New study results show that a structured exercise program following surgery and adjuvant chemotherapy reduced the risk of recurrent or new cancer and increased survival for patients with stage III and high-risk stage II colon cancer. The research was presented at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.
“After completing surgery and chemotherapy, about 30% of patients with high-risk stage II and stage III colon cancer will eventually experience recurrence of their disease. As oncologists, one of the most common questions we get asked by patients is ‘what else can I do to improve my outcome?’ These results now provide us with a clear answer: an exercise program that includes a personal trainer will reduce the risk of recurrent or new cancer, make you feel better, and help you live longer,” said lead study author Christopher Booth, MD, FRCPC, Queen’s University in Kingston, Canada. Between 2009 and 2023, the international CHALLENGE clinical trial enrolled 889 participants from six countries, with most participants enrolling from Canada and Australia. The median age of the participants was 61 years and 51% were female. Most of the patients (90%) had stage III colon cancer. The remaining 10% had high-risk stage II colon cancer.
All patients had previously received intent-tocure surgery and adjuvant chemotherapy. The patients were randomly assigned to participate in a structured exercise program (445 patients) or to receive health education materials promoting physical activity and healthy nutrition (444 patients). All participants also received standard cancer surveillance and follow-up care. Patients in the structured exercise program worked with a physical activity consultant twice a month for coaching sessions and supervised exercise sessions. The consultants gave each patient an “exercise prescription.” After 6 months, patients met with their physical activity consultant once a month, with additional sessions available for extra support if needed.
“This is the first randomized phase 3 trial in patients with stage III and high-risk stage II colon cancer to demonstrate that post-treatment exercise is both achievable and effective in improving disease-free survival. Exercise as an intervention is a no brainer and should be implemented broadly,” said Pamela Kunz, MD, Yale School of Medicine and an ASCO Expert in gastrointestinal cancers.
Key Findings
• Patients in both groups improved their physical function and sustained it, but it was significantly higher for patients in the structured exercise program. They had improvements that were maintained over all three years, in recreational physical activity, predicted VO2 max, and distance they could walk in six minutes.
• After a median follow-up of 7.9 years, 93 patients in the structured exercise program had their cancer recur, compared to 131 patients in the health education materials group. At five years, the disease-free survival rate was 80% in the structured exercise program and 74% in the health education materials group. Patients in the structured exercise program had a 28% lower risk of recurrent or new cancers developing than patients who only received health education materials.
• There were 41 people in the structured exercise program and 66 people in the health education materials group who died. After 8 years, overall survival was 90% in the structured exercise program and 83% in the health education materials group. Patients had a 37% lower risk of death if they participated in the structured exercise program.
Patients in the structured exercise program reported more musculoskeletal adverse events, such as muscle strains or bone fractures (19%), compared to the health education group (12%). Ten percent of these adverse events in the structured exercise program were related to their participation in the program. Researchers will explore how exercise reduces cancer recurrence by studying blood samples of the patients who participated in CHALLENGE.
This study was funded by the Canadian Cancer Society, the National Health and Medical Research Council, Cancer Research UK, and the University of Sydney Cancer Research Fund.