Cancer Epidemiology · Nov 3, 2026

The effect of exercise during adjuvant chemotherapy on outcomes in patients with colorectal cancer: A systematic review

By Taqi K, Arseneault-Monette E, Stockley C et al.

Background Adjuvant chemotherapy is a standard component of care for patients with resected stage II–III colorectal cancer (CRC), improving survival outcomes but often at the expense of quality of life (QoL) and functional status. Exercise and physical activity (PA) have emerged as a potential strategy to mitigate treatment-related toxicities and improve oncologic outcomes. This study aimed to evaluate the impact of PA and exercise and its interventions during adjuvant chemotherapy. Methods: A systematic review was performed using the MEDLINE, EMBASE, Web of Science, SCOPUS, CINAHL, and PsycINFO databases up to June 2025. Studies including adult CRC patients undergoing or recently completed adjuvant chemotherapy and participating in structured exercise program or PA assessment were eligible. Results: Nine studies encompassing 4070 patients were included, of whom 631 participated in structured exercise interventions. The interventions varied in modality, incorporating aerobic, resistance, and combined programs delivered in both supervised and home-based settings. Engagement in PA was associated with improvements in overall survival (OS) and disease-free survival (DFS) in selected studies, although measures and outcomes were highly heterogeneous. QoL findings were variable but generally favored exercise, with reported benefits in physical functioning, fatigue, cardiorespiratory fitness, and psychological well-being. In addition, exercise was linked in some studies to improved chemotherapy tolerance, including higher treatment completion rates and reduced treatment-related toxicities such as fatigue and neurotoxicity. Conclusions: Exercise during adjuvant chemotherapy in CRC is feasible and appears to improve functional and patient-reported outcomes, with a consistent signal toward improved survival. Supervised interventions may offer additional benefits through enhanced adherence and optimization of exercise delivery. However, heterogeneity in study design and outcome reporting limits definitive conclusions. Further high-quality randomized trials are needed to establish standardized exercise protocols and clarify their impact on long-term oncologic outcomes.

doi.org/10.1016/j.canep.2026.103267 PubMed 42976593 Interventions