THE PROTECTIVE POWER OF PHYSICAL ACTIVITY: INSIGHTS INTO COLON POLYPS AND COLORECTAL CANCER
Abstract
Background: Colorectal cancer (CRC) remains one of the most prevalent malignancies worldwide. Regular physical activity (PA) is increasingly recognized as a modifiable factor influencing both cancer prevention and patient outcomes. This review summarizes current evidence on the role of PA in CRC prevention, treatment, and survivorship, emphasizing its clinical significance and underlying biological mechanisms.
Methods: A narrative review of recent randomized trials, cohort studies, and meta-analyses published in peer-reviewed journals was conducted. Studies addressing PA in relation to CRC incidence, recurrence, postoperative recovery, and treatment-related outcomes were included.
Results: Evidence consistently demonstrates that regular PA reduces the risk of colorectal adenomas and cancer by approximately 20–30%. In CRC survivors, structured exercise programs improve physical and psychological well-being, mitigate treatment-related side effects, and may decrease recurrence and mortality risk. Randomized trials such as CHALLENGE and PHYSSURG-C highlight that supervision, intensity, and duration are critical for achieving clinical benefits. The beneficial effects of PA are mediated by metabolic, inflammatory, and immune pathways, including improved insulin sensitivity, reduced systemic inflammation, and enhanced immune function.
Conclusions: Regular physical activity should be considered as a component of colorectal cancer prevention and survivorship care, offering measurable benefits for both clinical outcomes and quality of life.
References
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834
Wojciechowska, U., Barańska, K., Miklewska, M., & Didkowska, J. A. (2023). Cancer incidence and mortality in Poland in 2020. Nowotwory. Journal of Oncology, 73(3), 129–145. https://doi.org/10.5603/NJO.2023.0026
Country Cancer Profiles 2025 | ECIR - European Cancer Inequalities Registry. (n.d.). Retrieved October 1, 2025, from https://cancer-inequalities.jrc.ec.europa.eu/country-cancer-profiles-2025
Nasaif, H. A., & Al Qallaf, S. M. (2018). Knowledge of Colorectal Cancer Symptoms and Risk Factors in the Kingdom of Bahrain: A Cross- Sectional Study. Asian Pacific Journal of Cancer Prevention: APJCP, 19(8), 2299–2304. https://doi.org/10.22034/APJCP.2018.19.8.2299
Kędzia-Berut, R., Berut, M., Włodarczyk, M., Włodarczyk, J., Dziki, Ł., Dziki, A., & Mik, M. (2023). Colorectal Cancer: Is it Still a Disease of the Elderly? Polski Przeglad Chirurgiczny, 96(0), 41–45. https://doi.org/10.5604/01.3001.0054.0956
Durko, L., & Malecka-Panas, E. (2014). Lifestyle Modifications and Colorectal Cancer. Current Colorectal Cancer Reports, 10(1), 45–54. https://doi.org/10.1007/s11888-013-0203-4
Metelski, A. (2019). Physical activity in Poland and the European Union. Quality in Sport, 5(3), 7–21. https://doi.org/10.12775/QS.2019.013
Dwojaczny, B., & Bejtka, M. (2023). Influence of physical activity on cognitive functions—Potential mechanisms and benefits. Journal of Education, Health and Sport, 13(3), 181–185. https://doi.org/10.12775/JEHS.2023.13.03.026
Dekker, E., Tanis, P. J., Vleugels, J. L. A., Kasi, P. M., & Wallace, M. B. (2019). Colorectal cancer. Lancet (London, England), 394(10207), 1467–1480. https://doi.org/10.1016/S0140-6736(19)32319-0
