{"entity":{"id":"idea-nl-exercise-dose-finding","kind":"idea","name":"A dose-finding trial for exercise after cancer","aka":[],"tldr":"CHALLENGE proved exercise works in colon cancer but not how much is needed. A trial comparing doses, as we would for a drug, would tell health systems what to fund.","summary":"Drugs get dose-finding; exercise got a single dose (about 10 MET-hours/week above baseline) chosen from cohort data. Cohorts suggest a dose-response with benefit continuing beyond 18 MET-hours/week, but also that the first few hours matter most. Health systems deciding what to reimburse need to know whether a cheaper, lower-dose or unsupervised programme retains most of the benefit.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Survivorship and late effects are neglected): NCI Office of Cancer Survivorship statistics","url":"https://cancercontrol.cancer.gov/ocs/statistics"}],"tags":[],"related":["idea-exercise-as-adjuvant","idea-bio2-exercise-reimbursement"],"cancers":["colorectal","breast-hr-positive"],"sections":["nutrition-lifestyle"],"technologies":["structured-exercise-survivorship","exercise-oncology"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["met-hours","energy-balance"],"trials":["challenge"],"people":[],"bottlenecks":["b-survivorship","b-trial-design","b-prevention-adoption"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"In colon or breast cancer survivors, disease-free survival improves in a dose-dependent manner across 5, 10 and 20 MET-hours/week of supervised activity, with most of the benefit achieved at 10 MET-hours/week, and objectively measured adherence (wearables) rather than prescribed dose predicts outcome.","rationale":"Dose-response evidence converts a single positive trial into a prescribable intervention, defines the minimum effective dose for resource-limited settings, and lets wearables substitute for self-report as the exposure measure.","test":"Three-arm randomised trial (n about 1,500) in stage II-III colon cancer after adjuvant chemotherapy with wearable-verified MET-hours, DFS primary endpoint, embedded cost-effectiveness and a biomarker sub-study (insulin, CRP, ctDNA).","maturity":"early-clinical","actor":"research","cost":"medium","horizonYears":6},"route":"/ideas/idea-nl-exercise-dose-finding/","neighbours":{"idea":[{"id":"idea-bio2-exercise-reimbursement","kind":"idea","name":"Pay for supervised exercise the way we pay for drugs","route":"/ideas/idea-bio2-exercise-reimbursement/"},{"id":"idea-exercise-as-adjuvant","kind":"idea","name":"Structured exercise prescribed like a drug in all curative-intent cancer care","route":"/ideas/idea-exercise-as-adjuvant/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"}],"technology":[{"id":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/"},{"id":"structured-exercise-survivorship","kind":"technology","name":"Structured exercise programmes after curative treatment","route":"/technologies/structured-exercise-survivorship/"}],"term":[{"id":"energy-balance","kind":"term","name":"Energy balance","route":"/terms/energy-balance/"},{"id":"met-hours","kind":"term","name":"MET-hours per week","route":"/terms/met-hours/"}],"trial":[{"id":"rejuv-trial-amico","kind":"trial","name":"AMICO: aerobic or resistance exercise to improve outcome in metastatic colorectal cancer","route":"/trials/rejuv-trial-amico/"},{"id":"challenge","kind":"trial","name":"CHALLENGE (CCTG CO.21)","route":"/trials/challenge/"}],"bottleneck":[{"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/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-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/"}]}}