Colon Cancer & Exercise: Better Outcomes & Quality of Life
Structured Exercise Boosts Colon Cancer Survival Rates
Updated June 09, 2025
A new study reveals that a structured exercise program can considerably improve survival rates for patients with stage III or high-risk stage II colon cancer following adjuvant chemotherapy. The research, presented at the 2025 American Society of Clinical Oncology (ASCO) meeting and published in the New England Journal of Medicine, highlights the benefits of physical activity in combating this disease.
The Canadian Cancer Trials Group (CCTG) conducted the randomized, phase 3 CO.21 Colon health and Lifelong Exercise Change (CHALLENGE) trial to investigate the impact of exercise on cancer outcomes. Dr. Christopher Booth, director of the division of Cancer Care and Epidemiology at Queen’s University Cancer Research Institute, emphasized that this was the first randomized controlled trial to specifically examine whether exercise could enhance cancer survival.
The trial involved 889 patients with resected colon cancer who had completed adjuvant therapy across 55 sites in six countries between 2009 and 2024. Participants were divided into two groups: one engaging in a structured exercise program (SEP), and the other receiving health education materials (HEM). The SEP group participated in a personalized exercise intervention over three years, aiming to increase recreational physical activity. The health education group received written guidance on physical activity and nutrition.
The exercise programs were tailored to each patient’s preferences and lifestyle. “The physical activity consultant worked with patients to create an exercise prescription based on the activities and the lifestyle of that individual,” Booth said. Most patients chose walking, aiming for 45 to 60 minutes of brisk walking three to four times per week.
After a median follow-up of 7.9 years, the SEP group showed a significant reduction in disease recurrence or death. The five-year disease-free survival (DFS) rate was 80.3% in the SEP group compared to 73.9% in the HEM group. The eight-year overall survival (OS) rate was 90.3% for SEP versus 83.2% for HEM.
Participants in the structured exercise program also reported greater improvements in physical function. Objective fitness measures, such as predicted maximum oxygen consumption and six-minute walk test distance, also improved.
“The CHALLENGE trial sets a new standard of care for the management of high-risk stage II and stage III colon cancer,” Booth said. “Exercise is no longer just an intervention that improves quality of life and fitness. It is a treatment that improves survival for colon cancer and should be made available to all patients.”
while adverse events were slightly more common in the SEP group (82% vs. 76.4% in the HEM group), most were musculoskeletal and attributed to the intervention.
what’s next
Booth suggests that health systems and providers should invest in behavior support programs to enable oncologists to refer patients to exercise specialists after chemotherapy. He believes this intervention is empowering, achievable, and enduring for health systems, offering a cost-effective approach to improving colon cancer outcomes.