A large international clinical trial found that patients with colorectal cancer who completed a structured exercise program following chemotherapy may have experienced better survival outcomes and fewer cancer recurrences compared with those who received health education alone.
In the study, researchers followed 889 patients with stage III or high-risk stage II colorectal cancer. All of the patients had completed surgery and chemotherapy and were randomly assigned to either a 3-year supervised exercise program or a group that received general health information on physical activity and nutrition.
After a median follow-up of 7.9 years, the patients in the exercise group had a 28% lower risk of disease recurrence, new primary cancer, or mortality. Five-year disease-free survival was 80.3% in the exercise group and 73.9% in the health-education group.
Overall survival was also higher with exercise. At 8 years, 90.3% of patients in the exercise group survived compared with 83.2% in the control group—reflecting a 37% lower risk of mortality.
The participants in the exercise group worked with physical activity consultants to increase aerobic activity to at least 10 MET-hours per week—equivalent to three or four brisk walks weekly. Most engaged in moderate-intensity activities such as walking. Throughout the intervention, this group maintained higher activity levels, greater cardiorespiratory fitness, and better physical functioning.
The improvement in disease-free survival was driven by lower rates of cancer recurrence and new primary cancers. Liver recurrence occurred in 3.6% of the exercise group vs 6.5% in the control group. New cancers, including breast and prostate cancers, were also less frequent in the exercise group.
Musculoskeletal adverse events occurred in 18.5% of the exercise group and 11.5% of the control group, with eight adverse events directly linked to exercise. Grade 3 or higher adverse events were reported in 15.4% of the exercise group and 9.1% of the control group.
At baseline, patients had a median age of 61 years and 51% were female. Most had received FOLFOX chemotherapy. Eligibility required less than 150 minutes of weekly exercise and the ability to complete a treadmill or walk test.
The findings, presented at ASCO 2025, supported the potential of structured exercise to improve long-term outcomes in colorectal cancer survivors. Improvements in cardiorespiratory fitness and physical function suggested benefits beyond recurrence risk reduction.
The trial was conducted at 55 sites across multiple countries and led by academic researchers with support from cancer organizations in Canada, Australia, and the United Kingdom.
