The message is clear; the time has arrived for a “Call to Action” so say two powerful editorials from the New England Journal of Medicine and British Journal of Sports Medicine.
Together, “Time to fund exercise programmes for cancer survivors” and “Exercise Extends Survival: Oncology Must Act Now” deliver a unified and urgent message: structured exercise is now an evidence-based adjuvant therapy that improves survival for patients with cancer, and the oncology community must respond. These editorials underscore that exercise is not optional wellness advice—it is actionable, measurable, and increasingly essential to modern cancer care.
Why These Editorials Matter for Clinicians
For clinicians, these editorials reshape the landscape of survivorship care. The most compelling evidence is the CHALLENGE trial, a large, international randomized controlled trial of 889 patients with stage II and III colon cancer showing that a structured, behaviorally supported exercise program improved both disease-free and overall survival compared with an education-only control group. Patients in the exercise arm achieved 90% overall survival at eight years versus 83% in the control group and experienced significantly reduced recurrence risk (HR 0.72). These survival differences rival, and in some cases exceed, the magnitude of benefit from certain systemic therapies.
Clinically, this evidence elevates physical activity from supportive care to a core therapeutic intervention. The editorials stress that the benefits of exercise occur independently of weight loss, shifting the focus toward biologic and immunometabolic pathways—reduced inflammation, beneficial cytokine/myokine profiles, enhanced immune surveillance, and reduced circulating tumor cells. For clinicians, this means exercise has cancer-specific mechanistic relevance, not merely general health benefits.
The editorials also call for professional responsibility. Oncology organizations, guideline committees, and national cancer-control programs must formally reevaluate their recommendations considering new RCT data. Previous “limited-no conclusion” assessments of physical activity and colon cancer survival are now outdated. Clinicians are urged to advocate for structured exercise pathways with the same seriousness as pharmacologic interventions.
Why These Editorials Matter for Patients
For patients, these editorials translate into empowerment, clear direction, and reassurance that lifestyle actions can directly influence survival. The evidence shows that moderate-to-vigorous physical activity—especially when supported through structured programs—can meaningfully reduce recurrence risk and prolong life. Importantly, the CHALLENGE intervention relied heavily on sustainable activity such as walking, supported by behavioral counseling. This makes it highly accessible for most survivors.
Patients also benefit from understanding that exercise is safe during survivorship, effective across age groups, independent of weight change, and synergistic with medical therapy. The message is concrete: moving more, and doing so consistently, is medicine.
System-Level Importance for Both Groups
A major theme across both editorials is that effective implementation requires more than individual effort. Much like cardiac rehabilitation, exercise oncology programs need stable funding, insurance coverage, and integration into routine care pathways. System-level barriers—not patient willingness—are the largest obstacles. Thus, both clinicians and patients are encouraged to advocate for policy changes that include:
- Coverage for supervised or semi-supervised exercise oncology programs
- Embedding exercise physiologists within cancer centers
- Routine referrals and standardized exercise prescriptions
- National cancer guidelines updated to reflect survival benefits
The editorials frame these investments as “best buys,” simultaneously improving outcomes, reducing recurrence-related costs, and enhancing quality of life.
A Call to Action
For clinicians, the call to action is to initiate conversations, provide exercise prescriptions, and refer patients to structured programs. For patients, the call is to engage in regular movement, seek professional guidance when possible, and understand that exercise is an evidence-based component of cancer therapy—not an optional afterthought.
Together, these editorials mark a turning point: exercise oncology has moved from promising to proven. With compelling RCT evidence, mechanistic plausibility, and strong patient-centered benefits, both clinicians and patients are urged to embrace exercise as a key component of cancer survivorship care.
References:
Time to fund exercise programmes for cancer survivors: the evidence is mounting, Fei-Fei Liu, Karim M Khan, Rae SM Yeung: Br J Sports Med 2025;0:1–2. doi:10.1136/bjsports-2025-110638
Extending Cancer Survival with Exercise: Time for Oncology to Act, Melinda L. Irwin, Ph.D., NEJM 393;1 NEJM.ORG July 3, 2025 DOI: 10.1056/NEJMe2506363
