Oncology and sustainability: how investing in physical activity fights colon cancer

A few days ago, at the American Society of Clinical Oncology 2025 congress, the results of the Cjallenge (Colon Health and Life-Long Exercise Change) study were presented, the first prospective clinical trial to demonstrate how physical exercise after surgery for cancer can increase the chances of recovery.

This important study randomized 900 patients, who had already undergone surgery and standard postoperative chemotherapy, to two different strategies. The first option consisted of consulting generic informational materials on lifestyle and health, which encouraged patients to practice aerobic sports. The second, instead, involved active participation in a three-year program of structured and supervised physical exercise, following the personalized advice of a trainer. To reach the goal, a brisk walk of 45 minutes 3-4 times a week was sufficient, but the same target was possible with 30 minutes repeated three times a week of various sports or recreational activities. The patient assigned to the active intervention attended motivational support sessions and physical activity classes supervised by the trainer, gradually increasing their physical activity over the course of the semesters.

The study results are dramatic and represent the first solid evidence that a behavioral intervention can increase the chances of recovery. After surgical procedures and traditional chemotherapy, guided exercise practice reduced the chance of colon cancer recurrence or death by 28%, equivalent to an absolute benefit of 7%.

In 2012, the international Avant study – involving over 3,500 patients operated on for colon cancer – aimed to demonstrate that adding an antiangiogenic drug to chemotherapy could increase the chances of recovery by 6% overall. An ambitious goal, but the results were disappointing: no concrete benefits were recorded. Today, however, the same goal has been achieved thanks to the structured physical activity proposed by the Challenge study, without resorting to expensive drug therapies.

In light of this evidence, the Italian College of Chief Physicians of Hospital Medical Oncology (Cipomo) underlines the strategic importance of the results of the Challenge trial, both in clinical and pharmaco-economic terms. If an innovative molecule had found space in the adjuvant treatment of patients operated for intestinal neoplasia - considering that in Italy 40,000 people get colon cancer every year and 25% of them receive post-operative oncological treatments - hundreds of millions of euros would have been spent on pharmacological therapy.