{"entity":{"id":"paper-courneya-challenge-structured-exercise-colon-nejm-2025","kind":"paper","name":"Structured exercise after adjuvant chemotherapy for colon cancer (CHALLENGE)","aka":[],"tldr":"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.\n\nFrom 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.","asOf":"2026-09-24","links":[{"label":"N Engl J Med 2025","url":"https://doi.org/10.1056/NEJMoa2502760"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/40450658/"}],"tags":["colorectal-evidence"],"related":["survivorship-roadmap","paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018"],"cancers":["colorectal","colon-cancer"],"sections":["supportive-care","nutrition-lifestyle"],"technologies":["exercise-oncology"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-funding-allocation","b-prevention-adoption"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2025,"doi":"10.1056/NEJMoa2502760","pmid":"40450658","authors":"Courneya KS, Vardy JL, O'Callaghan CJ, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":889},"route":"/key-papers/paper-courneya-challenge-structured-exercise-colon-nejm-2025/","neighbours":{"roadmap":[{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}],"paper":[{"id":"paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018","kind":"paper","name":"Duration of adjuvant chemotherapy for stage III colon cancer (the IDEA collaboration)","route":"/key-papers/paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018/"}],"cancer":[{"id":"colon-cancer","kind":"cancer","name":"Colon cancer (adenocarcinoma of the colon)","route":"/cancers/colon-cancer/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/"}],"bottleneck":[{"id":"b-funding-allocation","kind":"bottleneck","name":"Funding follows fashion, not burden","route":"/bottlenecks/b-funding-allocation/"},{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}],"idea":[{"id":"idea-crc-exercise-as-a-funded-treatment","kind":"idea","name":"Fund structured exercise after colon cancer surgery as a treatment, because a randomised trial says it works as well as a drug","route":"/ideas/idea-crc-exercise-as-a-funded-treatment/"}]}}