Exercise as a strategy to mitigate treatment-related toxicity in colon cancer: a narrative review

Colon cancer remains a major contributor to global cancer incidence and mortality. Standard treatments, including surgery, fluoropyrimidine-based chemotherapy, and targeted biological agents are frequently accompanied by substantial toxicity, such as chemotherapy-induced peripheral neuropathy (CIPN) and postoperative functional decline, which can impair quality of life and compromise treatment adherence [2, 5]. Physical exercise has emerged as a promising supportive strategy to attenuate these adverse effects and promote functional recovery [10, 2]. This narrative review synthesizes available evidence on toxicity associated with colon cancer treatment and examines the potential mitigating role of structured exercise interventions, with particular emphasis on CIPN and postoperative functional outcomes. A focused review of recent clinical studies was conducted, emphasizing four key investigations that evaluated exercise-based interventions during or after treatment with chemotherapy and/or surgery. These studies included randomized controlled trials, a qualitative study, and a process-evaluation protocol, and assessed outcomes related to neurological toxicity, physical fitness, feasibility, and acceptability of exercise programs. Across studies, exercise interventions ranging from supervised walking plus resistance programs to home-based and isometric training were consistently safe, well tolerated, and associated with beneficial effects on CIPN symptoms, physical fitness, and patient-reported feasibility [11-14]. Adherence was generally high, and no serious exercise-related adverse events were reported. Individualized prescription, flexibility of delivery (hospital and home-based), and ongoing clinical support emerged as critical determinants of success. The available evidence suggests that physical exercise can attenuate selected toxicities related to colon cancer treatment particularly neurological and functional impairments while supporting rehabilitation and survivorship. Integration of exercise into standard care pathways is recommended as a feasible and safe strategy, although larger, well-designed trials are required to define optimal exercise type, dose, and timing in patients with colon or colorectal cancer.