World-First Clinical Trial Confirms Exercise Boosts Survival in Colon Cancer

A Canadian Cancer Society-funded trial shows a 3-year structured exercise program post-chemotherapy improves survival for colon cancer patients. Involving 889 participants, the trial saw a 28% reduction in recurrence or new cancers and a 37% lower death risk. The 8-year overall survival rate was 90.3% in the exercise group compared to 83.2% in the control group.

World-first clinical trial confirms exercise improves survival for colon cancer. In a landmark clinical trial funded by the Canadian Cancer Society (CCS), structured exercise has emerged as a powerful treatment for colon cancer, marking a turning point in the integration of lifestyle interventions into oncology care. The study, the first of its kind to test whether exercise can directly improve survival in cancer patients, was presented at the American Society of Clinical Oncology (ASCO 2025) annual conference and published in the NEJM.

"Our findings show that exercise is no longer just a quality-of-life intervention for cancer patients that can be offered when and where possible," says study co-chair Dr Kerry Courneya, a professor of kinesiology at the University of Alberta. “It is a treatment for colon cancer that must be made available to all patients.”

The 17-year international  phase 3 trial, known as CHALLENGE, enrolled 889 patients with resected colon cancer who had completed adjuvant chemotherapy. Participants were randomized to either a three-year, moderate-intensity structured exercise program or standard health-education materials. After nearly eight years of follow-up, the exercise group had a 28% lower risk of disease recurrence, new primary cancers, or death compared to the control group. Overall survival was also significantly longer—by a remarkable 7 percentage points at eight years.

Beyond survival, the health economics of exercise as a therapeutic intervention are striking. Dr. Chris Booth, the study’s co-chair and a medical oncologist at Kingston Health Sciences Centre, notes, “This is the first clinical trial in the world designed to answer whether exercise can improve cancer survival, and the results are clear. The next step is to put this into practice. That means health systems will need to invest in behaviour support programs as part of standard care.”

The trial’s design allowed participants to choose their preferred forms of moderate exercise—from brisk walking to pickleball—targeting an additional 2.5 hours of activity per week.

Terri's story

Compliance was supported by regular coaching and accountability, key elements that participant Terri Swain-Collins credits for her ongoing health. Diagnosed with stage 3 colon cancer in 2021, she joined the trial after surgery and chemotherapy.

"One of the biggest benefits was having a semi-structured routine that works for my lifestyle with someone to hold me accountable," says Terri. “Simply being told to exercise by a physician wouldn't have been enough to get me to where I am today; having someone walk alongside me, guide me and check in regularly was what truly made it possible.”

Three years later, she continues to exercise regularly and remains cancer-free.

"By bridging the gap between bold ideas and routine practice, clinical trials are essential to driving research progress that can benefit patients," says Dr. Stuart Edmonds, Executive Vice President at CCS. “The results of this trial have the potential to save and improve lives for the tens of thousands of people in Canada affected by colorectal cancer each year, and we are proud our donors enabled us to support it.”

The international study co-chair was Dr Janette Vardy, from The University of Sydney (Australia) with funding from National Health and Medical Research Council. The UK team was led by Dr Victoria Coyle at Queen's University of Belfast, supported by Cancer Research UK.