Physical Activity: A Potential Pathway for Reducing Fatigue in Colorectal Cancer

New evidence from a longitudinal study of patients with colorectal cancer, presented at the 2026 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium, adds to a growing body of evidence linking physical activity with reduced cancer-related fatigue, offering a promising avenue for improved long-term outcomes and quality of life (QOL).¹

The study of over 1700 patients with colorectal cancer found that physical activity, specifically walking, was a significant predictor of lower fatigue and higher QOL across all time points evaluated across a 2-year follow-up period. Among patients with nonmetastatic disease, walking was associated with significantly lower odds of severe fatigue at 6 months (OR, 0.74; 95% CI, 0.58–0.95; P =.018) and 12 months (OR, 0.75; 95% CI, 0.58–0.96; P =.032), proving the most beneficial of all physical activity levels with an approximately 25% lowered odds of fatigue, especially early on in survivorship. Vigorous activity showed similar patterns.

“Overall, the strongest and most consistent effects appear during the first year after diagnosis, suggesting that the early survivorship phase may be a particularly important window for physical activity interventions to reduce fatigue,” said presenting author Louisa Liu, MD, Samuel Oschin Comprehensive Cancer Institute of Cedars-Sinai Medical Center.

Importantly, physical activity broadly translated into meaningful QOL benefits. In these patients with nonmetastatic disease, all physical activity types—walking, moderate activity, and vigorous activity—were associated with significantly higher odds of improved QOL at all follow-up time points (OR range, 1.33–1.85).

Another key finding was that patients who consistently engaged in vigorous activity over time had a lower risk of future fatigue, with this effect most pronounced in the nonmetastatic subgroup.

“Interestingly, we did not see the significant benefits from short-term spikes in activity… and this suggests that it’s the habitual, sustained engagement in physical activity that really makes a difference in the long term,” Liu noted.

“Ultimately, our findings support the integration of stage-specific and recovery phase-specific physical activity recommendations into routine colorectal cancer survivorship care,” Liu stated in her conclusion. “Taken together, the results highlight the potential of simple, scalable strategies like walking as accessible, low-risk tools to enhance long-term outcomes and improve how our patients feel long after treatment.”

Data Source and Study Design

Data were derived from the ColoCare Study (NCT02328677), a large, international, multicenter, prospective cohort study of adult patients with newly diagnosed colorectal cancer across all disease stages.² The study collected comprehensive data on clinical end points, lifestyle factors, and patient-reported outcomes.

The present analysis included a total of 1718 patients with colorectal cancer, including 835 patients with colon cancer and 859 patients with rectal cancer. All relevant end points—physical activity, fatigue, and QOL—were patient-reported. Following patients from diagnosis through long-term survivorship, the longitudinal nature of the dataset allowed Liu et al to assess associations between self-reported physical activity and fatigue over time at 6, 12, and 24 months postdiagnosis, stratifying by disease stage.

Findings in Patients With Metastatic Disease

While patients with nonmetastatic disease experienced improvements in fatigue and QOL, those with metastatic disease did not see the same benefits, despite these patients reporting consistently worse fatigue compared with patients with nonmetastatic disease (mean fatigue score, 40.7 vs 32.5; P <.001).

“We were a little disappointed by the results that we got within the metastatic cohort of patients,” Liu expressed during the question-and-answer session on the lack of significant associations between physical activity and fatigue in this group. She continued to describe several explanations hypothesized by investigators, namely the greater biologic and functional challenges faced by this group.

“Higher disease burden, the need for ongoing treatments, and subsequently…greater treatment-related [adverse] effects, as well as reduced capacity for exercise…may have blunted the observable effects of physical activity in this population,” Liu said.

Liu also mentioned the smaller sample size and limited follow-up period, which may have limited the investigators’ ability to detect meaningful associations. She emphasized that the findings from this group should not be taken to suggest that physical activity is ineffective for those with metastatic disease; rather, there is insufficient evidence to draw firm conclusions.

Limitations and Clinical Implications

As an observational study, investigators were unable to establish causality between physical activity and fatigue, nor were able to rule out the possibility of bidirectionality in which fatigue may conversely affect a patient’s ability to participate in physical activity. This “chicken and the egg” conundrum, as described by Jonathan Greer, MD, Massachusetts General Hospital and session discussion facilitator, warrants careful interpretation of the findings.

Furthermore, the study does not provide specific physical activity recommendations or guidelines for patients, such as exercise intensity, frequency, or duration.

“We don’t have very… specific guidelines at this point. The patients that we measured were regularly physically active and particularly with walking,” Liu said in response to an audience question.

Despite these limitations, Liu highlighted the immediacy and accessibility of the intervention’s benefits for patients, suggesting that even small amounts of regular activity can meaningfully improve patient outcomes in a way that is noticeable by patients.

“I think even just encouraging your patients to move more, whether that’s…going out and walking your dog or gardening or taking the stairs when at work, all these things do add up, and they make a difference over time. And I think…as for clinicians, framing that as a tangible benefit from these lower-risk, lower-intensity exercises like walking might be the key to broader adoption and participation by patients.”

Greer echoed the value of the study, adding, “Everyone in this room [can] apply these findings in clinic…and it’s a no-cost recommendation. Walking is free, and it’s something that all patients, no matter where they live and their general functional status, should be able to do. [QOL] and cancer-related fatigue are end points that are tangible and immediate, and if [patients] see benefits from walking, they’ll feel it right away.”

DISCLOSURES: Liu did not have any relevant interests to declare.

REFERENCES

1. Liu, L. Longitudinal study on the influence of physical activity in managing cancer-related fatigue in patients with colorectal cancer. Presented at: 2026 American Society of Clinical Oncology Gastrointestinal Cancers Symposium; January 8–10, 2026; San Francisco, California. Abstract 16.

2. ColoCare Study - Colorectal cancer cohort. ClinicalTrials.gov. Updated June 13, 2025. Accessed January 11, 2026. https://clinicaltrials.gov/study/NCT02328677