Exercise improved cancer survival – and a Canadian Study leads the way

Opinion published in The Vancouver Sun on June 11, 2025

History was made in the world of cancer research — not with a new drug, but with something far more accessible and powerful: exercise.

A landmark study published in The New England Journal of Medicine has confirmed, for the first time in a randomized controlled trial, that a structured exercise program can significantly improve survival for people treated for early-stage colon cancer. The CHALLENGE trial showed that a 3-year structured exercise program initiated after chemotherapy reduced the risk of cancer recurrence or death by 28%, and improved overall survival by 37% compared to health education alone.

Let that sink in: brisk walking a few times a week can improve survival as much — or more — than many modern cancer drugs, with none of the side effects and at a fraction of the cost.

For years, observational studies hinted that physically active cancer survivors tended to live longer and feel better. But these studies were limited by their design — confounded by the fact that healthier people might be more likely to exercise. Now, the CHALLENGE trial provides the gold-standard evidence we’ve been waiting for – led by Drs. Christopher Booth and Kerry Courneya through the Canadian Cancer Trials Group (CCTG), this ‘first-in-class’ trial enrolled 889 patients in Canada, Australia, and the UK and confirmed that supervised exercise with behaviour change support improves both disease-free and overall survival, while enhancing physical functioning and quality of life.

This has profound implications for cancer care — and for our health system.

First, it’s time to redefine “treatment.” Cancer care has long focused on surgery, chemotherapy, and radiation. But what happens after treatment is often an afterthought. Survivors may be left with side effects, fatigue, and fear of recurrence, and limited resources to support them. The CHALLENGE trial flips that paradigm: recovery isn’t passive. Exercise is not a “nice to have” — it is a powerful, life-prolonging intervention.

Second, access to structured exercise programs are not currently a standard-of-care for cancer survivors in Canada. That must change. These programs require relatively modest investment compared to the high costs of systemic therapies — yet they deliver survival benefits on par with expensive drugs. And unlike drugs, exercise can also reduce cardiovascular risk, improve mental health, and enhance overall quality of life.

Third, this is a Canadian success story. The CHALLENGE trial was conceived, led, and executed by Canadian investigators. The Canadian Cancer Society, together with global partners, funded this 15-year effort — a testament to the power of sustained investment in publicly funded clinical research. At a time when Canada’s health research ecosystem faces financial strain, the success of CHALLENGE highlights what’s possible when we back bold ideas with the resources they deserve.

Finally, the findings call on all of us — policymakers, cancer agencies and clinicians — to act. We must embed exercise into survivorship care across the country and telling people to exercise is not enough. This will require funding to support exercise professionals in cancer centres and the community, build incentives for survivor-focused programming, and eliminate structural barriers to participation. Survivorship care is not optional — it’s essential.

Of course, exercise is not a cure-all. Some patients may be unable to participate due to comorbidities or limitations. But for the majority, supervised aerobic activity like walking or cycling can and should be part of the care plan. Importantly, the CHALLENGE program was designed to be adaptable and accessible — guided by behavioral science, delivered by trained consultants, and tailored to each patient’s fitness level.

We should applaud the CHALLENGE investigators, the Canadian Cancer Trials Group, and the hundreds of patients who participated in this transformative trial. Their commitment will change how we support people after cancer — not just in Canada, but around the world.  Now, it’s our turn to rise to the challenge.