CLINICAL QUESTION

Following definitive therapy for stage 2 or 3 colorectal cancer, does a structured exercise program plus behavioral support increase the likelihood of disease-free survival?

BOTTOM LINE

A structured exercise program that added approximately 10 metabolic equivalent (MET) hours per week (equivalent to briskly walking 45–60 minutes three to four times per week) significantly improved overall and disease-free survival in patients who had been treated for mostly stage 3 colorectal cancer. Patients also received behavioral support. (Level of Evidence = 1b)

SYNOPSIS

The Canadian study identified 889 patients who had completed surgery and chemotherapy for high-risk stage 2 or 3 colorectal cancer. They were randomized to receive general health information (control) or a structured exercise program consisting of 12 mandatory behavioral support sessions alternating with 12 exercise sessions delivered over 24 weeks. For the next 24 weeks, the exercise group had behavioral support and exercise sessions every 2 weeks, which could be delivered remotely. During years 2 and 3 of the study, those participants had 24 mandatory behavioral support sessions that could be combined with an exercise session if the patient attended in person. Because the authors stratified the patients prior to randomization, the groups were closely balanced by age (median 61 years), performance status, and cancer stage (90% stage 3). The median time from diagnosis to enrollment in the study was 1 year.