Physical activity, especially walking, relieves fatigue in CRC survivors

A study presented at ASCO GI 2026 shows that colorectal cancer (CRC) survivors who remain physically active, particularly through walking, are less likely to experience severe fatigue and more likely to report better quality of life (QoL).

“Our study showed that greater physical activity (PA) was associated with lower fatigue and improved QoL across all timepoints, with the strongest and most consistent signal coming from walking,” said Dr Louisa Liu from Cedars-Sinai Medical Center, Los Angeles, California, US.

In non-metastatic patients (n=1,405), walking was associated with lower odds of severe fatigue at 6 (odds ratio [OR], 0.74; p=0.018) and 12 (OR, 0.75; p=0.032) months. A similar pattern was seen with vigorous activity (OR, 0.75; p=0.021 [6 months] and OR, 0.76; p=0.036 [12 months]). [ASCO GI 2026, abstract 16]

All PA types were tied to higher odds of improved QoL at 6, 12, and 24 months: ORs, 1.71, 1.77, and 1.83 (p≤0.001 for all), respectively, for walking; ORs, 1.45, 1.50, and 1.85 (p=0.002 for all), for moderate activity; and OR, 1.33; p=0.018, OR, 1.46; p=0.006, and OR, 1.61; p=0.019, for vigorous activity.

Liu said that patients with the highest walking levels had excellent QoL or reported minimal fatigue, and their walking levels increased steadily over time. Patients who walked more continued to report better outcomes even after 2 years of diagnosis.

Moreover, she noted that the most pronounced effects were observed in the first year after diagnosis. “[This suggests] that the early survivorship phase may be a particularly important window for PA interventions to reduce fatigue.”

Looking at the timing and consistency of activity, participants who consistently maintained higher levels of vigorous activity over time had a lower risk of future fatigue (between-person effect, -1.65; p<0.001), primarily driven by the non-metastatic subgroup (between-person effect, -2.01; p<0.001). “Interestingly, we did not see significant benefits from short-term spikes in activity, suggesting it is the habitual, sustained engagement that really makes a difference over the long term,” Liu explained.

Conversely, the long-term associations between PA and outcomes were not evident in the metastatic subgroup (n=313). Of note, metastatic patients reported persistently worse fatigue than non-metastatic patients at baseline (mean fatigue score, 40.7 vs 32.5; p<0.001). According to Liu, this is not unexpected given the biological and functional limitations in metastatic patients.

A simple step goes a long way

“Fatigue is a common and debilitating symptom in cancer patients, not just during treatment but often long afterwards … This ongoing fatigue impairs functional recovery, daily activity, and QoL, yet our toolbox of effective interventions remains limited,” said Liu. “Many CRC survivors continue to face unmet needs in survivorship, including physical and psychosocial support.”

“As more patients live longer after CRC, there is a growing and critical need for high-quality longitudinal data to improve our understanding of survivorship and inform strategies to improve long-term outcomes,” she continued.

The researchers used data from 1,718 patients (mean age 68.2 years, 58 percent men) from the ColoCare Study. Of these, 835 had colon cancer, while 859 had rectal cancer.

“[Our results showed that] something as simple as walking made a meaningful difference in how patients felt … This is especially important because walking is accessible, low risk, requires no special equipment, and can be easily woven into daily routine and survivorship care plans,” Liu said.

A scalable strategy for survivorship care

The results also support the incorporation of stage-specific and recovery-phase PA recommendations into routine CRC survivorship care. “[The study] adds nuance by exploring which types of PA are most beneficial, when during recovery they matter most, and showing how long-term patterns drive meaningful improvements,” Liu said.

“Taken together, the results highlight the potential of simple, scalable strategies such as walking as accessible, low-risk tools to enhance long-term outcomes and improve patients’ well-being long after treatment,” she concluded.