Jay K. Harness, MD, FACS
Over the past two decades, Exercise Oncology has moved from a supportive adjunct to a scientifically grounded therapeutic strategy. A convergence of high-quality randomized trials, implementation frameworks, and global policy calls now places the field at a decisive inflection point. Six 2025 publications highlighted here collectively argue that exercise is no longer optional or aspirational in cancer care—it is evidence-based, clinically meaningful, and ready for systematic integration.(1-6) Together, they signal that Exercise Oncology has reached a positive tipping point for patients, clinicians, and healthcare systems.
From Association to Causation: Survival Benefits Are Now Proven
The most transformative advance comes from the CHALLENGE trial and its accompanying editorials, which provide definitive randomized evidence that structured exercise improves both disease-free and overall survival in cancer patients. In stage II–III colon cancer, a three-year, behaviorally supported aerobic exercise program reduced recurrence, secondary cancers, and mortality, producing survival benefits comparable in magnitude to many approved oncologic therapies.
For patients, this marks a profound shift in expectations. Exercise is no longer framed solely as a way to reduce fatigue or improve quality of life—though it does both very well—but as an intervention capable of extending life itself. The question “Does exercise work?” has been answered with a resounding YES.
A Broad Spectrum of Benefits Across the Cancer Continuum
Beyond survival, decades of prior research summarized in these publications confirm that exercise improves physical function, cardiometabolic health, mental well-being, treatment tolerance, and recovery after therapy.
Exercise reduces cancer-related fatigue, anxiety, depression, sleep disturbance, and musculoskeletal decline, while enhancing independence and participation in daily life. These benefits span the entire cancer continuum—from prehabilitation and active treatment through survivorship and, when appropriate, palliative care.
Crucially, these outcomes matter deeply to patients. Living longer with cancer increasingly means living with treatment-related impairments and comorbidities. Exercise addresses what many patients identify as their most pressing concerns: strength, stamina, cognitive clarity, autonomy, and the ability to return to work and family roles. As survivorship populations expand globally, exercise emerges as one of the few interventions capable of simultaneously improving longevity and lived experience.
Implementation Is the New Frontier
If the evidence base is now strong, the implementation gap remains the central challenge. Several of the featured publications explicitly argue that the field must move from proof to practice. The analogy that “if exercise were a pill, we would all prescribe it” captures the paradox: exercise has drug-like efficacy but lacks drug-like infrastructure.
These authors outline what evidence-based exercise oncology programs require: appropriate dosing (frequency, intensity, time, and type), behavioral support to sustain adherence, trained professionals with oncology-specific expertise, and triage systems to match patients to the right level of supervision. Importantly, they emphasize that telling patients to “be more active” is insufficient. Structured, supported programs—much like cardiac rehabilitation—are what deliver durable benefits.
Calls to Action for Health Systems and Policymakers
Across all six publications, the calls to action are remarkably aligned. Health systems are urged to embed exercise into standard oncology pathways, rather than offering it as an optional or externally referred service. This includes integrating exercise assessment into routine care, embedding qualified exercise professionals within oncology teams, and leveraging community-based and telehealth models to improve access.
At the policy level, authors argue that reimbursement and accreditation standards must evolve. Just as nutrition services became mandated within accredited cancer centers, Exercise Oncology should be recognized as a core component of quality cancer care. The absence of consistent funding is no longer defensible given the strength of the evidence. Investment in exercise programs is framed not as a cost, but as a high-value strategy with potential returns in reduced recurrence, fewer complications, improved productivity, and lower long-term healthcare utilization.
Equity and Global Reach
Another defining feature of this tipping point is the global perspective. The call to action for physical activity implementation in Sub-Saharan Africa highlights exercise as a uniquely scalable, low-cost intervention in resource-constrained settings.
While acknowledging major gaps in infrastructure, workforce, and data, the authors argue that excluding exercise from cancer control strategies perpetuates inequity. Global organizations, funders, and academic partners are urged to support culturally adapted, region-specific programs so that the benefits of exercise oncology are not limited to high-income countries.
Similarly, the broader survivorship planning framework emphasizes that supportive care—including exercise—is essential for sustaining societal functioning as cancer prevalence rises worldwide.
Exercise is positioned not only as a clinical intervention, but as a public health investment with implications for workforce participation, caregiving burden, and economic resilience.
A Cultural Shift in Oncology Practice
Perhaps the most striking theme across these publications is cultural change. Oncology has long prioritized treatments that target tumors, often underestimating interventions that strengthen the patient. Exercise Oncology challenges this paradigm by reframing physical activity as a biologically active, patient-empowering therapy that complements—and amplifies—medical treatment.
For clinicians, this shift offers renewed agency: exercise is something they can prescribe today, with immediate benefits and minimal harm. For patients, it restores a sense of control at a time often dominated by passivity and side effects. For healthcare systems, it provides a rare opportunity to improve outcomes while aligning care with patient values and long-term sustainability.
Conclusion: The Moment to Act Is Now
Taken together, these six publications make a compelling case that Exercise Oncology has reached a positive tipping point. The science is robust, the benefits are multidimensional, and the pathways to implementation are increasingly clear. What remains is the will to act.
Embedding exercise as a standard component of cancer care will require leadership from clinicians, administrators, payers, and policymakers. But the rewards—for survival, quality of life, equity, and system efficiency—are substantial. Exercise is no longer merely supportive care. It is effective, evidence-based cancer therapy, and the time to integrate it fully into oncology practice is now.
References:
- Structured Exercise after Adjuvant Chemotherapy for Colon Cancer. Courneya, KS, Vardy, JL, O’Callaghan, CJ, et al. N Engl J Med 2025;393:13-25 DOI:10.1056/NEJMoa2502760
- If Exercise Were a Pill, We’d All Prescribe It to Patients With Cancer. But It’s Not. Schmitz, KH, Ligibel, JA, J Clin Oncol 44 (1), 5-8, DOI: 10.1200/JCO-25-01649.
- Extending Cancer Survival with Exercise–Time for Oncology to Act. Irwin, ML. N ENGL J MED 393;1 NEJM.ORG July 3, 2025.
- Time to fund exercise programmes for cancer survivors: the evidence is mounting. Liu, F-F, Khan, KM, Yeung, RSM. Br J Sports Med 2025;0:1–2.doi:10.1136/bjsports-2025-110638.
- Physical activity implementation for cancer care and prevention in Sub-Saharan Africia: a call to action. Douryang, M, Belinda, YNI, Pillay, L. Br J Sports Med 2025;0:1–2.doi:10.1136/bjsports-2025-110720
- Planning for cancer: building accessible and high-quality survivorship care for all. Haywood, D, Chan, A, Lustberg, MB, et al. Trends in Cancer, Month 2025, (In Press) https://doi.org/10.1016/j.trecan.2025.12.006
