“Movement as Medicine” by Nathaniel Dent

Movement as Medicine

Nathaniel Dent, Kutztown University of Pennsylvania 

Abstract

This literature review looks at the effectiveness of exercise as an intervention to slow tumor progression, reduce cancer recurrence rates post-chemotherapy, and enhance overall patient survivorship. Aside from its role in physiological recovery, physical activity also serves as a critical tool in fighting patient depression and psychological distress. Evidence shows that structured exercise is widely beneficial for both somatic and mental recovery, regardless of a patient’s baseline fitness level. By reviewing data from key clinical trials, most notably the Phase III CHALLENGE trial, this literature review analyzes the physical and psychological impacts of structured exercise on cancer recovery. Exercise could be seen as more than an elective lifestyle, but as a fourth pillar in cancer care, along with surgery, chemotherapy, and radiation. Implementing movement-based interventions can enhance both clinical outcomes and the quality of life of patients.

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Exercise could be the future of cancer treatment and medicine; while some people can fight through their illness and achieve remission, it is too common for cancer to resurface. Years of research suggest that consistent physical activity can lower the risk of cancer recurrence: fitness and health are undeniably linked, so studies and experiments like the ones that will be reviewed are incredibly valuable and innovative. This could change how doctors treat both patients currently undergoing treatment and those who have already survived cancer. For example, Baldwin (2025) demonstrates that when patients are provided with personal trainers, participants reported, on average, lower levels of depression, greater happiness, and substantially lower recurrence rates; these benefits are not limited to breast or colon cancer, as studies across multiple tumor types report similar findings. With more research, this topic represents the future of cancer treatment and truly shows that movement is medicine. Exercise is no longer just a lifestyle choice; it has the potential to become a scientifically recognized form of therapy that promotes survival and emotional healing in ways traditional medicine often cannot.

Cancer recurrence is one of the most formidable challenges in oncology survivorship. It is alarmingly common: data reported by the American Society of Clinical Oncology indicate that around 30% of survivors of common cancers, such as breast, colorectal, and prostate, can face recurrence (Baldwin, 2025). This can be devastating to both patients and their families; after months or even years of fighting this deadly disease and winning, cancer can return later with the same or greater intensity. Even after chemotherapy, surgery, and medication, there is still a lingering risk that the cancer will resurface somewhere in the body. Though these treatment methods are effective, they do not work to strengthen the body’s physical and metabolic resilience. 

Exercise, on the other hand, is both low risk and high reward. There are no harmful chemical side effects like those caused by chemotherapy, and it is extremely safe when properly supervised by professionals. As a result, exercise is now being taken more seriously and may eventually be viewed as the fourth pillar of cancer care alongside surgery, chemotherapy, and radiation. According to Amirsasan et al. (2022), exercise not only influences tumor behavior but also improves overall patient well-being by lowering inflammation, strengthening the immune system, and regulating hormones. It is capable of reducing fatigue, increasing the level of happiness, and improving the quality of one’s sleep if done correctly and regularly. Some large organizations, such as the American Society of Clinical Oncology (ASCO), American Cancer Society (ACS), and American College of Sports Medicine (ACSM), developed guidelines regarding exercise among cancer survivors; however, its practice does not happen uniformly across organizations. 

Barriers to practice are many, which include fatigue due to the treatment, fear of getting hurt, lack of motivation, and lack of availability of a fitness professional who understands the needs of cancer survivors. However, once patients are in the hands of professionals who know what they are doing, they will be able to overcome most of these barriers: for example, a professional fitness coach will be able to guide patients through exercises that will make them stronger without pushing their bodies too hard. One of the few barriers left would be the high cost of the program, especially considering the expenses of medical treatment. Nevertheless, if exercise keeps proving itself as a valid means of medical treatment, insurance could start covering the costs of trainers. 

The most important evidence that was found supporting exercise as a medical intervention comes from the CHALLENGE trial. This clinical trial was published by the American Society of Clinical Oncology on June 1, 2025. This large phase III colon cancer study demonstrated that structured physical activity can reduce cancer recurrence and improve survival. It was one of the few long-term studies exploring the impact of exercise on cancer recurrence, lasting several years and involving 889 patients. In the trial, colon cancer survivors were included who had already completed chemotherapy and surgery. Participants were divided into two groups: one group received a structured, three-year exercise program, while the control group received standard care. The experimental group had a 28% reduction in cancer recurrence compared to the control group, and an 80% disease-free survival rate compared to 74% in the control group. Perhaps most notably, the experimental group experienced a 37% reduction in mortality (Baldwin, 2025). These findings suggest that exercise not only improves quality of life but also leads to measurable clinical outcomes that can save lives. Amirsasan et al. (2022) demonstrate the even more intriguing possibility that regular physical activity can alter tumor behavior itself. Past treatments have had such wide-ranging effects outside of chemotherapy. And all this was achieved through a structured, supervised movement program rather than an additional drug or invasive procedure. Studies like this prove that exercise deserves recognition not merely as supportive therapy but as a true medical intervention that can complement traditional treatments.

Supporting these clinical findings, emerging research in colorectal cancer provides a biological explanation for why exercise works to prevent tumor growth and recurrence. One study published in Cancer Cell International explores the cellular mechanisms that link exercise to reduced cancer risk. The research found that being physically active can lower the risk of developing colorectal cancer by 24 to 40%. Exercise achieves this through several interconnected mechanisms. Amirsasan et al. (2022) explain that it reduces chronic inflammation, which helps prevent tumors from growing and becoming more aggressive. Second, it improves the regulation of insulin and insulin-like growth factors in the body, thereby reducing the growth signals that tumors depend on. Another point in the article also explains that exercise triggers apoptosis, which is the programmed death of precancerous and cancer cells, helping the body remove damaged or abnormal tissue before it spreads. Together, these biological processes show why people who maintain active lifestyles are less likely to develop cancer or experience recurrence. They also help explain why the CHALLENGE trial showed such a dramatic reduction in recurrence and mortality. While these studies represent a major step forward, most were conducted with relatively small and limited populations. More large-scale research is still needed to confirm and generalize these findings, but the biological reasoning already provides a strong foundation for seeing exercise as a scientifically valid treatment strategy.

