Can Exercise Reduce Cancer Recurrence? What the CHALLENGE Trial Tells Us
Updated: Oct 12
CANCER & REHABILITATION | RESEARCH REVIEW
By Rosy | Registered Associate Nutritionist (ANut) & Level 4 Cancer Exercise Rehabilitation Specialist
Updated October 2026 | Approximately 6-minute read
Exercise has long been recognised for its role in improving physical fitness, managing fatigue and supporting quality of life during and after cancer treatment. But emerging research suggests its benefits may extend beyond physical recovery.
Could structured exercise also influence the likelihood of cancer returning or improve long-term survival?
A landmark randomised controlled trial published in the New England Journal of Medicine in 2025 provides compelling evidence that exercise may improve disease-free survival following treatment for colon cancer (Courneya et al., 2025).
These findings are an important development in exercise oncology, but understanding what the research actually demonstrates is essential.
What is the CHALLENGE trial?
The CHALLENGE trial was a large, international randomised controlled trial involving 889 people who had undergone surgery for colon cancer and completed adjuvant chemotherapy.
Participants were randomly assigned to one of two groups:
Structured exercise: A three-year exercise programme incorporating professional coaching, behavioural support and individually tailored physical activity.
Health education: Participants received health education materials without the structured exercise intervention.
Researchers assessed disease-free survival, overall survival and adverse events over several years. Unlike observational studies, which identify associations between physical activity and health outcomes, randomised controlled trials can provide stronger evidence of a causal relationship. This makes the CHALLENGE trial particularly important (Courneya et al., 2025).
What did the researchers find?
The findings were encouraging. At five years, disease-free survival was higher in the structured exercise group than in the health education group.
This represents an absolute difference of 6.4 percentage points, favouring the exercise group. The researchers also reported a hazard ratio of 0.72 for disease recurrence, new primary cancer or death, indicating a 28% lower relative hazard of experiencing the combined outcome during follow-up (Courneya et al., 2025).
Importantly, that does not mean every participant experienced a 28% reduction in their individual risk of cancer recurrence.
The study also reported findings consistent with improved overall survival.
At eight years, overall survival was 90.3% in the exercise group compared with 83.2% in the health education group, an absolute difference of 7.1 percentage points (Courneya et al., 2025).
These results suggest that structured exercise following treatment for colon cancer may offer meaningful benefits beyond improvements in fitness and physical function.
Does this mean exercise prevents cancer from returning?
Not necessarily, and this is where careful interpretation matters.
The CHALLENGE trial provides strong evidence that a structured exercise programme improved disease-free survival in the population studied.
However, disease-free survival is a combined outcome encompassing cancer recurrence, new primary cancers and death.
The findings should therefore not be interpreted as demonstrating that exercise prevents cancer recurrence in every individual or across all cancer types.
There is also a substantial body of research examining physical activity following other cancer diagnoses.
For example, a large umbrella review by Filis et al. (2025), examining 740 meta-analytic associations, identified strong or highly suggestive evidence linking physical activity after breast cancer diagnosis with improved outcomes, including lower all-cause mortality and recurrence.
However, much of the evidence relating to recurrence and survival across different cancers comes from observational research.
Although these associations are encouraging, observational studies cannot establish cause and effect with the same confidence as a well-conducted randomised controlled trial.
The CHALLENGE findings strengthen the case for exercise as an important component of cancer care, while highlighting the need for further research across different cancer populations.
The wider benefits of exercise during and after cancer
Even where evidence relating to recurrence is less certain, the benefits of appropriately prescribed exercise for physical function and wellbeing are well established.
International exercise guidelines identify evidence that aerobic and resistance training can help improve:
Cancer-related fatigue
Muscular strength and physical function
Cardiorespiratory fitness
Health-related quality of life
Anxiety and depressive symptoms in some populations
(Campbell et al., 2019).
The American Society of Clinical Oncology (ASCO) also recommends aerobic and resistance exercise during active cancer treatment with curative intent, where appropriate, to help manage treatment-related effects and preserve physical capacity (Ligibel et al., 2022).
Importantly, these recommendations are based largely on improvements in symptoms, physical function and wellbeing. Evidence that exercise during active treatment improves cancer recurrence or survival outcomes remains less conclusive.
This distinction is important when discussing the different benefits of exercise with people living with and beyond cancer.
Is exercise always safe after cancer treatment?
Exercise is generally considered safe and beneficial for many people affected by cancer when it is appropriately prescribed.
However, cancer and its treatments can create additional considerations that may affect exercise selection, intensity and progression.
