Greater levels of physical activity in the first 2 years after a colorectal cancer diagnosis were associated with reduced cancer-related fatigue and improved quality of life in patients with nonmetastatic disease, according to findings from a prospective, multicenter, longitudinal analysis from a cohort of the International ColoCare Study. Walking was linked to a particularly greater reduction in cancer-related fatigue in patients with nonmetastatic disease, especially for the first year after diagnosis.
Similar associations between activity levels and quality-of-life outcomes were not seen in patients with metastatic disease. Findings from the longitudinal analysis are being presented at the 2026 ASCO Gastrointestinal Cancers Symposium (Abstract 16).
"For patients with nonmetastatic colorectal cancer, being physically active was consistently linked to lower fatigue and better quality of life throughout recovery," said study author Louisa Liu, MD, Hematology/Oncology Fellow Physician at Cedars-Sinai, when presenting the findings in a press briefing ahead of the symposium. "Something as simple as walking made a meaningful difference in how patients felt. Walking showed the greatest reduction in fatigue in the first year after diagnosis in patients with nonmetastatic colorectal cancer, and this is especially important because walking is accessible, low risk, it doesn't require any special equipment, and it could be easily woven into a daily routine and survivorship care plans."
Background and Study Methods
About 40% of survivors of colorectal cancer report feeling fatigue even years after treatment. Growing evidence is supporting physical activity for reducing patients' fatigue through multiple biologic and psychosocial pathways and by reducing systemic inflammation and improving sleep quality. However, several questions remain unanswered about the association.
The International ColoCare Study is a large study following patients with colorectal cancer from diagnosis through long-term survivorship. The cohort analysis focused on exploring the impact of different types of physical activity, including walking and vigorous exercise, on fatigue and other clinical outcomes. The cohort included 1,718 patients with colorectal cancer from the larger study who were assessed on their physical activities and impacts through questionnaires at baseline, 6, 12, and 24 months. Physical activity was measured in MET (metabolic equivalent of task) minutes per week.
The researchers used two different statistical models to explore predictions at one time and patterns over time.
Key Findings
The patients who were more physically active reported better outcomes in terms of both fatigue and quality of life, and Dr. Liu noted that this association was even greater as patients moved further along in their disease recovery.
"Walking in particular showed the clearest and most consistent association with these improved outcomes," Dr. Liu said. "Patients with excellent quality of life or minimal fatigue reported the highest walking levels, and these levels increase steadily over time and even two years out from diagnosis."
Patients who were more physically active continued to report better outcomes, especially among patients who walked more. "This suggests that the benefits of physical activity aren't just short term, they appear to persist well into survivorship, reinforcing the value of sustained movement as part of long-term care," Dr. Liu commented.
The association between higher activity levels and reduced fatigue/better quality of life was clear for patients with nonmetastatic disease, and consistent walking was found to be especially beneficial for patients at both 6 and 12 months after their diagnosis. These patterns continued out to 24 months, and even when considering factors such as treatment differences, body mass index, and race.
On the other hand, no long-term associations were found between physical activity and outcomes over time in patients with metastatic colorectal cancer. At all timepoints, these patients indicated greater levels of fatigue and worse quality of life than nonmetastatic patients. "I would say [this] is not unexpected considering the likely biologic and functional limitations in this group," Dr. Liu noted. "At this time we don't yet have strong evidence that physical activity changes fatigue trajectory in the long run for metastatic patients, but this is an area where more targeted research is really needed."
Long-term patterns of physical activity showed that fatigue was reduced and quality of life improved over time in patients who were consistent with their higher levels of activity. Short-term increases in physical activity did not appear to cause meaningful differences on clinical outcomes. "This suggests that when it comes to managing cancer-related fatigue, the key is to build steady lasting habits that patients can stick with throughout their recovery," Dr. Liu said.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
