2025 American Society of Clinical Oncology (ASCO) Annual Meeting<\/a> called the CHALLENGE study. They looked at stage III and stage II colorectal cancer, but the profound impact there was the reduction in recurrence, in new cancers, and the lower risk of death. [Investigators] compared one arm with a 3-year structured exercise program for 2 days a week\u2013\u2013we\u2019re not talking about an Ironman [Triathlon]\u2013\u2013and in the second arm, they gave some healthy information and said, \u201cHere\u2019s some healthy information, just live a healthy lifestyle via exercise.\u201d That had a profound impact. In fact, when you look at those statistics, they\u2019re comparable to some of the celebrated conventional cancer treatments. Now, that doesn\u2019t mean we replace them; it means that when cancer is present, [we are not] following this reductionist approach going from A to B to C to D. We must start bringing this kind of stacking therapy approach together. If we can add something like exercise with chemotherapy [plus] immunotherapy preceding surgery, the results will be better.<\/p>\nAnother [study], called the OPTIMUS study from the NHS in the UK, was following these patients through a 12- or 16-week exercise program. It was a much smaller study related to [48] patients, whereas the CHALLENGE study was almost 900. What they did is they followed these patients in 2 segments\u2013\u2013it was 8 weeks each time\u2013\u2013one with chemotherapy, which improved results, and one preceding surgery. They surgically resected and looked at the tumors. Here\u2019s where it gets into the \u201chow\u201d: they found CD8-positive T-cell infiltration and a reduction in immunosuppressing cells.<\/p>\n
This study, without saying it, showed that exercise is reprogramming the TME. Now, they didn\u2019t say this, and it needs [further validation], but you could frame it as exercise turning cold tumors hot. It is enabling the infiltration and the recruitment of immune cells within the TME, reprogramming it, and allowing the immune system to be engaged. Now, you\u2019re going to take what tends to be a predominantly immune-excluded environment and turn it into one where the immune system can now be harnessed. That is next level.<\/p>\n
It gets even better. I had a patient the other day who had recurrent stage IV cancer. I often say that\u2014and this applies to all doctors\u2014we say stupid things, and patients never forget them. We are trying with intent to say something, and the words [sometimes] just don\u2019t come out right\u2026. [Another] doctor said [to a patient], \u201cYour immune system is broken.\u201d The patient [says to me], \u201cHow can you help me? My immune system\u2019s broken.\u201d I said, \u201cIt\u2019s not broken. The problem is your immune system is not engaged; it doesn\u2019t know [how to attack malignant cells].\u201d<\/p>\n
Exercise will decrease myeloid-derived suppressor cells and regulatory T cells. These are key immunosuppressive cells that help to create immune suppression barriers in and around the tumor. That disengages the immune system. The immune system may see the tumor, but along [they] come\u2013\u2013there may be M2 macrophages, these myeloid-derived suppressor cells, and then the regulatory T cells\u2013\u2013they\u2019re rebuffing the immune system that\u2019s alerted but kept out. Now, it\u2019s not that the immune system\u2019s broken; it\u2019s that the immune system is not allowed to be engaged because of the tumor.<\/p>\n
How can integrative care specialists best tailor exercise to ensure patients are best positioned to experience the most benefit?<\/p>\n
That\u2019s where the precise nature of oncology is: [finding] the right treatment for the right patient, and the right combination at the right place and right time. If you have a patient come to you, and they\u2019re dealing with sarcopenia, cachexia, advanced stage IV cancer, and chemotherapy-induced peripheral neuropathy, you\u2019re not going to say, \u201cLet\u2019s get you doing some weights about 3 or 4 times a week. Let\u2019s go out and jog.\u201d No. You must say, \u201cOkay, you know what? Let\u2019s get you moving.\u201d<\/p>\n
First, [give a] proper assessment. What is the patient\u2019s activity like? [They may say,]
\u201cI\u2019m in a wheelchair all day,\u201d or \u201cI\u2019m in bed.\u201d Let\u2019s start building a strategy of saying, \u201cWell, let\u2019s have you, if you\u2019re capable\u2026Walk to the kitchen. Let\u2019s have you do a series of particular events during the day that get you mobile.\u201d Now, what we have is the ability to remove somebody from a sedentary life to actually moving. There are going to be natural remedies from [moving]: myokines, cytokines, and modulation of the immune system.<\/p>\n
