Exercise and Cancer Survival: Using Digital to Unlock Results at Scale

July 22, 2025

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The Colon Health and Lifelong Exercise Change (CHALLENGE) trial, conducted by the Canadian Cancer Trials Group and presented at ASCO 2025, will go down in history as a pivotal moment in cancer research. The question we have to ask now is: How can we use these findings to impact real-world care at scale?

The Colon Health and Lifelong Exercise Change (CHALLENGE) trial, conducted by the Canadian Cancer Trials Group and presented at ASCO 2025, will go down in history as a pivotal moment in cancer research: when science could finally prove (instead of relying on data that's purely a correlation) that regular exercise improves survival outcomes.

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For decades, observational data has signaled that patients with colorectal cancer who engage with exercise after treatment appear to have less risk of recurrence and live longer. However, with just cross-sectional data we could not make conclusions about cause and effect; Reverse causality may have been at play. But thanks to the CHALLENGE trial we can now tell patients with Stage III or Stage II high-risk colon cancer, exercise therapy has the potential to reduce the risk of recurrent or new cancer and increase survival.

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The question we have to ask now is: How can we use these findings to impact real-world care at scale? Understanding the study is the critical first step in answering this question.

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The CHALLENGE Trial Under The Spotlight: Contact Time Matters

Good science requires a solid research question based on a grounded hypothesis, sound methodology, collaboration, and most importantly: time and patience. The Phase III CHALLENGE Trial followed patients across 55 centers in six countries between 2009 and 2024, following each individual patient for 8 years — and checked all of these boxes.

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The study set out to examine the potential impact of long-term exercise therapy in patients with Stage III or Stage II high-risk colorectal cancer post-chemotherapy and surgery. In total 889 patients with a median age of 61 were randomized 1:1 to intervention or control. Patients in the control group received a health-education booklet only while those in the intervention group undertook a long-term structured exercise program. This included up to 72 face-to-face sessions over a 3-year period with intensive behavioral support from an exercise specialist who aimed to help the patient build up to and maintain 150 minutes of aerobic exercise a week.

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So what did they find? At 5 years disease-free survival was 80.3% in the exercise group and 73.9% in the health-education group. At 8 years the overall survival was 90.3% and 83.2% respectively. Just how impressive are these results? Dr. Julie Gralow, ASCO’s chief medical officer had this to say:

From what I see, the real reason this study worked is that intervention cohort members were provided constant behavioral support to make this change in exercise a long-term habit. They stuck with it. And that takes long-term, hands-on support — something Sidekick knows all about.

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Lessons Learned From Cardiovascular Disease‍

This is not the first time exercise has been shown to impact disease progression and survival. A Cochrane Review has shown that in patients with coronary heart disease, exercise-based rehabilitation reduces the risk of heart attack, all-cause mortality, and all-cause hospitalization, along with associated healthcare costs, and improves quality of life (Dibben et al. 2021). It’s no surprise this is considered a standard of care in most countries. However, despite the evidence of clinical and cost-effectiveness, participation is a global challenge, and when patients do engage with structured cardiac rehab, real-world adherence to exercise declines over time (David et al 2024).

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The reality is this: We need to support patients beyond the clinic in order to build a habit. But the problem with building any healthy habit is that our existing healthcare ecosystem wasn’t designed to deliver the ongoing support needed to stay on track.

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The healthcare system will fail to translate the findings from the likes of the CHALLENGE Trial into clinical practice without also providing behavioral support. What the study showed us is that light-touch education is helpful, but to move the needle it was structured exercise routine coupled with contact time — constant check-ins and support — that really mattered.

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Digital Health Technology as a Cost-Effective and Scalable Solution

When it comes to effective healthcare, the people delivering care matter. Given the time constraints on healthcare professionals, digital health technologies can serve to close those care gaps and provide location and time-independent support (Nguyen et al. 2023). When we think about exercise therapy across chronic disease it typically follows a straight-forward process that incorporates behavioral science at each level:

Assess: Gauge the right dose of exercise for the individual
Prescribe: Use goal setting to build upon an initial dose
Monitor: Develop a habit and facilitate safe progression
Re-Assess: Examine the clinical impact

To realize the findings of the CHALLENGE trial, digital technologies can augment this entire process and in doing so help expand the reach of the clinical team. Prior to starting aerobic-based exercise, assessments such as 6-minute walking tests — which were used in CHALLENGE — can be conducted remotely leveraging basic technologies in most smartphones (and which we’re using in Sidekick programs today). Prescription, monitoring, and progression of aerobic exercise volume, duration, and intensity are all easily managed with basic in-app functionalities. Add in report monitoring with behavioral support, and all of a sudden you have a solution that can reach millions of people and fundamentally save lives.

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We know that building habits is central to chronic disease self-care and this requires ongoing behavior change support. Sidekick programs are built on that very premise. We design programs that help people develop the self-care skills that matter most to them — and in doing so, make healthy habits stick long-term. Part of how we do that is by providing the support that the current healthcare ecosystem can’t.

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See how we’re delivering behavior change across +20 condition areas for Health Plans and Life Sciences, and find our latest research here.

About the author

Andy Grannell, PhD

PhD

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