Noël Racine, A., Margaritis, I., Duclos, M., Carré, F., Vuillemin, A., & Gautier, C. (2022). Costing the economic burden of prolonged sedentary behaviours in France. European Journal of Public Health, 32(Suppl 1), i3–i7. https://doi.org/10.1093/eurpub/ckac071
Sun, Y., Keat, O. B., & Rajabi, S. (2025). The role of physical activity and epigenetic changes in colorectal cancer prevention. Cancer Cell International, 25, 227. https://doi.org/10.1186/s12935-025-03872-1
Nagtegaal, I. D., Odze, R. D., Klimstra, D., Paradis, V., Rugge, M., Schirmacher, P., Washington, K. M., Carneiro, F., Cree, I. A., & WHO Classification of Tumours Editorial Board. (2020). The 2019 WHO classification of tumours of the digestive system. Histopathology, 76(2), 182–188. https://doi.org/10.1111/his.13975
Wang, J.-D., Xu, G.-S., Hu, X.-L., Li, W.-Q., Yao, N., Han, F.-Z., Zhang, Y., & Qu, J. (2024). The histologic features, molecular features, detection and management of serrated polyps: A review. Frontiers in Oncology, 14, 1356250. https://doi.org/10.3389/fonc.2024.1356250
Kyzer, S., Bégin, L. R., Gordon, P. H., & Mitmaker, B. (1992). The care of patients with colorectal polyps that contain invasive adenocarcinoma. Endoscopic polypectomy or colectomy? Cancer, 70(8), 2044–2050. https://doi.org/10.1002/1097-0142(19921015)70:8%253C2044::aid-cncr2820700805%253E3.0.co;2-x
Snover, D. C., Jass, J. R., Fenoglio-Preiser, C., & Batts, K. P. (2005). Serrated polyps of the large intestine: A morphologic and molecular review of an evolving concept. American Journal of Clinical Pathology, 124(3), 380–391. https://doi.org/10.1309/V2EP-TPLJ-RB3F-GHJL
Kahi, C. J., & Rex, D. K. (2015). Advances in colonoscopy. Gastrointestinal Endoscopy Clinics of North America, 25(2), xv–xvi. https://doi.org/10.1016/j.giec.2015.01.001
Hassan, C., Antonelli, G., Dumonceau, J.-M., Regula, J., Bretthauer, M., Chaussade, S., Dekker, E., Ferlitsch, M., Gimeno-Garcia, A., Jover, R., Kalager, M., Pellisé, M., Pox, C., Ricciardiello, L., Rutter, M., Helsingen, L. M., Bleijenberg, A., Senore, C., van Hooft, J. E., … Quintero, E. (2020). Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy, 52(8), 687–700. https://doi.org/10.1055/a-1185-3109
Sano, W., Hirata, D., Teramoto, A., Iwatate, M., Hattori, S., Fujita, M., & Sano, Y. (2020). Serrated polyps of the colon and rectum: Remove or not? World Journal of Gastroenterology, 26(19), 2276–2285. https://doi.org/10.3748/wjg.v26.i19.2276
Mezzapesa, M., Losurdo, G., Celiberto, F., Rizzi, S., d’Amati, A., Piscitelli, D., Ierardi, E., & Di Leo, A. (2022). Serrated Colorectal Lesions: An Up-to-Date Review from Histological Pattern to Molecular Pathogenesis. International Journal of Molecular Sciences, 23(8), 4461. https://doi.org/10.3390/ijms23084461
Yehia, L., Heald, B., & Eng, C. (2023). Clinical Spectrum and Science Behind the Hamartomatous Polyposis Syndromes. Gastroenterology, 164(5), 800–811. https://doi.org/10.1053/j.gastro.2023.01.026
Gorji, L., & Albrecht, P. (2023). Hamartomatous polyps: Diagnosis, surveillance, and management. World Journal of Gastroenterology, 29(8), 1304–1314. https://doi.org/10.3748/wjg.v29.i8.1304
