Wednesday, January 07, 2026 The CO.21 CHALLENGE trial has been selected by the editors as one of the top NEJM 15 articles of 2025. Each year, NEJM editors review the research published in the New England Journal of Medicine and select some of the most clinically significant studies for the annual Notable Articles collection. This year’s edition highlights 15 influential studies. Linked here is abbreviated CO21 document that includes the CO21 Editorial. Editorial Extending Cancer Survival with Exercise — Time for Oncology to ActMelinda L. Irwin, Ph.D., M.P.H.1The CHALLENGE findings underscore the need to integrate exercise into cancer care. Although current guidelines already recommend physical activity before, during, and after treatment,6,7 few adults — whether healthy or diagnosed with cancer — meet the recommended 2.5 hours per week of moderate-intensity activity, such as brisk walking.13 Without systems-level changes, physical activity levels are unlikely to increase. Although implementation studies are needed to identify the best strategies for integrating exercise into care, we should not wait. Clinicians can refer patients to community-based exercise programs and use or adapt existing services such as cardiac rehabilitation. Trained exercise counselors should be embedded within oncology care teams, with services covered by insurance. As oncology continues to advance, exercise must become a standard part of care. The time to act is now.
