ESMO Clinical Practice Guideline Express Update on the adoption of physical exercise in patients with localised colon cancer
- Study type
- Clinical guideline
- Study name
- ESMO Express Update 2026
- Design
- Express Update of the ESMO clinical guideline on localised colon cancer, with level of evidence, grade of recommendation and ESMO-MCBS v2.0 score
- Source
- ESMO Open · 2026
In plain words
Based on the results of the CHALLENGE trial, the European Society for Medical Oncology (ESMO) now recommends that patients with stage 3 or high-risk stage 2 colon cancer who have finished chemotherapy be told about the benefits of a regular exercise programme guided by a coach, and take part in one if possible. The goal is about 10 MET-hours of activity a week; that is roughly 150 minutes of moderate aerobic activity such as brisk walking. Stopping smoking, cutting down on alcohol and a diet rich in vegetables and fruit are also recommended.
Key guideline recommendations
- I, A
Patients with resected stage 3 or high-risk stage 2 colon cancer should be informed of the available evidence indicating a survival benefit from a structured exercise programme.
- I, A
Healthcare professionals should clearly inform patients with stage 3 or high-risk stage 2 disease of their eligibility for a structured exercise programme and identify the necessary infrastructure and support [I, A]. They should also assess the patient's medical condition, preferences and attitudes and potential challenges to delivering the programme, including adherence and financial toxicity [I, A].
- II, B; ESMO-MCBS v2.0: A
After discussion and shared decision-making about exercise intensity and feasibility, participation of eligible patients in a structured exercise programme can be recommended.
- IV, B
Coordinated health system investment to build capacity and infrastructure for delivering behavioural support and exercise programmes, together with the necessary support and guidance for patients, can be recommended.
- III, A
Patients with resected localised colon cancer should be encouraged to maintain a healthy lifestyle, including exercise (10 MET-hours per week), smoking cessation, avoidance of heavy alcohol use and a healthy diet rich in vegetables, fruits and berries (adapted to bowel function).
Study population
Patients with resected localised colon cancer, particularly stage 3 or high-risk stage 2 after completion of adjuvant chemotherapy.
Clinical significance and place in guidelines
This update brought structured exercise into the official ESMO localised colon cancer guideline for the first time, with level of evidence I and an ESMO-MCBS grade A score, and updated the adjuvant treatment algorithm for stages 2 and 3. The main guideline remains the 2020 version (Argilés et al., Ann Oncol 2020).
Limitations
Based on a single trial (CHALLENGE) with relatively fit patients; the feasibility of delivering the programme without infrastructure (supervised sessions, health coach) and the effect of simplified or lower-intensity versions of the programme are unknown; economic data have not yet been published.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.