I vividly remember my patient who had just finished chemotherapy and surgery for stage 3 colon cancer. She looked at me and asked if there was anything she could do — anything more than just waiting and following up with scans. She was in remission, technically cancer free, but the silence that followed her treatment left her anxious.
I told her to live her life and try not to think about it. But I also knew she deserved more than that.
As an oncologist, I’ve spent years focused on the intricacies of systemic therapy — chemotherapy dosing, molecular profiling, clinical trial eligibility. But when it comes to survivorship, we often go quiet. We don’t have a roadmap. And yet, that’s when many patients feel most vulnerable.
A landmark New England Journal of Medicine study published in June of this year reminded me that sometimes the most powerful intervention is also the simplest one: exercise.
The CHALLENGE trial followed nearly 900 people with high-risk stage 2 or 3 colon cancer for almost a decade. After completing surgery and chemotherapy, participants were randomly assigned to either receive health education materials or take part in a structured, three-year exercise program guided by certified physical activity consultants.
The results were striking. After nearly eight years of follow-up, those in the exercise group had a 28% lower risk of cancer recurrence, a new primary cancer, or death. Their risk of death from any cause was 37% lower. Overall survival in the exercise group was 90.3%, compared to 83.2% in the control group.
In other words: Exercise isn’t just safe during cancer recovery — it may actually help save lives.
Patients in the exercise group were coached to gradually increase the intensity of their physical activity by about 10 metabolic equivalent task (MET) hours per week — the equivalent of 45 to 60 minutes of brisk walking, three to four times a week. They also received behavioral support to help maintain that level of activity across the full three years.
Crucially, the benefits weren’t tied to weight loss. There were no meaningful differences in body weight or waist circumference between groups.
Instead, researchers point the benefit likely came from improved metabolic function, reduced inflammation, better immune surveillance, or other biological mechanisms that help suppress microscopic tumor cells left behind after treatment.
And the benefits didn’t stop at colon cancer. Fewer participants in the exercise group developed new primary cancers — including breast, prostate, and colorectal tumors. Liver metastases, one of the most common recurrence sites in colon cancer, were also less frequent.
Yes, musculoskeletal issues were slightly more common in the exercise group, but most were mild and manageable. What patients achieved in return was far more impactful: Patients also saw notable improvements in cardiorespiratory fitness, walking distance, and physical functioning, which are key predictors of long-term health and quality of life, especially after chemotherapy.
These findings should prompt a rethinking of cancer care guidelines and reinforce the need for insurance-covered support programs that make structured exercise accessible. The key to the CHALLENGE intervention wasn’t just movement. It was the structure and behavioral reinforcement that made patients more likely to sustain it over time.
Too often, when chemotherapy ends, the scaffolding falls away. But survivorship isn’t the absence of disease — it’s a phase that demands its own kind of care. Recurrence risk lingers. Uncertainty hangs heavy. And patients are often left to navigate their recovery alone. We owe them more than follow-up scans and reassuring words.
This trial drives home a basic but powerful truth: Moving your body matters.
It’s time for exercise to be more than an afterthought in oncology. We need guidelines that reflect the evidence — and systems that empower patients to act on it. Because when treatment ends, patients don’t just need hope. They need a roadmap.
And now, thanks to the CHALLENGE trial, we finally have one worth following.
Do you integrate structured exercise into standard cancer care? Share in the comments.
Khushali Jhaveri, MD, India-bred and recently transplanted to Indiana via Tampa, Florida, and Washington, DC, is a lymphoma specialist at Indiana University in Indianapolis.
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