Regular physical activity—particularly walking—can reduce cancer-related fatigue and improve quality of life for people with colorectal cancer, especially during recovery from treatment. The new findings, presented last week at the American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium, add to the growing evidence that movement is medicine for cancer patients and survivors.

“Fatigue is one of the most common struggles that cancer survivors face. This longitudinal study provides clear evidence that increased levels of physical activity in colon cancer survivors with early-stage disease can lead to improved quality of life,” ASCO expert Joel Saltzman, MD, of Cleveland Clinic’s Taussig Cancer Center, said in a news release.

Fatigue is a common symptom of cancer itself and can be a side effect of many medications used to treat it. Cancer-related fatigue, which often persists after treatment, can have a negative impact on functional ability and overall quality of life. Previous studies have found that around 40% of colorectal cancer survivors report moderate to severe fatigue even years after treatment completion.

While people experiencing fatigue may feel too exhausted to exercise, even light physical activity can help. Louisa Liu, MD, of Cedars-Sinai Medical Center, and colleagues looked at the impact of different levels of physical activity on cancer-related fatigue during the two-year period following a colorectal cancer diagnosis.

This analysis, supported by the National Institute of Health’s National Institute of Nursing Research, included more than 1,700 patients in the international ColoCare study. Just over half were men, the mean age was 67 years and three quarters were white. Nearly 20% had metastatic cancer at the time of diagnosis. People with nonmetastatic and metastatic cancer had similar activity levels at baseline, but those with metastatic disease reported worse fatigue.

Physical activity levels were assessed at the time of diagnosis and again at six months, one year and two years later using the International Physical Activity Questionnaire (IPAQ), which has patients record how often and for how long they engaged in different levels of activity over the past week. Moderate activities included brisk walking and housecleaning, while vigorous activities included running and bicycling. The researchers calculated Metabolic Equivalent of Task (MET) minutes per week, a personalized indicator of energy expenditure. Low physical activity was defined as less than 600 MET minutes per week, moderate activity as 600 to 3,000 MET minutes per week and high activity as more than 3,000 MET minutes per week. Quality of life was also assessed using a standardized questionnaire.

Among patients with nonmetastatic colorectal cancer, those who reported regular physical activity six to 12 months after diagnosis saw their fatigue scores decline significantly from baseline at one year, with further improvement at two years. People with the highest reported activity levels had the lowest fatigue scores and best quality-of-life scores. Significant improvement was seen both in those who reported regular walking and those who engaged in more vigorous activity.

Among people with metastatic cancer, those who reported regular exercise also had improved fatigue scores at 12 and 24 months, but the changes did not reach the threshold for statistical significance.

Looking at specific types of activity, walking had the “strongest and most consistent signal” of benefit, according to Liu, who noted that consistent physical activity over time yielded the greatest benefit.

A study presented at last year’s ASCO annual meeting showed that a structured exercise program after colon cancer surgery was associated with a reduced risk of disease recurrence and improved survival. The new findings suggest that simpler interventions are also beneficial. Walking is low risk, accessible, doesn’t require any special equipment and “can be easily woven into everyday routines,” Liu said.

The researchers noted that physical activity levels at the time of diagnosis were not reliably associated with long-term fatigue and quality-of-life outcomes, but rather activity levels during post-diagnosis follow-up were a stronger predictor of better outcomes. This suggests that it’s never too late to start, and interventions to support long-term physical activity are an important part of cancer care.

The researchers now aim to learn more about the biological and behavioral pathways underlying these findings using data from wearable devices to track real-time activity and sleep patterns as well as metabolic assessments of muscle function and recovery. They will also investigate barriers to physical activity across diverse patient populations to inform personalized survivorship interventions.

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