He, D.-G., Chen, X.-J., Huang, J.-N., Chen, J.-G., Lv, M.-Y., Huang, T.-Z., Lan, P., & He, X.-S. (2022). Increased risk of colorectal neoplasia in inflammatory bowel disease patients with post-inflammatory polyps: A systematic review and meta-analysis. World Journal of Gastrointestinal Oncology, 14(1), 348–361. https://doi.org/10.4251/wjgo.v14.i1.348
Candel, I., Wetwittayakhlang, P., Bessissow, T., & Lakatos, P. L. (2025). The Importance of Post-Inflammatory Polyps (PIPs) in Colorectal Cancer Surveillance in Inflammatory Bowel Diseases. Journal of Clinical Medicine, 14(2), 333. https://doi.org/10.3390/jcm14020333
Rezende, L. F. M. de, Sá, T. H. de, Markozannes, G., Rey-López, J. P., Lee, I.-M., Tsilidis, K. K., Ioannidis, J. P. A., & Eluf-Neto, J. (2018). Physical activity and cancer: An umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases. British Journal of Sports Medicine, 52(13), 826–833. https://doi.org/10.1136/bjsports-2017-098391
Kruk, J., & Czerniak, U. (2013). Physical activity and its relation to cancer risk: Updating the evidence. Asian Pacific Journal of Cancer Prevention: APJCP, 14(7), 3993–4003. https://doi.org/10.7314/apjcp.2013.14.7.3993
Wang, J., Huang, L., Gao, Y., Wang, Y., Chen, S., Huang, J., Zheng, W., Bao, P., Gong, Y., Zhang, Y., Wang, M., & Wong, M. C. S. (2020). Physically active individuals have a 23% lower risk of any colorectal neoplasia and a 27% lower risk of advanced colorectal neoplasia than their non-active counterparts: Systematic review and meta-analysis of observational studies. British Journal of Sports Medicine, 54(10), 582–591. https://doi.org/10.1136/bjsports-2018-100350
Wolin, K. Y., Yan, Y., Colditz, G. A., & Lee, I.-M. (2009). Physical activity and colon cancer prevention: A meta-analysis. British Journal of Cancer, 100(4), 611–616. https://doi.org/10.1038/sj.bjc.6604917
Simons, C. C. J. M., Hughes, L. A. E., van Engeland, M., Goldbohm, R. A., van den Brandt, P. A., & Weijenberg, M. P. (2013). Physical activity, occupational sitting time, and colorectal cancer risk in the Netherlands cohort study. American Journal of Epidemiology, 177(6), 514–530. https://doi.org/10.1093/aje/kws280
Kirkegaard, H., Johnsen, N. F., Christensen, J., Frederiksen, K., Overvad, K., & Tjønneland, A. (2010). Association of adherence to lifestyle recommendations and risk of colorectal cancer: A prospective Danish cohort study. BMJ (Clinical Research Ed.), 341, c5504. https://doi.org/10.1136/bmj.c5504
Oruç, Z., & Kaplan, M. A. (2019). Effect of exercise on colorectal cancer prevention and treatment. World Journal of Gastrointestinal Oncology, 11(5), 348–366. https://doi.org/10.4251/wjgo.v11.i5.348
Edwards, B. K., Noone, A.-M., Mariotto, A. B., Simard, E. P., Boscoe, F. P., Henley, S. J., Jemal, A., Cho, H., Anderson, R. N., Kohler, B. A., Eheman, C. R., & Ward, E. M. (2014). Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer, 120(9), 1290–1314. https://doi.org/10.1002/cncr.28509
Wolin, K. Y., Yan, Y., & Colditz, G. A. (2011). Physical activity and risk of colon adenoma: A meta-analysis. British Journal of Cancer, 104(5), 882–885. https://doi.org/10.1038/sj.bjc.6606045
Wele, P., Wu, X., & Shi, H. (2022). Sex-Dependent Differences in Colorectal Cancer: With a Focus on Obesity. Cells, 11(22), 3688. https://doi.org/10.3390/cells11223688
