After surgery and chemotherapy for colon cancer, join a supervised exercise program and keep it up for 3 years

After surgery and chemotherapy for colon cancer, people who joined a supervised exercise program for 3 years had about a 28% lower chance of recurrence, a new cancer, or death, and about a 37% lower chance of death. Of those alive at 8 years, about 90% were in the exercise group and about 83% had only received pamphlets. People who trained had more muscle and joint injuries.

Cost

Walking and similar exercise cost nothing. An assessment and an exercise plan at a hospital rehabilitation clinic or an exercise-prescription clinic take a registration fee and test fees; a private coach is extra. Several extra hours of exercise a week are needed, and it has to be kept up for 3 years. People who train have more muscle and joint injuries.

Benefit

A randomized trial at 55 centers (CHALLENGE) enrolled 889 people with colon cancer. All had finished surgery and adjuvant chemotherapy, were high-risk stage II or stage III, and had no metastasis at enrollment. They enrolled 2 to 6 months after chemotherapy ended, and before enrollment they exercised less than 150 minutes a week. 445 joined a 3-year exercise program; 444 received only health pamphlets. For the first 6 months of the program, they met an exercise coach every other week to talk about how to keep going, and also trained a session while the coach watched. From 6 to 12 months this became a meeting or a phone call, and from then until year 3 only minimal support remained. The target was 10 more metabolic-equivalent hours a week than before (a unit of exercise amount); anything of moderate intensity or above counted, and the program expected most people to choose walking. After a year, weekly leisure exercise had risen by 15.6 metabolic-equivalent hours in the exercise group and by 5.1 in the control group. Median follow-up was 7.9 years. Recurrence, a new cancer, or death was about 28% lower in the exercise group than in the control group, HR 0.72 (95% CI 0.55–0.94). At 5 years, the share free of these events was 80.3% versus 73.9%. Death was about 37% lower, HR 0.63 (0.43–0.94). At 8 years, 90.3% versus 83.2% were alive. Musculoskeletal adverse events were 18.5% versus 11.5%. A cost analysis of the same trial, on Canadian public health care, put the exercise program at 2917 Canadian dollars per person up front, but with fewer recurrences the 5-year total cost was 1589 Canadian dollars less per person

Notes

The trial enrolled colon cancer only, not rectal cancer, and only people whose surgery had cleared the tumor, who had finished chemotherapy, and who had no metastasis. It does not carry straight over to other cancers or to people with late disease. The main result is recurrence, a new cancer, or death. Death overall is a secondary result; the authors' wording is "consistent with living longer," and they do not treat it as settled. There is no ready-made program of the same kind in China; an oncology or rehabilitation department can write an exercise prescription. Have a fitness assessment before starting; everyone in the trial had an exercise test before enrollment. How to count walking: see section 2, item 11 (walk to 7000–8000 steps a day). Strength training: see section 2, item 16 (strength training). The person who benefits is mainly you.

Sources · 4

1. Courneya KS, Vardy JL, O'Callaghan CJ, et al.; CHALLENGE Investigators (2025). Structured Exercise after Adjuvant Chemotherapy for Colon Cancer. New England Journal of Medicine, 393(1), 13-25. doi.org/10.1056/NEJMoa2502760
2. ClinicalTrials.gov NCT00819208. Colon Health and Life-Long Exercise Change Trial（试验方案与入组条件）. clinicaltrials.gov/study/NCT00819208
3. Courneya KS, Vardy JL, O'Callaghan CJ, et al. (2016). Effects of a Structured Exercise Program on Physical Activity and Fitness in Colon Cancer Survivors: One Year Feasibility Results from the CHALLENGE Trial. Cancer Epidemiology, Biomarkers & Prevention, 25(6), 969-977. doi.org/10.1158/1055-9965.EPI-15-1267
4. Chan KKW, Chu RWK, Cheung MC, et al.; CHALLENGE Investigators (2026). Structured Exercise Program After Adjuvant Chemotherapy for Colon Cancer: A Cost-Utility Analysis of the CHALLENGE Trial. Journal of Clinical Oncology, 44(22), 2130-2139. doi.org/10.1200/JCO-26-00765