These can include:
Persistent cancer-related fatigue
Peripheral neuropathy and balance difficulties
Reduced mobility or muscular strength
Bone health concerns, including osteoporosis or bone metastases
Cardiovascular complications or treatment-related changes in heart function
Lymphoedema or other treatment-related limitations
International guidelines emphasise the importance of adapting exercise to the individual, with additional assessment and medical guidance where indicated (Campbell et al., 2019). Exercise is not entirely without risk.
In the CHALLENGE trial, musculoskeletal adverse events were reported in 18.5% of participants receiving the exercise intervention, compared with 11.5% in the health education group (Courneya et al., 2025).
This reinforces the value of appropriately structured programmes, individual assessment and gradual progression.
A personal and professional perspective
My interest in cancer exercise rehabilitation is both professional and personal.
Following my own breast cancer diagnosis in 2023, returning to exercise became an important part of rebuilding my physical strength and confidence.
However, the process was far from straightforward.
Fatigue, treatment-related side effects and changes in my physical capabilities meant that activities I had previously taken for granted could suddenly feel challenging.
Progress was gradual, and learning to adapt my expectations became an important part of recovery. That experience strengthened my commitment to supporting others navigating similar challenges.
I subsequently completed my Level 4 CanRehab Cancer & Exercise Rehabilitation qualification, building on my existing background in nutrition and personal training.
My approach combines professional knowledge with an understanding that recovery is rarely linear. Exercise needs to be appropriate to the individual, their medical circumstances and their current capabilities.
The goal is not simply to return to a previous level of fitness, but to support physical function, confidence and quality of life in a way that is realistic and sustainable.
What does this research mean for people living with and beyond cancer?
The CHALLENGE trial represents an important step forward in our understanding of exercise and cancer outcomes.
For people who have completed treatment for colon cancer and have circumstances similar to those studied, the findings support the potential value of structured exercise as part of ongoing care.
For people affected by other cancers, the wider research continues to support physical activity for its established benefits in strength, fatigue management, physical functioning and wellbeing.
However, exercise recommendations should always be individualised.
The most appropriate starting point will depend on factors such as cancer diagnosis, treatment history, current symptoms, physical capacity and medical considerations.
For some people, this may involve gradually rebuilding everyday activity. For others, a structured combination of aerobic and resistance exercise may be appropriate.
The aim is not to exercise as much as possible, but to find an appropriate level of activity that supports recovery, health and quality of life.
The takeaway
The CHALLENGE trial provides compelling evidence that structured exercise following treatment for colon cancer can improve disease-free survival, with findings also consistent with improved overall survival.
Alongside established evidence for improvements in fatigue, strength, physical function and wellbeing, the findings reinforce the important role exercise can play in comprehensive cancer care.
Exercise is not a replacement for oncology treatment, nor does it guarantee protection against cancer recurrence. But when appropriately prescribed, it can be a valuable tool in supporting physical recovery and long-term health. For those living with and beyond cancer, specialist guidance can help make the journey back to exercise feel safer, more manageable and more achievable.
Specialist Cancer Exercise Rehabilitation with ROSY
At ROSY, we offer personalised cancer exercise rehabilitation to support people living with and beyond cancer.
Our programmes take account of individual needs, treatment-related effects and physical capabilities, with a focus on rebuilding strength, improving physical function and developing confidence in movement.
Disclaimer: This article is intended for general educational purposes and does not constitute individual medical advice. Exercise during or after cancer treatment should take account of personal medical circumstances, treatment-related effects and any relevant recommendations from the oncology team. Specialist assessment or medical clearance may be necessary before beginning or progressing an exercise programme.
References
Campbell, K.L. et al. (2019) 'Exercise guidelines for cancer survivors: Consensus statement from International Multidisciplinary Roundtable', Medicine & Science in Sports & Exercise, 51(11), pp. 2375–2390. Available at: https://doi.org/10.1249/MSS.0000000000002116
Courneya, K.S. et al. (2025) 'Structured exercise after adjuvant chemotherapy for colon cancer', New England Journal of Medicine, 393(1), pp. 13–25. Available at: https://doi.org/10.1056/NEJMoa2502760
Filis, P. et al. (2025) 'Grading the evidence for physical activity and any outcome in cancer survivors: An umbrella review of 740 meta-analytic associations', Critical Reviews in Oncology/Hematology, 207, 104602. Available at: https://doi.org/10.1016/j.critrevonc.2024.104602
Ligibel, J.A. et al. (2022) 'Exercise, diet, and weight management during cancer treatment: ASCO guideline', Journal of Clinical Oncology, 40(22), pp. 2491–2507. Available at: https://doi.org/10.1200/JCO.22.00687
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