Walking Linked to 26% Lower Odds of Severe Fatigue After Colorectal Cancer

Patients with colorectal cancer who stayed consistently active after diagnosis, primarily by walking, reported less fatigue and better quality of life over two years, according to an observational study published in the Journal of the National Comprehensive Cancer Network.

The study followed 1,718 patients with newly diagnosed colorectal cancer. A patient's activity level at diagnosis did not determine how they felt later, which suggests the months after diagnosis may be a window for becoming more active.

How was walking linked to fatigue in patients with colorectal cancer?

Patients who reported more walking had 22% lower odds of severe fatigue at six months and 26% lower odds at 12 months. Walking was also associated with better quality of life at each follow-up point.

Cancer-related fatigue differs from ordinary tiredness because rest does not always relieve it, and it can interfere with work, social life and everyday activities. Nearly 40% of colorectal cancer survivors have historically reported persistent fatigue, according to Cedars-Sinai researchers.

"I assumed that people engaging in more vigorous activities would have the best outcomes, but that wasn't the case," said Dr. Louisa Liu, the study's first author and a hematology-oncology fellow at Cedars-Sinai Cancer during the research.

Later in recovery, vigorous activity showed a benefit at 24 months. It was associated with 35% lower odds of severe fatigue, the strongest association seen at that time point.

"We found that consistency, rather than the intensity of the exercise, was most beneficial," Liu explained. "Walking can be self-paced and easily adapted to a patient's energy level and physical ability, so patients who walked were better able to do it consistently."

Does activity level at diagnosis affect fatigue after colorectal cancer?

Physical activity rose steadily over the two-year study while fatigue generally decreased and quality of life improved, and higher activity levels were consistently associated with better outcomes.

Earlier analyses from the study found that physical activity at 12 months, rather than at diagnosis, was the strongest independent predictor of lower fatigue and better quality of life at 24 months and beyond. Patients who were inactive around the time of diagnosis may still benefit from becoming more active during recovery, according to those results.

Among patients whose cancer had not spread to other parts of the body (metastasized), walking was associated with lower fatigue at several points in recovery. The link between activity and better outcomes was less clear among patients with metastatic disease.

What did the colorectal cancer fatigue study measure?

Researchers assessed physical activity when patients entered the study and again approximately six, 12 and 24 months after diagnosis. Patients reported time spent walking, doing moderate activities such as brisk walking or household tasks, and doing vigorous activities. Researchers converted those reports into metabolic equivalent task (MET) minutes per week, a standard way to combine how long and how hard a person is active, and measured fatigue and quality of life with a validated cancer questionnaire.

Unlike studies testing structured exercise programs, the research looked at activity in patients' everyday lives, including walking, household chores, swimming and yoga.

Cancer-related fatigue can stem from treatment side effects, loss of muscle tissue and the emotional demands of living with cancer. Physical activity may address several of those causes at once by supporting muscle mass, metabolism, mental well-being and physical functioning, according to the researchers.

What are the limitations of the colorectal cancer walking study?

Because the study was observational, researchers followed patients' existing activity rather than randomly assigning them to walk or stay inactive, so the findings do not show that walking itself reduced fatigue. Patients who felt healthier or less fatigued may also have been better able to exercise. The researchers said clinical trials are needed to confirm the results.

References

1. Liu L, Kazemian E, Loroña NC, et al. "Longitudinal Study on the Influence of Physical Activity in Managing Fatigue in Patients With Colorectal Cancer." Journal of the National Comprehensive Cancer Network. Published September 22, 2026.

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