Loading
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.
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].
Why: Exercise during treatment improves fitness, strength and tiredness, and being inactive makes recovery slower.
“Oncology providers should recommend regular aerobic and resistance exercise during active treatment with curative intent and may recommend preoperative exercise for patients undergoing surgery for lung cancer.”
Why: Most people can simply start; some side effects need the programme adjusting to avoid falls or injury.
“No comorbidities No further pre-exercise medical evaluation * Follow general exercise recommendations Peripheral neuropathy, arthritis/musculoskeletal issues, poor bone health (e.g., osteopenia or osteoporosis), lymphedema Recommend pre-exercise medical evaluation * Modify general exercise recommendations based on assessments Consider referral to trained personnel”
American College of Sports Medicine, Medicine and Science in Sports and Exercise 2019
Why: These carry a higher risk of harm during exercise, such as fracture or a heart problem, and need a supervised programme.
“Lung or abdominal surgery, ostomy, cardiopulmonary disease, ataxia, extreme fatigue, severe nutritional deficiencies, worsening/changing physical condition (i.e., lymphedema exacerbation), bone metastases Pre-exercise medical evaluation * and clearance by physician prior to exercise Referral to trained personnel”
American College of Sports Medicine, Medicine and Science in Sports and Exercise 2019
Why: Requiring tests first puts people off; most can start gentle exercise safely without them.
“For this reason, no assessments are required to start low intensity aerobic training (i.e., walking or cycling), resistance training with gradual progression, or a flexibility program in most survivors.”
American College of Sports Medicine, Medicine and Science in Sports and Exercise 2019
Why: This is the dose that most consistently improved tiredness, mood, physical function and quality of life in trials.
“Based on the current literature, an effective exercise prescription that most consistently addresses health-related outcomes experienced due to a cancer diagnosis and cancer treatment includes moderate intensity aerobic training at least 3 times per week, for at least 30 minutes, for at least 8–12 weeks. The addition of resistance training to aerobic training, at least 2 times per week, using at least 2 sets of 8–15 repetitions at least 60% of one repetition maximum, appears to results in similar benefits”
American College of Sports Medicine, Medicine and Science in Sports and Exercise 2019
Why: Weakened bone can break under heavy or sudden loads.
“Avoid contraindicated movements that place an excessively high load on fragile skeletal sites. These include the following: high-impact loads, hyperflexion or hyperextension of the trunk, flexion or extension of the trunk with added resistance, and dynamic twisting motion”
American College of Sports Medicine, Medicine and Science in Sports and Exercise 2019
Why: A trained professional can tailor the programme to the person's treatment and side effects and keep it safe.
“best practice cancer care to include referral to an accredited exercise physiologist or physiotherapist with experience in cancer care.”
Why: In a large randomised trial a coached three-year programme lowered the chance of the cancer coming back or of dying.
“Patients with resected stage III or high-risk stage II colon cancer should be informed of the available evidence suggesting survival benefits from a structured exercise programme [I, A].”
ESMO, ESMO Open 2026 · [I, A]
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
For everyone during curative treatment, ASCO 2022 (recommend aerobic and resistance exercise) and the ACSM 2019 roundtable (dose, triage, avoid inactivity) agree; COSA 2018 goes further in calling referral to an accredited exercise professional best practice. After colon cancer, ESMO's 2026 Express Update is the strongest graded recommendation read, resting on the CHALLENGE trial: inform eligible patients [I, A] and recommend a structured programme after shared decision-making [II, B; MCBS A]. No guideline read yet extends the survival claim to other cancers.
ASCO, Journal of Clinical Oncology 2022 · American College of Sports Medicine, Medicine and Science in Sports and Exercise 2019 · COSA, Medical Journal of Australia 2018 · ESMO, ESMO Open 2026 · New England Journal of Medicine 2025
Where it differs: Three years of behavioural support and supervised exercise, aiming for an increase of at least 10 MET-hours a week in recreational aerobic activity (about 150 minutes of moderate activity), starting soon after adjuvant chemotherapy.
Evidence: Phase 3 trial of 889 patients: disease-free survival hazard ratio 0.72 (95 per cent confidence interval 0.55 to 0.94); hazard ratio for death 0.63; musculoskeletal adverse events 18.5 against 11.5 per cent. ESMO 2026 notes adherence to supervised sessions fell from 79 per cent in months 1 to 6 to 44 per cent in months 13 to 36.
Where it differs: Exercise before an operation rather than during or after treatment.
Evidence: ASCO 2022: may be recommended, because it reduced postoperative length of stay and complications in patients with lung cancer.
Where it differs: A consensus panel set 11 good-practice recommendations for older survivors on medical clearance, pre-exercise assessment, prescription, tolerance and safety, delivery and behavioural support, aiming to keep barriers low.
Evidence: Consensus (GRADE evidence-to-decision framework for good practice statements, 85 per cent agreement threshold), not graded evidence.
A three-year supervised exercise programme after chemotherapy cut recurrence and death by roughly a third in 889 patients, an effect the size of adjuvant chemotherapy. No health system has a funding line for it.
Getting fitter and better nourished before an operation reduces complications and speeds recovery. It is cheap, but only a few hospitals do it.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Participation in a structured exercise programme after colon cancer “After discussion and joint decision making on exercise intensity and implementability, participation of eligible patients in a structured exercise programme can be recommended [II, B; ESMO-Magnitude of Clinical Benefit Scale (MCBS) v2.0 score: A].” | [II, B; ESMO-MCBS v2.0 score: A] | ESMO, ESMO Open 2026 |
| Exercise reduces fatigue during treatment “1.1. Clinicians should recommend exercise (aerobic, resistance, or a combination) to reduce the severity of fatigue during cancer treatment.” | Moderate; Strong | ASCO and SIO, Journal of Clinical Oncology 2024 |
| Disease-free survival with structured exercise after colon cancer “At a median follow-up of 7.9 years, disease-free survival was significantly longer in the exercise group than in the health-education group (hazard ratio for disease recurrence, new primary cancer, or death, 0.72; 95% confidence interval [CI], 0.55 to 0.94; P = 0.02).” | phase 3 randomised trial, P = 0.02 | New England Journal of Medicine 2025 |
Shares CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer, Exercise & lifestyle oncology and the tags exercise, survivorship, supportive-care.
Shares Cancer-related fatigue (tiredness), Exercise & lifestyle oncology, European Society for Medical Oncology (ESMO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, survivorship.
Shares European Society for Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO) and the tags protocol, survivorship.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares Structured exercise programmes after curative treatment, The exercise prescription after cancer: the dose the guidelines state, Exercise & lifestyle oncology and the tags exercise, survivorship.
Shares Fund structured exercise after colon cancer surgery as a treatment, because a randomised trial says it works as well as a drug, Structured exercise programmes after curative treatment, Exercise during chemotherapy and radiotherapy, Cancer-related fatigue (tiredness) and the tag survivorship.
Shares European Society for Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.