Colon cancer patients who are supported to do regular exercise are more likely to survive the disease, according to a trial we helped fund. 

As well as showing that exercise can cut the risk of death and cancer recurrence, the results highlight the importance of personalised support in helping people develop the right routine for them.

“For an intervention that isn’t a drug, exercise offers remarkable benefits for patients,” said Professor Charles Swanton, our chief clinician. “For some people with colon cancer, physical activity can be a game-changer that shifts the course of their recovery.”

Patients on the CO21 CHALLENGE trial had already finished their cancer treatment, which included surgery and chemotherapy, but they still faced a risk that their cancer could come back. The researchers wanted to see if increasing their activity levels would help them stay well.

Half of the people who took part received standard health education materials with guidance on exercise and healthy eating, while the rest were given regular support from a trainer to help them reach a weekly exercise target.

After five years, 80% of people supported to do structured exercise remained cancer free, compared with 74% of those who were given the standard booklets. At eight years, 90% of people with structured exercise programmes were still alive, up from 83% in the health education materials group.

Overall, the patients in the structured programme were 37% less likely to die in the eight years following their treatment.

Professor Vicky Coyle at the University of Belfast, who led the research in the UK, said: “During the trial, we supported people to reach their weekly exercise target in a way that worked for them. This could be a brisk walk for around 40 minutes every day, but some patients were also doing circuit classes, cycling, swimming, and many other activities.  

“Our study gives clear, encouraging evidence that physical activity can reduce the risk of cancer returning for some people with colon cancer. We now need to work with policymakers and healthcare providers to embed exercise into treatment plans where appropriate.” 

More than an academic exercise

Research has already shown that exercise can lower the risk of people developing certain cancers – including colon cancer, which is a form of bowel cancer.  

The CHALLENGE trial took a different approach, focusing on whether exercise could help people stay cancer free after finishing treatment for stage 2 or 3 colon cancer. All 889 participants were well enough to exercise when they joined, but none of them were meeting recommended activity levels. 

The structured exercise programme tested in the trial lasted three years and involved people regularly meeting with an expert physical activity consultant. For the first six months, participants received in-person coaching sessions every week. Over time, this was reduced to one session per month, either in person or online.

The goal was to increase exercise levels by at least the equivalent of a 30-minute jog every other day. On average, people in the structured exercise group did more than twice as much.

While the health materials offered valuable information about exercise, the results indicate that expert support makes a crucial difference. The trial’s physical activity consultants helped people find and develop exercise routines that matched their abilities, preferences and normal activity levels.

Margaret Tubridy, a 69-year-old from North Belfast who took part in the trial, said: “I had never exercised in my life, but with the right support and encouragement I was able to walk more and more. From there I started going to classes at the gym and now I do weight training twice a week, pole walking, and I’m in a walking group. I had never been to a gym before, but once I was shown how to use the machines and do the exercises, I loved it.  

“It’s been almost five years since my cancer diagnosis and if I meet anyone, I tell them I am doing great. Taking part in the trial helped me so much – I am stronger, fitter, and my anxiety is better. I never thought at 69 years of age I would be able to do all of this – I am chuffed to bits.” 

Exercise as cancer treatment

The CHALLENGE trial didn’t directly investigate the reasons for exercise’s positive effect on colon cancer survival, but researchers believe it could be linked to the way physical activity helps regulate hormone levels, reduce inflammation, and strengthen the immune system. 

Dr Joe Henson, an Associate Professor in Lifestyle Medicine at the University of Leicester who worked on the trial, said: “Leading the exercise sessions in Leicester, I saw firsthand that they reduced fatigue, lifted people’s mood and boosted their physical strength. We know that physical activity regulates several key biological processes that could explain these results, and further research will help us uncover why.” 

As that research continues, the CHALLENGE trial’s findings give policymakers and health services a clear reason to start focusing on using tailored exercise support to help more people survive cancer. 

Caroline Geraghty, our senior specialist information nurse, said: “Being active has many benefits, and this study shows that exercise doesn’t only improve wellbeing – it can also boost people’s chances of surviving colon cancer. 

“Everyone recovering from cancer should have access to tailored support to help them live longer, better lives. This trial has the potential to transform clinical practice, but only if health services have the necessary funding and staff to make it a reality for patients. 

“It’s important to remember that every cancer journey is different – starting new activities after treatment can feel overwhelming, and it may not be the right option for everyone. Take things at your own pace and speak to your doctor to discuss what is safe for you.”