# Structured exercise after adjuvant chemotherapy for colon cancer (CHALLENGE)

Source: https://onco.cc/key-papers/paper-courneya-challenge-structured-exercise-colon-nejm-2025/  
OnCo record `paper-courneya-challenge-structured-exercise-colon-nejm-2025` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A three-year supervised exercise programme after chemotherapy cut recurrences and deaths by about a third. It is the first randomised proof that exercise itself is cancer treatment.

## Summary

Courneya, Vardy, O'Callaghan and colleagues conducted a phase 3 randomised trial at 55 centres, assigning patients with resected colon cancer who had completed adjuvant chemotherapy to a structured exercise programme or to health-education materials alone over three years. The primary end point was disease-free survival.

From 2009 through 2024, 889 patients underwent randomisation: 445 to exercise and 444 to health education. The 15-year enrolment period is itself part of the finding, because a trial of this design attracts no commercial sponsor.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: colorectal-evidence
- Journal: New England Journal of Medicine
- Year: 2025
- DOI: 10.1056/NEJMoa2502760
- Authors: Courneya KS, Vardy JL, O'Callaghan CJ, et al.
- Findings: At a median 7.9 years, disease-free survival was significantly longer with exercise: hazard ratio 0.72 (95 percent CI 0.55 to 0.94, p=0.02).; Five-year disease-free survival 80.3 percent against 73.9 percent (difference 6.4 percentage points, 95 percent CI 0.6 to 12.2).; Overall survival hazard ratio 0.63 (0.43 to 0.94); eight-year overall survival 90.3 percent against 83.2 percent (difference 7.1 percentage points, 1.8 to 12.3).; Musculoskeletal adverse events in 18.5 percent of the exercise group against 11.5 percent of the health-education group.
- What it means: An effect size comparable to adjuvant chemotherapy, from a behavioural intervention with no drug cost, which makes the delivery problem (who funds the trainers) the binding constraint rather than the evidence.
- Caveats: The intervention is a supervised programme with a behaviour-support consultant, not advice to exercise; health systems have no funding line for it.; Open-label with a health-education comparator, so the effect includes everything that comes with structured contact.; Colon cancer after adjuvant chemotherapy; it does not speak to rectal cancer or to the metastatic setting.

## Sources

- N Engl J Med 2025: https://doi.org/10.1056/NEJMoa2502760
- PubMed: https://pubmed.ncbi.nlm.nih.gov/40450658/

## Connected records

- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)
- key papers: [Duration of adjuvant chemotherapy for stage III colon cancer (the IDEA collaboration)](https://onco.cc/key-papers/paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018/)
- cancers: [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/), [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- 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/)
- bottlenecks: [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- ideas: [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/)

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