Kathryn H. Schmitz, PhD, MPH and Jennifer A. Ligibel, MD
Summary: Cancer Fitness by Jay K. Harness, MD, FACS
This commentary highlights a transformative message for modern cancer care: exercise is one of the most powerful therapies available to patients with cancer, improving symptoms, quality of life, and—crucially—survival. Yet unlike a medication, exercise requires behavioral change, supportive infrastructure, and policy reform before it can be fully integrated into oncology practice.
A central impetus for this editorial is the CHALLENGE trial, a landmark study of 889 patients with stage II–III colon cancer who had completed adjuvant chemotherapy. Patients assigned to a three-year supervised aerobic exercise program experienced a 28% improvement in disease-free survival and an even more striking 37% improvement in overall survival compared with usual care. These gains were driven by fewer distant recurrences and fewer second primary cancers. Such results represent the strongest evidence to date that structured exercise after a cancer diagnosis can directly influence long-term outcomes, not just quality of life. For physicians, this trial elevates exercise from a supportive recommendation to a bona fide survival-enhancing intervention.
The commentary emphasizes that patients and clinicians must understand what constitutes an evidence-based exercise oncology program. Decades of research summarized by the American College of Sports Medicine (ACSM) demonstrate that exercise reduces fatigue, anxiety, depression, sleep disturbance, body composition changes, and lymphedema. Typically, effective prescriptions involve at least 30 minutes of moderate aerobic exercise three times per week, plus resistance training twice weekly. However, the exercise “dose” needed to improve survival or reduce recurrence may differ and remains an active area of research.
Importantly, most patients cannot succeed with exercise by receiving a brochure or a verbal recommendation alone. Behavioral support is crucial. The CHALLENGE trial incorporated supervised exercise, regular coaching, and theory-based behavior-change strategies. For patients, this underscores that exercise is safe, achievable, and far more successful when supported by trained professionals.
The commentary stresses the need for specialized exercise providers. Some patients may need physical therapy due to frailty or treatment-related limitations; others benefit from oncology-trained exercise physiologists. Credentialing programs, such as the ACSM/ACS Cancer Exercise Specialist certification, help ensure patient safety and appropriate expertise.
A key message for physicians is the importance of triaging patients to the right level of support. The EXCEEDS tool, highlighted in the article, offers a validated way to guide patients toward oncology rehabilitation, supervised programs, or community resources. Page 3 also features an infographic outlining the stakeholders—clinicians, administrators, exercise professionals, accreditation bodies, and payers—needed to build a national infrastructure for exercise oncology.
Finally, the commentary calls attention to the policy and reimbursement barriers limiting access. Unlike drugs, lifestyle interventions face slow adoption. To prevent a decades-long delay like diabetes-prevention programs, oncology must develop accreditation standards, secure CMS reimbursement, and generate return-on-investment analyses showing that exercise programs cost a fraction of modern systemic therapies.
For both patients and physicians, the message is clear: exercise is a safe, accessible, evidence-based therapy that can improve survival and quality of life, but realizing its full potential requires system-level change. Until exercise is delivered with the same rigor as medical treatments, patients will not receive the full benefits that this powerful “non-pill” therapy offers.
Reference: JCO- Comments and Controversies-https://doi.org/10.1200/JCO-25-01649
