Structured Exercise Cuts Colon Cancer Recurrence and Death Risk, Study Finds

• Participants were randomized into two groups — One group received general health education materials encouraging physical activity. The other group received those same materials along with a personalized, three-year exercise program. This program included regular coaching sessions that helped participants gradually increase their activity, focusing on moderate, consistent movement like brisk walking or light jogging.

• The exercise targets were designed to be achievable — The weekly goal was 20 metabolic equivalent tasks (MET)-hours per week, a standard measure of energy expenditure. This is equivalent to five one-hour brisk walks or about two hours of jogging. The program emphasized gradual increases, long-term adherence, and a sustainable, individualized approach rather than intensity or uniform prescriptions.

• Activity levels rose significantly in the exercise group — At baseline, both groups averaged around 10 MET-hours per week. Over time, the exercise group averaged 20 MET-hours, while the education group increased only slightly to about 15.

The exercise group also showed improvements in cardiorespiratory fitness and physical function. Musculoskeletal complaints, such as soreness or mild strains, were reported in 18.5% of the exercise group, compared to 11.5% in the education group, and were generally manageable.

• Exercise improved disease-free survival — After nearly eight years of follow-up, those in the exercise group had a significantly better chance of staying cancer-free. After a follow-up of 7.9 years, five-year disease-free survival was 80.3% in the exercise group compared to 73.9% in the education group. This equates to a 28% relative reduction in risk.

• Overall survival also improved significantly — At eight years, overall survival reached 90.3% in the exercise group and 83.2% in the education group. This represents a 37% relative reduction in the risk of death. The magnitude of this effect is comparable to some conventional cancer therapies, highlighting the clinical value of structured physical activity in recovery.

• Exercise is a beneficial part of standard post-treatment cancer care — According to the study co-chair, Janette Vardy, a Professor at the Faculty of Medicine in Health at the University of Sydney:

“Based on our results, what we should definitely see is that a structured exercise program should be being offered to people at the latest for when they finish their chemotherapy. This shows that exercise isn’t just beneficial, it can be lifesaving.

Something as simple as physical activity can significantly improve life expectancy and long-term outcomes for people with colon cancer. Our findings will change the way we treat colon cancer.”⁵

• Shear pressure from increased blood flow may disrupt tumor processes — Exercise increases cardiac output and blood velocity, creating mechanical forces (shear pressure) along the vascular walls. These forces influence how cancer cells interact with blood vessels and impact the progression or spread of colon cancer.

• Exercise modifies the systemic milieu — Regular physical activity alters the body’s internal hormonal and metabolic environment. These changes, referred to as shifts in the systemic milieu, help reduce factors that support tumor growth and progression.

• Immune function is enhanced by physical activity — The review identified immune activation as a possible mechanism. Exercise improves immune surveillance and supports the body’s ability to detect and respond to cancer cells.

• Extracellular vesicles may mediate signaling effects — Physical activity prompts the release of extracellular vesicles from skeletal muscles. These vesicles contain proteins, microRNAs, and other molecules that influence tumor biology, including inflammation, angiogenesis, and cell signaling.

• Strength training lowered the risk of several major diseases — Resistance-based activities were associated with a 10% to 17% lower risk of death from any cause, along with significantly lower incidence of cardiovascular disease, diabetes, lung cancer, and all cancers combined. These effects were independent of whether the person also did aerobic exercise, highlighting a distinct physiological role for strength work in chronic disease prevention.

• Optimal benefit was seen at moderate weekly doses — The analysis showed the most benefit from 30 to 60 minutes per week of strength training. Relative risk for all-cause mortality reached its lowest point around 40 minutes weekly, while cardiovascular disease saw the steepest drop near 60 minutes.

Beyond those ranges, the protective effect flattened or reversed slightly, which the authors interpret as a possible stress threshold or overuse effect in some populations. For most adults, this translates to two 20- to 30-minute sessions per week.

• Combining strength and cardio amplified results — Participants who did both muscle-strengthening and aerobic activities experienced even greater benefits. The combination was linked to a 40% lower risk of all-cause mortality, a 46% lower risk of cardiovascular death, and a 28% lower risk of dying from cancer.

• Underlying mechanisms likely involve muscle-driven metabolic regulation — Strength training increases or maintains lean muscle mass, which in turn improves insulin sensitivity, glucose metabolism, and systemic inflammation — factors linked to cancer and metabolic disease risk. The review highlights that skeletal muscle plays a direct role in metabolic control, making it a relevant tissue in cancer biology and immune function.

• Moderate activity was consistently beneficial with no upper limit — Moderate physical activity, such as walking, gardening, housework, or recreational cycling, was associated with steady, continuous reductions in cardiovascular and all-cause mortality. In other words, the more people engaged in these moderate forms of movement, the greater the benefit, with no sign of harm even at high volumes.

In addition, activities done for fun, like team sports, racquet games, or active play, had surprisingly strong links to long-term health. These forms of movement tend to be social, enjoyable, and easier to sustain. They may not always feel like workouts, but they still offer protective effects for the heart and brain.

• Vigorous exercises delivered benefits up to a point — The benefits of vigorous activities like running or high-intensity interval training began to level off around 75 minutes per week.

Pushing beyond that threshold didn’t offer more protection, and for some people, especially those in midlife, it slightly increased cardiovascular risks like atrial fibrillation. The takeaway is not to avoid vigorous activity, but to recognize that moderation matters, even when you’re training hard.

• Strength training followed a different pattern entirely — When practiced in balanced doses, strength training supports muscle mass, bone density, metabolism, insulin sensitivity, and even mood and cognitive function. But when overdone, it can backfire.

The graph below from the meta-analysis shows the J-shaped dose-response for strength training activities and all-cause mortality. As you can see, the benefit maxes out right around 40 to 60 minutes a week. Beyond that, you’re losing benefit:

Once you get 130 to 140 minutes of strength training per week, your longevity benefit becomes the same as if you weren’t doing anything. Moreover, if you train for three to four hours a week, you actually end up with worse long-term survival than people who don’t strength train.