Structured exercise programs will result in improved quality of life in colon cancer

Stage III or high risk stage II patients Colon cancer Those who participated in the 3-year structured exercise program that began after adjuvant chemotherapy showed improved disease-free survival (DFS), overall survival (OS), and patient-reported physical function, showing patient-reported physical function, according to a study published at the 2025 American Society of Clinical Oncology (ASCO) annual conference, compared to patients who received health education materials and standard surveillance, and were published at the annual conference. New England Journal of Medicine.^1,2

A structured exercise program should be part of standard care for colon cancer following adjuvant chemotherapy, the authors of the Commandos study recommend. | Image credit: drawen -stock.adobe.com

Preclinical and observational studies demonstrate the potential for post-diagnosis exercise to improve cancer outcomes, and the Canadian Cancer Trial Group (CCTG) launched a randomized 3 CO.21 colon health and lifetime exercise change (challenge) trial (NCT00819208) to address the gaps in randomized controlled studies.

“The Challenge Study is the world's first randomised controlled trial to specifically ask whether exercise can improve cancer survival,” said Christopher Booth, MD, FRCPC, lead study author Christopher Booth, MD, FRCPC, director of the Department of Cancer Treatment and Epidemiology in Ontario, Ontario, Canada, in his presentation at ASCO.

The trial enrolled 889 patients with resected colon cancer who completed adjuvant therapy at 55 sites in six countries between 2009 and 2024. Patients were randomized to participate in a structured exercise program (SEP; n = 445) or receive only health education material (hem; n = 444) over three years.²

While the hem participants received written guidance promoting physical activity and nutrition, people in the SEP group engaged in personalized, behaviorally supported exercise interventions for three years. SEP aimed to increase metabolic equivalent time at least 10 times a week within the first six months. The patients themselves selected the preferred type, frequency and intensity of aerobic activity and selected using a program that helped them increase and maintain physical activity levels.

“The physical activity consultant worked with the patient to create exercise prescriptions based on the individual's activities and lifestyle,” Booth explained. “This can include aerobic forms of exercise, from swimming to cycling, kayak, kayak, running, running, kayak, kayak, kayak, running. However, most patients can embark on a walking program and achieve their goals by adding three or four active 45-60-minute walks a week.”

The primary endpoint was DFS, measured using a secondary endpoint including OS and patient-reported physical features, a 36-item short form (SF-36) survey, and objective fitness measures.

At the median follow-up of 7 years, participants in the SEP experienced a significant reduction in disease recurrence or death. DFS in 5 years was 80.3% in the SEP group, but 73.9% in the HEM group (HR, 0.72; 95% CI, 0.55-0.94; p = .017). The OS for 8 years was 90.3% in SEP, but the hem was 83.2% (HR, 0.63; 95%CI, 0.43-0.94; p = .022).

Participants in the SEP group reported significant improvements in the SF-36 physical function subscale vs. HEM group at 6 months, 1 year, 18 months, 2 years, and 3 years. The SEP group also improved objective measures of fitness, including predicted oxygen consumption and 6-minute walk test distance.

In an AS-treated safety analysis of 428 patients in the SEP group who completed at least one exercise session, 4444 patients in the tail group had secondary events (AEs) in 82% of patients in the SEP group and 76.4% of patients in the HEM group. Musculoskeletal AE was reported in 19% of participants in the SEP group, and 10% of musculoskeletal AE in the SEP group was reported to be attributable to intervention, compared to 12% in the HEM group.

“Structured exercise programs after adjuvant chemotherapy for colon cancer improved fitness, disease-free survival, and overall survival,” Booth concluded. Data on the breast cancer space suggest that these results can be generalized to a wider cancer space. “These results demonstrate a new, first-class anti-cancer effect of new forms of cancer therapy. Furthermore, the magnitude of improved disease-free survival and overall survival is comparable to many standard medical therapies.”

“The Challenge Trial sets up a new standard of care for the management of high-risk Stage II and Stage III colon cancer,” Booth said. “Exercise is no longer an intervention that improves quality of life and fitness. It is a treatment that improves the survival of colon cancer and needs to be available to all patients.”

Telling patients to exercise alone isn't enough, Booth added. Healthcare systems, healthcare providers, hospitals, and payers should invest in behavioral support programs so that oncologists can refer patients to exercise specialists after adjuvant chemotherapy.

“This intervention empowers patients, is achievable for patients, and is sustainable for the health system at a much lower cost than standard medical therapy,” Booth said.

reference

1. BoothCM, Vardy JL, O'Callaghan CJ, and others Stage 3 or high-risk stage 2 colon cancer: a randomized phase III trial of the effects of structured exercise programs on disease-free survival (DFS) of the Canadian Cancer Trial Group (CCTG) Co.21 (challenge). J Clin Oncol. 2025; 43 (Suppl 17). doi: 10.1200/jco.2025.43.16_suppl.lba3510.

2. CourseyaKS, Vardy JL, O'Callaghan CJ, Structured exercise after adjuvant chemotherapy for et al. n engl j with. Released online on June 1, 2025. doi:10.1056/nejmoa2502760