If you have finished surgery and chemotherapy for colon cancer, join a guided exercise program and keep at it for a full three years

Cost

Exercise like walking costs nothing. Going to a hospital rehabilitation department or an exercise-prescription clinic for a fitness assessment and an exercise program means a registration fee and exam fees, and a private trainer costs extra. You spend several more hours a week exercising and have to keep it up for three years. People who exercised had somewhat more muscle and joint injuries.

What you get

A randomized trial at 55 centers (CHALLENGE) enrolled 889 patients with colon cancer. All had finished surgery and adjuvant chemotherapy, had high-risk stage II or stage III disease, and had no metastasis when they enrolled. They enrolled 2 to 6 months after chemotherapy ended, and before enrolling they exercised less than 150 minutes a week. 445 joined a three-year exercise program, and 444 received only health education materials. In the first 6 months of the program they met an exercise coach every two weeks to talk about how to keep going, and also exercised once under the coach's eye. From 6 to 12 months this changed to in-person or phone sessions, and after that, until year 3, only minimal support remained. The goal was 10 more MET-hours (a unit for measuring the amount of exercise) of exercise per week than before; any exercise of moderate intensity or above counted, and the program expected most people to choose walking. At 1 year, the exercise group had 15.6 more MET-hours of recreational exercise per week, and the control group had 5.1 more. Median follow-up was 7.9 years. Recurrence, a new cancer or death was about 28% lower in the exercise group than in the control group, HR 0.72 (95% CI 0.55–0.94). At 5 years, the share without these events was 80.3% versus 73.9%. Death was about 37% lower, HR 0.63 (0.43–0.94). The share still alive at 8 years was 90.3% versus 83.2%. Musculoskeletal adverse events were 18.5% versus 11.5%. The cost analysis of the same trial, based on Canada's publicly funded health care, found that the exercise program cost 2917 Canadian dollars per person up front, but because there were fewer recurrences, the total 5-year cost was 1589 Canadian dollars per person lower

Notes

The trial enrolled only colon cancer, not rectal cancer, and only people whose surgery removed all of the cancer, who finished chemotherapy and who had no metastasis. So it can't be applied directly to other cancers or to people with advanced disease. The main result was recurrence, a new cancer or death. Overall death was a secondary result, and the authors' wording is "consistent with living longer," not a firm conclusion. There is no ready-made program like this in China; you can ask the oncology or rehabilitation medicine department for an exercise prescription. Do a fitness assessment before you start; in the trial everyone took an exercise test before enrolling. For how to count walking, see §2.11 (walk 7000–8000 steps a day). For strength training, see §2.16 (strength training). The beneficiary is mainly you.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. 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
2. 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
3. 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
4. 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

Translated from the Chinese original. Original book, section 16, tip 14. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer