After surgery and adjuvant chemotherapy for colon cancer, participate in a structured exercise program and maintain it for three years

For individuals completing surgery and adjuvant chemotherapy for colon cancer, participating in a 3-year structured, supervised exercise program reduced recurrence, secondary cancers, or death by 28%, and lowered overall mortality by 37%. At 8 years, ~90% of guided exercisers were alive compared to ~83% of those receiving educational materials alone.

Low cost. Aerobic exercises like brisk walking cost nothing; clinical baseline fitness assessment and exercise prescription at hospital rehabilitation or sports medicine clinics incur outpatient registration fees. Committing several hours weekly over a 3-year structured protocol requires sustained willpower. Exercisers experience slightly higher rates of minor musculoskeletal strains.

The multicenter CHALLENGE randomized controlled trial conducted across 55 medical centers enrolled 889 high-risk stage II or stage III colon cancer patients who had completed curative resection and adjuvant chemotherapy without metastasis (enrolled 2–6 months post-chemotherapy, baseline physical activity <150 minutes/week). Participants were randomized to a 3-year structured exercise program (n=445) or health education materials (n=444). The intervention featured bi-weekly behavioral support meetings with physical activity consultants for the first 6 months with supervised exercise, shifting to monthly in-person/phone contacts from months 6–12, and minimal maintenance support through year 3. The goal was adding 10 metabolic equivalent of task (MET)-hours/week of physical activity (achievable via brisk walking). At 1 year, recreational physical activity increased by 15.6 MET-hours/week in the exercise group vs. 5.1 in controls. Over a median follow-up of 7.9 years, disease-free survival (recurrence, new primary cancer, or death) was 28% higher in the exercise group (HR 0.72, 95% CI: 0.55–0.94); 5-year disease-free survival was 80.3% vs. 73.9%. Overall mortality was reduced by 37% (HR 0.63, 95% CI: 0.43–0.94); 8-year overall survival was 90.3% vs. 83.2%. Musculoskeletal adverse events occurred in 18.5% vs. 11.5%. Economic evaluation using Canadian healthcare costs revealed that despite an initial program cost of 2,917 CAD per patient, reduced cancer recurrence resulted in a net 5-year savings of 1,589 CAD per patient.

The CHALLENGE trial strictly enrolled colon cancer patients (excluding rectal cancer) who had undergone complete curative resection and chemotherapy without distant metastases; findings cannot be generalized to advanced metastatic disease or other malignancies. Overall mortality was a secondary endpoint; authors noted findings are consistent with extended survival. Consult oncology and rehabilitation specialists for individualized exercise prescriptions and baseline cardiopulmonary assessments. Daily walking volume benchmarks are covered in Chapter 2, Rule 11. Resistance strength training is detailed in Chapter 2, Rule 16. Beneficiary is yourself.

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. https://doi.org/10.1056/NEJMoa2502760；ClinicalTrials.gov NCT00819208. Colon Health and Life-Long Exercise Change Trial（试验方案与入组条件）. https://clinicaltrials.gov/study/NCT00819208；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. https://doi.org/10.1158/1055-9965.EPI-15-1267；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. https://doi.org/10.1200/JCO-26-00765