Structured Exercise Improves Disease-Free and Overall Survival in Patients Treated for Colon Cancer
A phase 3 randomized trial published in The New England Journal of Medicine, has demonstrated that a structured exercise program significantly improves disease-free survival in patients with resected colon cancer following adjuvant chemotherapy. The study also found trends consistent with longer overall survival, providing level 1 evidence for incorporating physical activity into post-treatment care plans.
Conducted across 55 centers from 2009 through 2024, the trial randomized 889 patients to either a 3-year structured exercise intervention (n=445) or to a control group that received health-education materials alone (n=444). The primary endpoint was disease-free survival.
At a median follow-up of 7.9 years, disease-free survival was significantly greater in the exercise group. The hazard ratio (HR) for disease recurrence, new primary cancer, or death was 0.72 (95% CI, 0.55–0.94; P=0.02). The 5-year disease-free survival rate reached 80.3% in the exercise group compared to 73.9% in the control group, a difference of 6.4 percentage points (95% CI, 0.6–12.2).
Overall survival data further supported the benefit of exercise. The HR for death in the exercise group was 0.63 (95% CI, 0.43–0.94), with an 8-year survival rate of 90.3% compared to 83.2% in the control group—a 7.1 percentage point improvement (95% CI, 1.8–12.3).
“A 3-year structured exercise program initiated soon after adjuvant chemotherapy for colon cancer resulted in significantly longer disease-free survival,” the authors reported. They added that the results were also “consistent with longer overall survival.”
While the benefits were clear, the study noted an increased incidence of musculoskeletal adverse events in the exercise group, reported in 18.5% of patients versus 11.5% in the health-education group. These findings underscore the importance of individualized exercise prescription and monitoring, particularly in post-treatment cancer populations.
This study delivers the first high-level evidence that structured physical activity post-chemotherapy confers a survival advantage in colon cancer. For practicing gastroenterologists, these results support the integration of supervised exercise counseling into survivorship care planning.
The data indicate that exercise is not merely safe but may be a disease-modifying intervention. As the authors concluded, the findings “support longer overall survival in the exercise group,” adding weight to the growing movement toward lifestyle-focused strategies in oncologic care.
Reference
Courneya KS, Vardy JL, O'Callaghan CJ, et al. Structured exercise after adjuvant chemotherapy for colon cancer. N Engl J Med. Published online June 1, 2025. doi:10.1056/NEJMoa2502760