Although the advantages of exercise are strongly supported, the problem of sustaining activity despite ongoing treatment seems complicated. It is at this stage that behavioral and motivational assistance plays its role. Haussmann et al. (2023) carried out a longitudinal study among 115 individuals with different forms of cancer: breast, prostate, or colorectal. The goal of the investigation was to discover predictors of exercise adherence. According to this study, counseling from a healthcare specialist is a factor that motivates people to start exercising and set realistic goals. However, it was stated that the most accurate predictions could be made on the basis of a patient's baseline activities and self-efficacy: one's belief in one's own capacity to achieve something. In other words, although counseling is helpful, only intrinsic motivation is likely to help a person continue exercising. Those people who have low baseline activity or believe in themselves will be able to adhere to exercise throughout the whole period of treatment. Hence, the conclusion can be drawn: a customized approach should be taken into account. Encouragement aimed at motivating individuals to build self-discipline and self-confidence would be extremely effective. Despite the fact that motivation is personal, structured guidance can also work wonders.

Beyond reducing recurrence, physical activity offers immediate mental and physical benefits during cancer treatment. Regular exercise improves quality of life, increases physical strength, and reduces psychological distress. Two studies focusing on breast cancer patients show this clearly. Vehmanen et al. (2022) compared women who stayed active during treatment with those who did not. Inactive patients suffered from higher rates of anxiety, depression, and treatment side effects, while their overall quality of life was significantly lower. In contrast, women who exercised regularly experienced better emotional health, fewer physical symptoms, and a greater sense of control over their recovery. The second study, conducted by Antunes et al. (2019), explored the effects of a 16-week supervised exercise program for women with little to no prior fitness experience. Despite their inexperience, participants improved in nearly every measurable category: strength, endurance, fatigue reduction, and daily functioning. Their overall health and confidence grew substantially by the end of the program. This study becomes important because of the ability of exercise to include anyone and everyone who needs to get fit through this process, regardless of their current physical capability. It proves that even people who have very little physical capability to start with can still be successful if they have the right guidance.

All these facts indicate that physical activity is far more than a small addition to cancer therapy; it is an effective intervention that can revolutionize the whole paradigm of treating the condition. Physical activity helps avoid recurrence, increases biological resistance, and positively impacts the psychological state. The study carried out under the title CHALLENGE demonstrated the largest reductions in the risks of recurrence and mortality through physical activity. The biological studies reported in Cancer Cell International explained why such positive changes occur, highlighting such factors as decreased inflammation, hormone regulation, improvements in the processes of insulin regulation, and even apoptosis of cancerous cells. Motivation and proper encouragement were key points highlighted by the behavioral studies. Breast cancer studies showed the positive effects of physical activity on the quality of life and mental state of patients, especially of previously sedentary people.

When synthesized, the collective evidence demonstrates that exercise is low risk, accessible, and capable of producing both physical and psychological transformations that no drug alone can achieve. It strengthens the body in unique ways, supports the mind, and gives patients a renewed sense of control during one of the most difficult experiences of their lives. With further research and better access to supervised programs, movement could realistically become the fourth pillar of cancer care. Based on all the evidence that is currently available, exercise deserves recognition not as a side note in treatment plans but as a true form of medicine, one that heals through action, strength, and perseverance.

References

Amirsasan, R., Akbarzadeh, M., & Akbarzadeh, S. (2022). Exercise and colorectal cancer: Prevention and molecular mechanisms. Cancer Cell International, 22(1). https://doi.org/10.1186/s12935-022-02670-3

Antunes, P., Esteves, D., Nunes, C., Joaquim, A., Pimentel, F. L., & Fonseca-Moutinho, J. (2019). Health-related quality of life and physical fitness in breast cancer patients: The impact of a supervised physical exercise program in women with no exercise experience. Psychology, Health & Medicine, 24(9), 1038–1046. https://doi.org/10.1080/13548506.2019.1597978

Baldwin, K. (2025, June 1). Movement is medicine: Structured exercise program may lower risk of cancer recurrence and death for some colon cancer survivors. American Society of Clinical Oncology. https://www.asco.org/about-asco/press-center/news-releases/movement-medicine-structured-exercise-program-challenge

Haussmann, A., Ungar, N., Tsiouris, A., Schmidt, L. I., Müller, J., von Hardenberg, J., Wiskemann, J., Steindorf, K., & Sieverding, M. (2023). Determinants of physical activity during cancer treatment: A longitudinal exploration of psycho-cognitive variables and physician counseling. Journal of Behavioral Medicine, 47(4), 566–580. https://doi.org/10.1007/s10865-023-00458-y

Vehmanen, L., Mattson, J., Karademas, E., Oliveira-Maia, A. J., Sousa, B., Pat-Horenczyk, R., Mazzocco, K., Simos, P., Cardoso, F., Pettini, G., Marzorati, C., Kolokotroni, E., Stamatakos, G., Frasquilho, D., & Poikonen-Saksela, P. (2022). Associations between physical exercise, quality of life, psychological symptoms and treatment side effects in early breast cancer. The Breast Journal, 2022, 1–8. https://doi.org/10.1155/2022/9921575