The news at a glance
- About 900 people with bowel cancer who had finished chemotherapy either took part in a regular exercise programme with a coach for 3 years or were only given an information leaflet [1].
- In the exercise group, the cancer coming back, a new cancer or death was about a quarter less common [1].
- After 8 years, more patients in the exercise group were also still alive [1].
- As well as working better, the programme also cost less overall [2]. Talk to your doctor before you start exercising (exercise during treatment).
- Overall survival: how long patients lived.
- Progression-free survival: how long the disease did not get worse.
- Disease-free or event-free survival: how long the disease did not come back after treatment.
- Median: the number that half of patients were above and half below; for example, "a median of 10 months" means that in half of patients the disease stayed under control for at least 10 months.
- Phase 3: a large, careful study comparing a new drug with the usual treatment; the basis of most approvals.
Talk to your doctor about what this result means for you.
What was reported?
For physicians
Laboratory and observational studies had long shown that more active people have better outcomes after cancer, but there was no definitive evidence from a randomised trial [1]. The CHALLENGE trial (CCTG CO.21), run at 55 centres from 2009 to 2024, randomised patients with resected colon cancer who had completed adjuvant chemotherapy to a structured exercise programme for 3 years (445 patients) or health-education materials only (444 patients) [1]. Patients had stage III or high-risk stage II disease [2].
With a median follow-up of 7.9 years, disease-free survival was significantly longer in the exercise group. 5-year disease-free survival was 80.3% vs 73.9%, and the hazard ratio for death was estimated at 0.63 [1].
The exercise programme included behavioural support and a personalised physical activity prescription from a physical activity consultant, more intensive in the first 6 months and then tapering; the goal was to increase physical activity by at least 10 MET-hours per week over baseline (trial registration on ClinicalTrials.gov).
What does this finding mean for patients?
This study shows that regular exercise after bowel cancer treatment is not just "health advice" but part of the treatment: in this study, patients who took part in the exercise programme had their cancer come back less often and lived longer [1]. The important point is that the programme was gradual, tailored to each person and supported by a coach. Before you start, talk to your doctor about the right type and intensity of activity; muscle and joint injuries were slightly more common in the exercise group [1].
Trial details (for physicians)
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- This is the first level 1 evidence (a phase 3 randomised trial) showing an effect of an exercise intervention on disease-free survival in cancer; the overall survival benefit (HR 0.63; 95% CI 0.43 to 0.94) was a secondary endpoint and was reported as "consistent" [1].
- The intervention began after completion of adjuvant chemotherapy and lasted 3 years; referral to a structured, coach-led programme, not just general advice, is in line with this evidence [1, 3].
- Musculoskeletal adverse events occurred in 18.5% of the exercise group vs 11.5% [1].
- In an economic analysis from the Canadian public payer perspective, despite an initial cost of CAD 2,917 per patient, the exercise programme was overall cheaper and more effective than health education [2].
Limitations and next steps
- Patients and coaches knew which intervention was given (blinding was not possible), and enrolment took 15 years [1].
- The results apply to colon cancer after adjuvant chemotherapy and cannot be directly generalised to all cancers or to metastatic disease [1, 3].
- The effect was achieved in a setting with trained coaches and behavioural support; delivering it in other health systems requires similar infrastructure [2, 3].
Reviews published after these results have suggested that structured exercise be built systematically into the care pathway after adjuvant treatment for colon cancer, similar to enhanced recovery after surgery (ERAS) programmes [3].
Main study
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Key study
1 itemStructured Exercise after Adjuvant Chemotherapy for Colon Cancer
References
3 referencesShow all references, 3 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2
- 3
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/news/exercise-colon-cancer-challenge-trial/
