New research shows how colon cancer survivors can overcome mental hurdles to stick with long-term exercise — a shift in mindset that could lower their risk of the disease coming back and improve their chances of survival.
In a study tracking patients in a three-year structured exercise program, the results showed that because of the support they received, participants experienced a boost in confidence, enjoyment and motivation to make exercise part of their regular routine.
The findings reveal how to support survivors “in adopting and maintaining exercise over the long term,” says University of Alberta researcher Dr. Kerry Courneya, lead author on the study.
The findings build on landmark research showing that structured exercise lowers the risk of recurrence and improved survival for colon cancer patients, emerging from the Colon Health and Life-Long Exercise Change (CHALLENGE) trial, the first Phase 3 clinical trial designed to test whether physical activity directly improves survival rates for colon cancer.
“The innovative aspect of this new study is that we were successfully able to keep patients exercising for the entire three-year period that was necessary to test this question,” says Courneya, a professor in the Faculty of Kinesiology, Sport, and Recreation and former Canada Research Chair in Physical Activity and Cancer.
“Short-term exercise adherence is fairly achievable in most studies, which typically span about 12 weeks, but longer-term adherence can be difficult to achieve in clinical trials and in real life.”
The study focused on improving how patients felt about taking up sustained moderate to vigorous physical activity for three years.
“According to the theory of planned behaviour we used — the key beliefs that influence whether someone will engage in any behaviour, including exercise — is that they have to perceive it as beneficial, enjoyable and not too difficult; be confident they can do it and have lots of social support and opportunities; and be motivated and have a detailed plan to follow.
“Those are the beliefs we tried to promote in our study.”
Between 2009 and 2024, the study tracked almost 900 patients with Stage 2 or 3 colon cancer after surgery and chemotherapy to test whether a structured support program could help them stay active long-term. Evenly divided into one of two groups, they received either a tailored exercise plan and 48 one-on-one coaching sessions over three years to help them set goals and build confidence, or they were given standard health pamphlets.
Researchers used 17 evidence-based behaviour change techniques that included topics such as how to make exercise fun, how to develop a detailed plan for exercise, overcoming barriers, benefits of exercise, how to identify opportunities for exercise and how to develop a social support network.
Patients who had regular coaching felt much better about staying active at almost every check-in over the three years, the results showed.
The biggest improvement was in planning skills, in knowing how and when to schedule physical activity into their daily lives. They felt much more motivated and supported by those around them, and enjoyed exercising more. Coached patients also reported higher confidence in their abilities, saw more opportunities to be active and found working out to be less difficult than those who only received printed educational materials.
“We were able to improve all of the key social cognitive beliefs about exercise for the entire three-year period, which is exciting,” Courneya says. “Many studies only show short-term improvements in a few social cognitive beliefs that are not sustained over the longer term.”
The findings show that “with the right support, long-term exercise behaviour change is possible for many colon cancer survivors after chemotherapy,” he notes.
“And that’s vital, because making exercise a part of their lifestyle will lower their risk of recurrence and improve survival.”