# Exercise & lifestyle oncology

Source: https://onco.cc/technologies/exercise-oncology/  
OnCo record `exercise-oncology` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Structured exercise during and after treatment, which the CHALLENGE trial showed improves survival in colon cancer.

## Summary

The CHALLENGE trial (NEJM 2025) randomised colon cancer survivors to a structured exercise programme and showed improved disease-free and overall survival, the first level-1 evidence that exercise changes cancer outcomes. Exercise also reduces fatigue, cardiotoxicity, and chemotherapy-induced neuropathy.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-04
- Principle: Aerobic and resistance training modulate insulin, inflammation, and immune function.
- Strengths: Cheap, safe, patient-controlled
- Limitations: Delivery and adherence at scale

## Sources

- CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer (New England Journal of Medicine 2025): https://doi.org/10.1056/NEJMoa2502760
- ClinicalTrials.gov NCT02750826: BWEL (Breast Cancer Weight Loss, Alliance A011401): https://clinicaltrials.gov/study/NCT02750826

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early-onset colorectal cancer (under 50)](https://onco.cc/cancers/early-onset-colorectal/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/), [Prevention & Risk](https://onco.cc/fronts/prevention/), [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- companies: [Canadian Cancer Trials Group (CCTG)](https://onco.cc/companies/cctg/), [Osara Health](https://onco.cc/companies/osara-health/), [Outperform Cancer](https://onco.cc/companies/outperform-cancer/), [Perci Health](https://onco.cc/companies/perci-health/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/), [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/), [Paths to cures: interception, eradication, control](https://onco.cc/roadmaps/cure-paths/), [Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it](https://onco.cc/roadmaps/rejuvenation-roadmap/), [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)
- ideas: [A dedicated programme for cachexia and treatment toxicity research](https://onco.cc/ideas/idea-fund-cachexia-programme/), [A dose-finding trial for exercise after cancer](https://onco.cc/ideas/idea-nl-exercise-dose-finding/), [A survivorship research endowment funded by a levy on curative therapy prices](https://onco.cc/ideas/idea-fund-survivorship-endowment-levy/), [Aggregated single-patient crossover trials for symptom and supportive treatments](https://onco.cc/ideas/idea-tr1-aggregated-n-of-1-supportive-care/), [Catch wasting early with a smart scale and a step counter](https://onco.cc/ideas/idea-bio2-remote-weight-step-monitoring/), [Combine the new anti-wasting antibody with exercise and protein](https://onco.cc/ideas/idea-bio2-gdf15-plus-exercise/), [Evidence-based integrative oncology in every cancer centre to meet demand safely](https://onco.cc/ideas/idea-moon-integrative-oncology-bridge/), [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/), [Get the one approved appetite drug licensed beyond a single country](https://onco.cc/ideas/idea-bio2-anamorelin-access/), [Multimodal prehabilitation for older patients before major cancer surgery](https://onco.cc/ideas/idea-acc-prehabilitation-older-surgery/), [Pay for supervised exercise the way we pay for drugs](https://onco.cc/ideas/idea-bio2-exercise-reimbursement/), [Qualify a physical function endpoint so anti-wasting drugs can be approved](https://onco.cc/ideas/idea-bio2-cachexia-function-endpoint/), [Read muscle loss automatically from scans patients already have](https://onco.cc/ideas/idea-bio2-ai-sarcopenia-from-ct/), [Structured exercise prescribed like a drug in all curative-intent cancer care](https://onco.cc/ideas/idea-exercise-as-adjuvant/), [Test protein and resistance training during immunotherapy](https://onco.cc/ideas/idea-bio2-protein-plus-training-during-io/), [Treat cachexia as a disease: GDF-15 blockade plus anabolic and nutrition bundles](https://onco.cc/ideas/idea-moon-cachexia-as-treatable-disease/), [Treat cachexia before it starts](https://onco.cc/ideas/idea-cachexia-gdf15-prevention/), [Treat wasting like sepsis: a trigger, a bundle, an audit](https://onco.cc/ideas/idea-bio2-cachexia-pathway-code/), [Trials of structured cognitive rehabilitation for cancer-related cognitive impairment](https://onco.cc/ideas/idea-acc-cognitive-rehabilitation-after-chemotherapy/)
