# Exercise during and after cancer treatment: assessment, dose and referral

Source: https://onco.cc/protocols/exercise-during-and-after-cancer-treatment/  
OnCo record `exercise-during-and-after-cancer-treatment` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Exercise is safe for most people during and after cancer treatment and helps with tiredness, fitness, strength and mood. The usual aim is to build up to about 30 minutes of moderate activity such as brisk walking three times a week, plus strength exercise twice a week, starting low. Some people should be checked first, for example with cancer in the bones, heart or lung disease, or nerve damage.

## Summary

ASCO (2022) recommends that oncology providers recommend regular aerobic and resistance exercise during active treatment with curative intent, and says preoperative exercise may be recommended before lung cancer surgery. The ACSM roundtable (2019) concluded that exercise testing and training are generally safe, that every survivor should avoid inactivity, and that moderate aerobic training at least three times a week for at least 30 minutes, for 8 to 12 weeks, with or without resistance training twice a week, improves anxiety, depression, fatigue, physical function and quality of life. It adapts the NCCN triage: no further evaluation for people without comorbidities; a pre-exercise medical evaluation for neuropathy, musculoskeletal problems, poor bone health or lymphoedema; and evaluation, clearance and referral to trained staff for bone metastases, recent lung or abdominal surgery, an ostomy, cardiopulmonary disease, ataxia, extreme fatigue or severe malnutrition. COSA (2018) calls for referral to an accredited exercise physiologist or physiotherapist as best practice.

The CHALLENGE trial (2025) is the first phase 3 evidence of a survival effect: a three-year structured programme started after adjuvant chemotherapy for colon cancer lengthened disease-free survival (5-year 80.3 against 73.9 per cent, hazard ratio 0.72), with findings consistent with longer overall survival. The ESMO Express Update (2026) now says patients with resected stage III or high-risk stage II colon cancer should be told of this evidence and of their eligibility [I, A], and that participation can be recommended after shared decision-making [II, B; ESMO-MCBS A].

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: exercise prescription in cancer; physical activity after cancer; exercise oncology; structured exercise after colon cancer; CHALLENGE exercise programme; avoid inactivity
- Tags: protocol; exercise; survivorship; supportive-care

## Connected records

- protocols: [Cancer-related fatigue: screening, treatable causes and management](https://onco.cc/protocols/cancer-related-fatigue-screening-and-management/), [Chronic pain in cancer survivors: assessment, non-opioid treatment first and careful opioid use](https://onco.cc/protocols/chronic-pain-in-cancer-survivors/), [Lymphoedema after breast cancer: risk reduction, surveillance, early compression and treatment](https://onco.cc/protocols/lymphoedema-risk-reduction-surveillance-and-treatment/)
- cancers: [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Exercise during chemotherapy and radiotherapy](https://onco.cc/technologies/exercise-during-chemotherapy/), [Structured exercise programmes after curative treatment](https://onco.cc/technologies/structured-exercise-survivorship/), [The exercise prescription after cancer: the dose the guidelines state](https://onco.cc/technologies/exercise-prescription-after-cancer/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/)
- terms: [Bone metastases and skeletal-related events](https://onco.cc/terms/bone-metastases/), [Cancer-related fatigue (tiredness)](https://onco.cc/terms/cancer-related-fatigue/)
- key papers: [CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer](https://onco.cc/key-papers/paper-challenge-exercise-nejm-2025/)
- ideas: [Four weeks of training and nutrition before major cancer surgery, as standard](https://onco.cc/ideas/idea-bio2-prehabilitation-standard/), [Fund structured exercise after colon cancer surgery as a treatment, because a randomised trial says it works as well as a drug](https://onco.cc/ideas/idea-crc-exercise-as-a-funded-treatment/)

---
JSON: https://onco.cc/api/v1/entities/exercise-during-and-after-cancer-treatment.json