  32. Y. Matsuzawa, “Therapy insight: adipocytokines in metabolic syndrome and related cardiovascular disease,” Nature Clinical Practice Cardiovascular Medicine, vol. 3, no. 1, pp. 35–42, 2006. View at Publisher · View at Google Scholar · View at Scopus
  33. G. De Pergola and F. Silvestris, “Obesity as a major risk factor for cancer,” Journal of Obesity, vol. 2013, Article ID 291546, 11 pages, 2015. View at Publisher · View at Google Scholar · View at Scopus
  34. C. Keller, P. Keller, M. Giralt, J. Hidalgo, and B. K. Pedersen, “Exercise normalises overexpression of TNF-α in knockout mice,” Biochemical and Biophysical Research Communications, vol. 321, no. 1, pp. 179–182, 2004. View at Publisher · View at Google Scholar · View at Scopus
  35. J. C. Brown, K Winters-Stone, A Lee, and K. H Schmitz, “Cancer, physical activity, and exercise,” Comprehensive Physiology, vol. 2, no. 4, pp. 2775–809, 2012. View at Publisher · View at Google Scholar
  36. D. Hanahan and R. A. Weinberg, “The hallmarks of cancer,” Cell, vol. 100, no. 1, pp. 57–70, 2000. View at Publisher · View at Google Scholar · View at Scopus
  37. D. Hanahan and R. A. Weinberg, “Hallmarks of cancer: the next generation,” Cell, vol. 144, no. 5, pp. 646–674, 2011. View at Publisher · View at Google Scholar · View at Scopus
  38. A. Ruiz-Casado, A. Martín-Ruiz, L. M. Pérez, M. Provencio, C. Fiuza-Luces, and A. Lucia, “Exercise and the hallmarks of cancer,” Trends in Cancer, vol. 3, no. 6, pp. 423–441, 2017. View at Publisher · View at Google Scholar · View at Scopus
  39. B. M. Gabriel and J. R. Zierath, “The limits of exercise physiology: from performance to health,” Cell Metabolism, vol. 25, no. 5, pp. 1000–1011, 2017. View at Publisher · View at Google Scholar · View at Scopus
  40. N. Spyrou, K. I. Avgerinos, C. S. Mantzoros, and M. Dalamaga, “Classic and novel adipocytokines at the intersection of obesity and cancer: diagnostic and therapeutic strategies,” Current Obesity Reports, vol. 7, no. 4, pp. 1–16, 2018. View at Google Scholar