Hautala, A. J., Kiviniemi, A. M., Mäkikallio, T. H., Kinnunen, H., Nissilä, S., Huikuri, H. V., & Tulppo, M. P. (2006). Individual differences in the responses to endurance and resistance training. European Journal of Applied Physiology, 96(5), 535–542. https://doi.org/10.1007/s00421-005-0116-2
Zou, D., Xin, X., Xu, Y., Xu, H., & Xu, T. (2025). A cross-sectional study on the association between physical activity and the risk of colon cancer based on NHANES 2007-2018. Scientific Reports, 15(1), 3297. https://doi.org/10.1038/s41598-025-88067-4
Stein, M. J., Baurecht, H., Bohmann, P., Fervers, B., Fontvieille, E., Freisling, H., Friedenreich, C. M., Konzok, J., Peruchet-Noray, L., Sedlmeier, A. M., Leitzmann, M. F., & Weber, A. (2024). Diurnal timing of physical activity and risk of colorectal cancer in the UK Biobank. BMC Medicine, 22(1), 399. https://doi.org/10.1186/s12916-024-03632-4
Lynch, B. M., Cerin, E., Owen, N., Hawkes, A. L., & Aitken, J. F. (2008). Prospective relationships of physical activity with quality of life among colorectal cancer survivors. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 26(27), 4480–4487. https://doi.org/10.1200/JCO.2007.15.7917
McGowan, E. L., Speed-Andrews, A. E., Rhodes, R. E., Blanchard, C. M., Culos-Reed, S. N., Friedenreich, C. M., & Courneya, K. S. (2013). Sport participation in colorectal cancer survivors: An unexplored approach to promoting physical activity. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 21(1), 139–147. https://doi.org/10.1007/s00520-012-1501-0
Courneya, K. S., Vardy, J. L., O’Callaghan, C. J., Gill, S., Friedenreich, C. M., Wong, R. K. S., Dhillon, H. M., Coyle, V., Chua, N. S., Jonker, D. J., Beale, P. J., Haider, K., Tang, P. A., Bonaventura, T., Wong, R., Lim, H. J., Burge, M. E., Hubay, S., Sanatani, M., … CHALLENGE Investigators. (2025). Structured Exercise after Adjuvant Chemotherapy for Colon Cancer. The New England Journal of Medicine, 393(1), 13–25. https://doi.org/10.1056/NEJMoa2502760
Brown, J. C., Ma, C., Shi, Q., Saltz, L. B., Shields, A. F., & Meyerhardt, J. A. (2025). The association of physical activity with survival in colon cancer versus a matched general population: Data from Cancer and Leukemia Group B 89803 and 80702 (Alliance). Cancer, 131(5), e35727. https://doi.org/10.1002/cncr.35727
Park, J., Kim, J. H., Lee, H. J., Park, S. J., Hong, S. P., Cheon, J. H., Kim, W. H., Park, J. S., Jeon, J. Y., & Kim, T. I. (2017). The Effects of Physical Activity and Body Fat Mass on Colorectal Polyp Recurrence in Patients with Previous Colorectal Cancer. Cancer Prevention Research (Philadelphia, Pa.), 10(8), 478–484. https://doi.org/10.1158/1940-6207.CAPR-17-0065
Ahn, K.-Y., Hur, H., Kim, D.-H., Min, J., Jeong, D. H., Chu, S. H., Lee, J. W., Ligibel, J. A., Meyerhardt, J. A., Jones, L. W., Jeon, J. Y., & Kim, N. K. (2013). The effects of inpatient exercise therapy on the length of hospital stay in stages I-III colon cancer patients: Randomized controlled trial. International Journal of Colorectal Disease, 28(5), 643–651. https://doi.org/10.1007/s00384-013-1665-1
