# CHALLENGE (CCTG CO.21)

Source: https://onco.cc/trials/challenge/  
OnCo record `challenge` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The first randomised trial to show that a coached exercise programme after cancer treatment reduces recurrence and death, in colon cancer.

## Summary

889 patients across Canada, Australia, UK, Israel and the US were randomised within 2-6 months of completing adjuvant chemotherapy to a structured exercise programme delivered by physical activity consultants (behavioural support sessions and supervised exercise, tapering over three years, targeting an increase of 10 MET-hours/week) or to health-education materials. Median follow-up 7.9 years. Disease-free survival at 5 years 80.3% vs 73.9% (HR 0.72, 95% CI 0.55-0.94); overall survival at 8 years 90.3% vs 83.2% (HR 0.63, 95% CI 0.43-0.94). Physical functioning and VO2 improved in the exercise arm; musculoskeletal adverse events were more common (18.5% vs 11.5%). The effect size is comparable with adding oxaliplatin to fluoropyrimidine adjuvant therapy. Limitations: one disease, open-label, participants were relatively fit volunteers, and the intervention required a trained workforce.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-08
- Registry id: NCT00819208
- Phase: 3
- Setting: Resected stage III or high-risk stage II colon cancer after adjuvant chemotherapy: 3-year structured exercise programme vs health-education materials
- Sponsor: Canadian Cancer Trials Group
- Enrolled: 889
- Result: DFS HR 0.72; OS HR 0.63; 8-year OS 90.3% vs 83.2%.
- Outcomes: Disease-free survival at 5 years: Structured exercise 80.3% vs Health education 73.9%, HR 0.72; Overall survival at 8 years: Structured exercise 90.3% vs Health education 83.2%, HR 0.63
- Replication: None yet; CHALLENGE-design trials in breast and prostate cancer are being planned. Consistent with decades of cohort data on physical activity and colon cancer survival.

## Sources

- ClinicalTrials.gov NCT00819208: https://clinicaltrials.gov/study/NCT00819208
- Courneya et al. (NEJM 2025): https://doi.org/10.1056/NEJMoa2502760

## Connected records

- ideas: [A dose-finding trial for exercise after cancer](https://onco.cc/ideas/idea-nl-exercise-dose-finding/), [Pay for supervised exercise the way we pay for drugs](https://onco.cc/ideas/idea-bio2-exercise-reimbursement/), [Structured exercise prescribed like a drug in all curative-intent cancer care](https://onco.cc/ideas/idea-exercise-as-adjuvant/)
- cancers: [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early-onset colorectal cancer (under 50)](https://onco.cc/cancers/early-onset-colorectal/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/)
- technologies: [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Structured exercise programmes after curative treatment](https://onco.cc/technologies/structured-exercise-survivorship/), [The exercise prescription after cancer: the dose the guidelines state](https://onco.cc/technologies/exercise-prescription-after-cancer/)
- drugs: [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/)
- companies: [Canadian Cancer Trials Group (CCTG)](https://onco.cc/companies/cctg/)
- institutions: [Canadian Cancer Society](https://onco.cc/institutions/canadian-cancer-society/), [Princess Margaret Cancer Centre](https://onco.cc/institutions/princess-margaret/)
- terms: [Absolute versus relative benefit (number needed to treat)](https://onco.cc/terms/absolute-benefit/), [Decentralised trial](https://onco.cc/terms/decentralised-trial/), [Energy balance](https://onco.cc/terms/energy-balance/), [Event-free / disease-free survival (EFS, DFS, iDFS, RFS)](https://onco.cc/terms/efs/), [Hazard ratio (HR)](https://onco.cc/terms/hazard-ratio/), [MET-hours per week](https://onco.cc/terms/met-hours/), [Overall survival (OS)](https://onco.cc/terms/os/), [Pragmatic trial](https://onco.cc/terms/pragmatic-trial/), [Randomised trial](https://onco.cc/terms/randomised-trial/)
- trials: [AMICO: aerobic or resistance exercise to improve outcome in metastatic colorectal cancer](https://onco.cc/trials/rejuv-trial-amico/), [IDEA collaboration](https://onco.cc/trials/idea-collaboration/), [MOSAIC](https://onco.cc/trials/mosaic/)
- people: [Christopher M. Booth](https://onco.cc/people/christopher-booth/), [Kerry S. Courneya](https://onco.cc/people/kerry-courneya/)
- bottlenecks: [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/)
- key papers: [CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer](https://onco.cc/key-papers/paper-challenge-exercise-nejm-2025/)
- roadmaps: [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/), [Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it](https://onco.cc/roadmaps/rejuvenation-roadmap/), [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/), [Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on](https://onco.cc/roadmaps/trial-modernisation-roadmap/)

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