That\u2019s acute, not chronic; that\u2019s one of the areas where we get mixed up. Exercise will acutely increase interleukin-6, not chronically. Human studies [show] if you block interleukin-6 and epinephrine with exercise, you block the ability of natural killer cells to infiltrate and lead to tumor necrosis. Acute vs chronic is very different as it relates to immune signaling.<\/p>\n
There, in that patient instance, you go, \u201cLet\u2019s just get you mobile now. Let\u2019s build a strategy from that.\u201d If somebody comes in and says, \u201cI\u2019ve never exercised,\u201d and they are 350 pounds, it\u2019s kind of the same concept. Let\u2019s just get [them] walking. Then, once you get that pattern set in place, you say, \u201cHey, let\u2019s get you doing some 1-pound dumbbells as you\u2019re walking 1 day a week.\u201d [You must] build it because acute and chronic are different, and resistance and cardio are different as they relate to the immune system.<\/p>\n
But let\u2019s say an athlete comes in. We had a patient who said, \u201cI was a professional rower competing in the Olympics.\u201d It\u2019s not going to take much to tell them, \u201cAll right, let\u2019s get you doing cardio 3 days a week. Let\u2019s get you doing resistance training twice a week.\u201d The [opposite] is the problem here; I\u2019ve got to tone them back. I say, \u201cLook, you\u2019re not training for the Olympics; we\u2019re training for your immune system, which is very different.\u201d<\/p>\n
We have to look at disease stage; that plays a big role in this, too. For stage IV or III [disease], I\u2019m going to approach it differently. For stage I or II [disease], I approach it differently. We have to look at each person and see where they are. What are they capable of doing? Let\u2019s be honest; there are many of us who are athletes, and there are many who are not. Some people have that innate athletic ability, so in that aspect, you say, \u201cLet\u2019s build in free-weight resistance training because I know you can do this.\u201d But don\u2019t just say \u201cdo it,\u201d say, \u201cHere\u2019s what I want you to do.\u201d<\/p>\n
What does that mean? \u201cI\u2019m going to go out there and be Arnold Schwarzenegger, and put 300 pounds on the bench press?\u201d No. I want you, if you haven\u2019t lifted in a while, to take 10-pound dumbbells. I want it to be so embarrassingly low weight that you\u2019re embarrassed to be in the gym, and I want you to do high-rep, low-weight [lifting]. I want you to do 3 sets. I want you to do 45 seconds of rest in between. Then, we\u2019re going to build on that with biceps, triceps, and lat lifts. Then, we\u2019re going to say, \u201cLet\u2019s focus on the lower body muscle groups: glutes, hamstrings, and [gastrocnemius].\u201d<\/p>\n
What you do now is start to instruct. Just as we would say, \u201cHere\u2019s what we\u2019re going to do from a surgical perspective to remove the tumor, and here\u2019s what we\u2019re going to do from an oncological perspective.\u201d We need to do the same thing with exercise because research is now [about] showing the what and the how. Exercise is not a replaceable therapy; it is a biologically interventional therapy that stands on its own. But in conjunction with other therapies, it becomes an amazing stacking or sequential use of therapies that will help patients not just overcome their cancer but have better outcomes and live longer. That\u2019s a concept I can dive into.<\/p>\n
ReferencesCourneya KS, Vardy JL, O\u2019Callaghan CJ, et al. Structured exercise after adjuvant chemotherapy for colon cancer. N Engl J Med. 2025;393(1):13-25. doi:10.1056\/NEJMoa2502760Rayner CJ, Bartlett DB, Allen SK, et al. Prehabilitation during neoadjuvant chemotherapy results in an enhanced immune response in esophageal adenocarcinoma tumors: A randomized controlled trial. J Sport Health Sci. 2025;14:101063. doi:10.1016\/j.jshs.2025.101063 <\/p>\n","protected":false},"excerpt":{"rendered":"Incorporating structured exercise into conventional oncology care may reprogram the tumor immune microenvironment (TME) and significantly optimize treatment…\n","protected":false},"author":2,"featured_media":444034,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[37],"tags":[565,134,111,139,69],"class_list":["post-444033","post","type-post","status-publish","format-standard","has-post-thumbnail","category-fitness","tag-fitness","tag-health","tag-new-zealand","tag-newzealand","tag-nz"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/444033","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/comments?post=444033"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/444033\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media\/444034"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media?parent=444033"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/categories?post=444033"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/tags?post=444033"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}