{"entity":{"id":"paper-challenge-exercise-nejm-2025","kind":"paper","name":"CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer","aka":[],"tldr":"In CHALLENGE, three years of supervised, goal-based exercise after adjuvant chemotherapy for colon cancer reduced recurrence or death by 28% and deaths by 37%, the first randomised proof that exercise itself improves cancer survival.","summary":"CHALLENGE (CCTG CO.21) randomised 889 patients with resected stage III or high-risk stage II colon cancer who had completed adjuvant chemotherapy to a 3-year structured exercise programme (behavioural support and supervised sessions, targeting an increase of at least 10 MET-hours per week) or to health-education materials alone. The primary endpoint was disease-free survival.\n\nAfter a median follow-up of nearly 8 years, 5-year DFS was 80.3% with exercise versus 73.9% with education (HR 0.72). Eight-year overall survival was 90.3% versus 83.2% (HR 0.63). Physical functioning improved and musculoskeletal adverse events were more common in the exercise arm.\n\nThis is the first phase 3 trial to show that an exercise intervention, rather than exercise as a correlate, lengthens survival in cancer.","asOf":"2026-09-08","links":[{"label":"DOI","url":"https://doi.org/10.1056/NEJMoa2502760"},{"label":"ClinicalTrials.gov NCT00819208","url":"https://clinicaltrials.gov/study/NCT00819208"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/40450658/"}],"tags":[],"related":["idea-exercise-as-adjuvant","idea-bio2-exercise-reimbursement","idea-bio2-gdf15-plus-exercise","survivorship-roadmap","paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018"],"cancers":["colorectal","colon-cancer"],"sections":["nutrition-lifestyle","supportive-care"],"technologies":["exercise-oncology"],"targets":[],"drugs":[],"companies":["cctg"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":["dancey-janet"],"bottlenecks":["b-survivorship","b-prevention-adoption","b-generic-repurposing","b-funding-allocation"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2025,"doi":"10.1056/NEJMoa2502760","pmid":"40450658","authors":"Courneya KS, Vardy JL, O'Callaghan CJ, et al. (Canadian Cancer Trials Group CO.21)","paperType":"rct","findings":["Five-year disease-free survival 80.3% vs 73.9% (HR 0.72, 95% CI 0.55-0.94)","Eight-year overall survival 90.3% vs 83.2% (HR 0.63, 95% CI 0.43-0.94)","Median follow-up 7.9 years across 55 centres in Canada, Australia, the UK, France, Israel and the US","Musculoskeletal adverse events 18.5% vs 11.5%; the programme was delivered by physical activity consultants over 3 years"],"whatItMeans":"For colon cancer survivors, a prescribed, supported exercise programme is now an evidence-based treatment with a survival benefit comparable to many drugs. Health systems will need to fund exercise consultants as they fund chemotherapy. The trial does not tell us whether unsupervised advice achieves the same.","caveats":["The intervention was intensive (behavioural support for 3 years); uptake and cost in routine care are untested","Participants were fit enough to enrol and motivated; benefit in frail or sedentary populations is unproven","Open-label; DFS assessment could be influenced by differential surveillance","Recruitment took 15 years, so adjuvant regimens evolved during the trial"],"changedPractice":true,"participants":889},"route":"/key-papers/paper-challenge-exercise-nejm-2025/","neighbours":{"idea":[{"id":"idea-bio2-gdf15-plus-exercise","kind":"idea","name":"Combine the new anti-wasting antibody with exercise and protein","route":"/ideas/idea-bio2-gdf15-plus-exercise/"},{"id":"idea-crc-exercise-as-a-funded-treatment","kind":"idea","name":"Fund structured exercise after colon cancer surgery as a treatment, because a randomised trial says it works as well as a drug","route":"/ideas/idea-crc-exercise-as-a-funded-treatment/"},{"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/"}],"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/"}],"paper":[{"id":"paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018","kind":"paper","name":"Duration of adjuvant chemotherapy for stage III colon cancer (the IDEA collaboration)","route":"/key-papers/paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018/"}],"cancer":[{"id":"colon-cancer","kind":"cancer","name":"Colon cancer (adenocarcinoma of the colon)","route":"/cancers/colon-cancer/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/"},{"id":"rejuv-frontier-what-works","kind":"technology","name":"What actually works after treatment","route":"/technologies/rejuv-frontier-what-works/"}],"company":[{"id":"cctg","kind":"company","name":"Canadian Cancer Trials Group (CCTG)","route":"/companies/cctg/"}],"person":[{"id":"christopher-booth","kind":"person","name":"Christopher M. Booth","route":"/people/christopher-booth/"},{"id":"dancey-janet","kind":"person","name":"Janet Dancey","route":"/people/dancey-janet/"},{"id":"kerry-courneya","kind":"person","name":"Kerry S. Courneya","route":"/people/kerry-courneya/"}],"bottleneck":[{"id":"b-funding-allocation","kind":"bottleneck","name":"Funding follows fashion, not burden","route":"/bottlenecks/b-funding-allocation/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"},{"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/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}],"trial":[{"id":"challenge","kind":"trial","name":"CHALLENGE (CCTG CO.21)","route":"/trials/challenge/"}]}}