Onerup, A., Li, Y., Afshari, K., Angenete, E., de la Croix, H., Ehrencrona, C., Wedin, A., & Haglind, E. (2024). Long-term results of a short-term home-based pre- and postoperative exercise intervention on physical recovery after colorectal cancer surgery (PHYSSURG-C): A randomized clinical trial. Colorectal Disease: The Official Journal of the Association of Coloproctology of Great Britain and Ireland, 26(3), 545–553. https://doi.org/10.1111/codi.16860
Amirsasan, R., Akbarzadeh, M., & Akbarzadeh, S. (2022). Exercise and colorectal cancer: Prevention and molecular mechanisms. Cancer Cell International, 22(1), 247. https://doi.org/10.1186/s12935-022-02670-3
Van Vulpen, J. K., Velthuis, M. J., Steins Bisschop, C. N., Travier, N., Van Den Buijs, B. J. W., Backx, F. J. G., Los, M., Erdkamp, F. L. G., Bloemendal, H. J., Koopman, M., De Roos, M. A. J., Verhaar, M. J., Ten Bokkel-Huinink, D., Van Der Wall, E., Peeters, P. H. M., & May, A. M. (2016). Effects of an Exercise Program in Colon Cancer Patients undergoing Chemotherapy. Medicine and Science in Sports and Exercise, 48(5), 767–775. https://doi.org/10.1249/MSS.0000000000000855
Morielli, A. R., Usmani, N., Boulé, N. G., Tankel, K., Severin, D., Nijjar, T., Joseph, K., & Courneya, K. S. (2016). A Phase I Study Examining the Feasibility and Safety of an Aerobic Exercise Intervention in Patients With Rectal Cancer During and After Neoadjuvant Chemoradiotherapy. Oncology Nursing Forum, 43(3), 352–362. https://doi.org/10.1188/16.ONF.352-362
Piringer, G., Fridrik, M., Fridrik, A., Leiherer, A., Zabernigg, A., Greil, R., Eisterer, W., Tschmelitsch, J., Lang, A., Frantal, S., Burgstaller, S., Gnant, M., Thaler, J., & Austrian Breast and Colorectal Cancer Study Group (ABCSG). (2018). A prospective, multicenter pilot study to investigate the feasibility and safety of a 1-year controlled exercise training after adjuvant chemotherapy in colorectal cancer patients. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 26(4), 1345–1352. https://doi.org/10.1007/s00520-017-3961-8
Lin, K.-Y., Shun, S.-C., Lai, Y.-H., Liang, J.-T., & Tsauo, J.-Y. (2014). Comparison of the effects of a supervised exercise program and usual care in patients with colorectal cancer undergoing chemotherapy. Cancer Nursing, 37(2), E21-29. https://doi.org/10.1097/NCC.0b013e3182791097
Mols, F., Beijers, A. J. M., Vreugdenhil, G., Verhulst, A., Schep, G., & Husson, O. (2015). Chemotherapy-induced peripheral neuropathy, physical activity and health-related quality of life among colorectal cancer survivors from the PROFILES registry. Journal of Cancer Survivorship: Research and Practice, 9(3), 512–522. https://doi.org/10.1007/s11764-015-0427-1
Giovannucci, E. (2001). Insulin, insulin-like growth factors and colon cancer: A review of the evidence. The Journal of Nutrition, 131(11 Suppl), 3109S-20S. https://doi.org/10.1093/jn/131.11.3109S
Giovannucci, E. (2007). Metabolic syndrome, hyperinsulinemia, and colon cancer: A review. The American Journal of Clinical Nutrition, 86(3), s836-842. https://doi.org/10.1093/ajcn/86.3.836S
Hakam, A., Yeatman, T. J., Lu, L., Mora, L., Marcet, G., Nicosia, S. V., Karl, R. C., & Coppola, D. (1999). Expression of insulin-like growth factor-1 receptor in human colorectal cancer. Human Pathology, 30(10), 1128–1133. https://doi.org/10.1016/s0046-8177(99)90027-8
