Exercise as Cancer Therapy: Nature Reviews Clinical Oncology | October 2026

What Does the Review Highlight?

This review examines whether structured exercise can move beyond supportive cancer care to become an active anticancer therapeutic intervention.

• Cancer prevention: Higher physical activity is consistently associated with lower incidence of several cancers, although observational associations do not establish causality.
• Survival after diagnosis: Exercise is associated with lower cancer-specific and all-cause mortality across multiple malignancies, but randomised evidence remains limited.
• CHALLENGE trial—positive: A phase III trial demonstrated that structured exercise improved disease-free survival and overall survival in patients with colon cancer after surgery and adjuvant chemotherapy.
• ECHO trial—negative: In ovarian cancer, structured exercise during first-line systemic therapy did not improve progression-free survival.
• Exercise and immunotherapy: No adequately powered trial has demonstrated improved tumour response to systemic therapy, including immune checkpoint inhibitors.
• LEANer trial: A promising pathological complete response signal emerged from an underpowered subgroup analysis involving combined exercise and nutritional intervention—not definitive evidence.
• Biological mechanisms: Exercise may modify systemic inflammation, metabolism, immune function and the tumour microenvironment, potentially influencing cancer progression and treatment response.
• Precision exercise oncology: Future trials must establish optimal exercise dose, intensity, timing, patient selection and biological predictors of benefit.

Why Does It Matter?

The CHALLENGE trial represents an important advance: structured exercise improved hard oncological outcomes, not merely fatigue, fitness or quality of life.

However, the contrasting negative ECHO trial demonstrates that exercise cannot yet be assumed to provide equivalent anticancer benefits across different malignancies.

GastroAGI Takeaway

Exercise is moving from supportive care toward evidence-based anticancer therapy—but its disease-modifying benefits are cancer-specific.

For appropriately selected patients with colon cancer who have completed surgery and adjuvant chemotherapy, structured exercise now has randomised phase III evidence supporting improved recurrence-related outcomes and survival.

This strengthens the rationale for integrating supervised, individualised exercise programmes into colorectal cancer survivorship care.