ideasIdea
Structured exercise prescribed like a drug in all curative-intent cancer care
The CHALLENGE trial showed a supervised exercise programme improves survival in colon cancer. Extend it to breast, prostate, and lung cancer with the same rigour.
Level-1 evidence now exists for exercise improving DFS and OS. Implementation is the barrier: reimbursement, workforce, and adherence.
Confidence
50%–75%likelyOnCo editors (initial estimate), 2026-09-07 · CHALLENGE gives level-1 evidence in colon cancer; replication in other cancers is likely but slow.
Hypothesis
A 3-year structured exercise programme after curative treatment improves iDFS in TNBC (and other cancers) with effect sizes comparable to some adjuvant drugs.
Rationale
Mechanisms include insulin/IGF reduction, inflammation, and immune surveillance; effect size in CHALLENGE (DFS HR 0.72) rivals drugs.
What would test it
Run CHALLENGE-design trials in TNBC and prostate cancer with health-economic analysis and digital delivery arms.
Maturity
being tested at scale
cancers
3technologies
2trials
1ideas
9A dedicated programme for cachexia and treatment toxicity researchA dose-finding trial for exercise after cancerA survivorship research endowment funded by a levy on curative therapy pricesCombine the new anti-wasting antibody with exercise and proteinFour weeks of training and nutrition before major cancer surgery, as standardMultimodal prehabilitation for older patients before major cancer surgeryPay for supervised exercise the way we pay for drugsTest protein and resistance training during immunotherapyTrials of structured cognitive rehabilitation for cancer-related cognitive impairment