- technologies: [After treatment in Australia: a stated model of survivorship care](https://onco.cc/technologies/rejuv-access-survivorship-care-australia/), [Cachexia-directed therapy (GDF-15 blockade)](https://onco.cc/technologies/cachexia-therapy/), [Cancer neuroscience: cutting the nerve supply](https://onco.cc/technologies/nerve-tumour-denervation/), [Cardiopulmonary exercise testing: the hardest number in recovery](https://onco.cc/technologies/rejuv-measure-cardiopulmonary-exercise-testing/), [Cognitive behavioural therapy for fatigue and distress](https://onco.cc/technologies/cbt-fatigue-distress/), [Compression, decongestive therapy and exercise for lymphoedema](https://onco.cc/technologies/lymphoedema-decongestive-therapy/), [CT body composition and sarcopenia measurement](https://onco.cc/technologies/ct-body-composition-sarcopenia/), [Dance and movement therapy](https://onco.cc/technologies/dance-movement-therapy/), [Dietitian-led weight-loss programmes in HR-positive breast cancer](https://onco.cc/technologies/dietitian-led-weight-loss-breast/), [Electronic patient-reported outcomes and remote monitoring](https://onco.cc/technologies/remote-patient-monitoring/), [Evidence-based integrative oncology](https://onco.cc/technologies/integrative-oncology/), [Exercise during chemotherapy and radiotherapy](https://onco.cc/technologies/exercise-during-chemotherapy/), [Exercise is the best-evidenced thing on this front, and most survivors are not doing it](https://onco.cc/technologies/rejuv-access-exercise-programmes/), [Frailty and late effects in survivors](https://onco.cc/technologies/rejuv-age-frailty-and-late-effects/), [Mediterranean and plant-forward dietary patterns](https://onco.cc/technologies/mediterranean-plant-forward-diet/), [Metabolic therapy: starving the tumour of a nutrient](https://onco.cc/technologies/metabolic-therapy/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [Resistance training and protein for cachexia and sarcopenia](https://onco.cc/technologies/resistance-training-cachexia/), [Sleep and circadian interventions in cancer](https://onco.cc/technologies/sleep-circadian-interventions/), [Structured exercise programmes after curative treatment](https://onco.cc/technologies/structured-exercise-survivorship/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [Systematic drug repurposing](https://onco.cc/technologies/drug-repurposing/), [Tai chi and qigong](https://onco.cc/technologies/tai-chi-qigong/), [The exercise prescription after cancer: the dose the guidelines state](https://onco.cc/technologies/exercise-prescription-after-cancer/), [Walking, gripping and standing up: the tests that take five minutes](https://onco.cc/technologies/rejuv-measure-functional-tests/), [What actually works after treatment](https://onco.cc/technologies/rejuv-frontier-what-works/), [Yoga during and after cancer treatment](https://onco.cc/technologies/yoga-cancer/)
- people: [Christopher M. Booth](https://onco.cc/people/christopher-booth/), [Kerry S. Courneya](https://onco.cc/people/kerry-courneya/), [Virginia Sun](https://onco.cc/people/virginia-sun/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Rehabilitation is recommended everywhere and commissioned almost nowhere](https://onco.cc/bottlenecks/rejuv-agenda-rehabilitation-not-commissioned/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)
- pathways: [Cancer cachexia](https://onco.cc/pathways/cachexia-biology/), [Lipid synthesis, uptake & cholesterol](https://onco.cc/pathways/lipid-metabolism-cancer/)
- key papers: [CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer](https://onco.cc/key-papers/paper-challenge-exercise-nejm-2025/)
- terms: [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [MET-hours per week](https://onco.cc/terms/met-hours/)
- trials: [AMICO: aerobic or resistance exercise to improve outcome in metastatic colorectal cancer](https://onco.cc/trials/rejuv-trial-amico/), [BWEL (Breast Cancer Weight Loss, Alliance A011401)](https://onco.cc/trials/bwel/), [CHALLENGE (CCTG CO.21)](https://onco.cc/trials/challenge/), [PREHAB: multimodal prehabilitation before colorectal cancer surgery](https://onco.cc/trials/prehab-trial/)
- institutions: [European Society for Clinical Nutrition and Metabolism](https://onco.cc/institutions/espen/), [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/), [Olivia Newton-John Cancer Wellness and Research Centre](https://onco.cc/institutions/onj-cancer-centre/), [Wilmot Cancer Institute, University of Rochester](https://onco.cc/institutions/wilmot/)
- collections: [LIVESTRONG at the YMCA](https://onco.cc/collections/livestrong-at-the-ymca/), [Penny Brohn UK](https://onco.cc/collections/penny-brohn-uk/)

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