Sax, A. T., Jenkins, D. G., Devin, J. L., Hughes, G. I., Bolam, K. A., & Skinner, T. L. (2014). The insulin-like growth factor axis: A biological mechanism linking physical activity to colorectal cancer survival. Cancer Epidemiology, 38(4), 455–459. https://doi.org/10.1016/j.canep.2014.05.011
Devin, J. L., Bolam, K. A., Jenkins, D. G., & Skinner, T. L. (2016). The Influence of Exercise on the Insulin-like Growth Factor Axis in Oncology: Physiological Basis, Current, and Future Perspectives. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 25(2), 239–249. https://doi.org/10.1158/1055-9965.EPI-15-0406
McTiernan, A., Yasui, Y., Sorensen, B., Irwin, M. L., Morgan, A., Rudolph, R. E., Surawicz, C., Lampe, J. W., Ayub, K., Potter, J. D., & Lampe, P. D. (2006). Effect of a 12-month exercise intervention on patterns of cellular proliferation in colonic crypts: A randomized controlled trial. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 15(9), 1588–1597. https://doi.org/10.1158/1055-9965.EPI-06-0223
Campbell, K. L., McTiernan, A., Li, S. S., Sorensen, B. E., Yasui, Y., Lampe, J. W., King, I. B., Ulrich, C. M., Rudolph, R. E., Irwin, M. L., Surawicz, C., Ayub, K., Potter, J. D., & Lampe, P. D. (2007). Effect of a 12-month exercise intervention on the apoptotic regulating proteins Bax and Bcl-2 in colon crypts: A randomized controlled trial. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 16(9), 1767–1774. https://doi.org/10.1158/1055-9965.EPI-07-0291
Pedersen, L., Idorn, M., Olofsson, G. H., Lauenborg, B., Nookaew, I., Hansen, R. H., Johannesen, H. H., Becker, J. C., Pedersen, K. S., Dethlefsen, C., Nielsen, J., Gehl, J., Pedersen, B. K., Thor Straten, P., & Hojman, P. (2016). Voluntary Running Suppresses Tumor Growth through Epinephrine- and IL-6-Dependent NK Cell Mobilization and Redistribution. Cell Metabolism, 23(3), 554–562. https://doi.org/10.1016/j.cmet.2016.01.011
Klampfer, L. (2011). CYTOKINES, INFLAMMATION AND COLON CANCER. Current Cancer Drug Targets, 11(4), 451–464. https://doi.org/10.2174/156800911795538066
Mehl, K. A., Davis, J. M., Clements, J. M., Berger, F. G., Pena, M. M., & Carson, J. A. (2005). Decreased intestinal polyp multiplicity is related to exercise mode and gender in ApcMin/+ mice. Journal of Applied Physiology (Bethesda, Md.: 1985), 98(6), 2219–2225. https://doi.org/10.1152/japplphysiol.00975.2004
Oshima, M., & Taketo, M. M. (2002). COX selectivity and animal models for colon cancer. Current Pharmaceutical Design, 8(12), 1021–1034. https://doi.org/10.2174/1381612023394953
Guffey, C. R., Fan, D., Singh, U. P., & Murphy, E. A. (2013). Linking obesity to colorectal cancer: Recent insights into plausible biological mechanisms. Current Opinion in Clinical Nutrition and Metabolic Care, 16(5), 595–600. https://doi.org/10.1097/MCO.0b013e328362d10b
Hojman, P., Gehl, J., Christensen, J. F., & Pedersen, B. K. (2018). Molecular Mechanisms Linking Exercise to Cancer Prevention and Treatment. Cell Metabolism, 27(1), 10–21. https://doi.org/10.1016/j.cmet.2017.09.015
Mailing, L. J., Allen, J. M., Buford, T. W., Fields, C. J., & Woods, J. A. (2019). Exercise and the Gut Microbiome: A Review of the Evidence, Potential Mechanisms, and Implications for Human Health. Exercise and Sport Sciences Reviews, 47(2), 75–85. https://doi.org/10.1249/JES.0000000000000183
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