Structured exercise as an adjuvant therapy in colon cancer:
Key message: study found a 3-year structured exercise program initiated soon after adjuvant chemotherapy resulted in significantly longer disease-free survival at median follow-up of 7.9 years.
In this phase 3, randomized trial conducted at 55 centers, patients with resected colon cancer who had completed adjuvant chemotherapy were assigned to participate in a structured exercise program (exercise group) or to receive health-education materials alone (health-education group) over a 3-year period. The primary end point was disease-free survival:
- from 2009 through 2024, a total of 889 patients underwent randomization to the exercise group (445 patients) or the health-education group (444 patients)
- goal of the exercise program was to increase recreational aerobic exercise from baseline by at least 10 metabolic equivalent task (MET)–hours per week during the first 6 months and then to maintain or further increase the amount during the final 2.5 years
- focus was on promoting aerobic exercise of at least moderate intensity, such as brisk walking, which has an intensity of approximately 4 METs (MET values indicate the intensity of the activity, not time)
- Brisk walking for an hour has a value of 4 MET-hours
- note that patients could choose the type, frequency, intensity, and duration of aerobic exercise
- at a median follow-up of 7.9 years, disease-free survival was significantly longer in the exercise group than in the health-education group (hazard ratio for disease recurrence, new primary cancer, or death, 0.72; 95% confidence interval [CI], 0.55 to 0.94; P=0.02)
- the 5-year disease-free survival was 80.3% in the exercise group and 73.9% in the health-education group (difference, 6.4 percentage points; 95% CI, 0.6 to 12.2)
- the study authors concluded "...found that a 3-year structured exercise program that was initiated within 6 months after the completion of adjuvant chemotherapy for colon cancer improved disease-free survival. The intervention also resulted in findings that were consistent with improved overall survival, patient-reported physical functioning, and objective physical functioning and fitness as compared with health education alone, with only a modest increase in musculoskeletal adverse events. Our trial provides robust evidence of a substantial benefit-to-harm ratio in favor of structured exercise over a sedentary lifestyle and supports its incorporation into standard care. Knowledge alone, however, is unlikely to change patient behavior and outcomes. To achieve meaningful increases in exercise will require that health systems invest in behavior-support programs..."
Reference:
- Courney KS et al. Structured Exercise after Adjuvant Chemotherapy for Colon Cancer. N Engl J Med June 1st 2025.