Colorectal Cancer: A 2026 Clinical Overview for Fitness and Rehabilitation Professionals

Colorectal cancer (CRC) remains one of the most significant global health challenges and is increasingly relevant to exercise professionals working across prevention, treatment, and survivorship care.

As of the most recent global estimates (2024–2026 projections), colorectal cancer is the third most commonly diagnosed cancer worldwide and a leading cause of cancer-related mortality. Updated epidemiological models estimate over 2.2 million new cases annually, with projections suggesting that global incidence may exceed 3.2 million new cases by 2040. The United States and China continue to represent a substantial proportion of future disease burden.

While incidence has declined among older adults due to improved screening and early polyp detection, a concerning trend persists: rates of colorectal cancer in adults under age 50 continue to rise, with increases estimated at roughly 1-2% per year in many developed nations. This shift has major implications for fitness professionals, as younger, active individuals may now present with CRC during peak working and training years.

Understanding Colorectal Cancer

Colorectal cancer refers to malignancies occurring in the large intestine, which includes:

• Colon – approximately five feet of the large bowel
• Rectum – the final six to eight inches

Because tumors can develop anywhere along this pathway and often share biological and treatment characteristics, colon and rectal cancers are typically grouped together clinically.

Most colorectal cancers begin as polyps that form along the inner lining of the colon or rectum. Over time, some polyps may undergo malignant transformation.

Types of Polyps

Adenomatous polyps (adenomas)

• Considered precancerous
• Greater likelihood of progression to malignancy

Hyperplastic or inflammatory polyps

• More common
• Typically low malignant potential

Risk increases with:

• Polyps larger than 1 cm
• Multiple polyps
• Personal history of advanced adenomas

For fitness professionals, understanding polyp biology reinforces the importance of long-term lifestyle behaviors in cancer prevention and recurrence risk reduction.

Understanding Colorectal Cancer

Colorectal cancer refers to malignancies occurring in the large intestine, which includes:

• Colon – approximately five feet of the large bowel
• Rectum – the final six to eight inches

Because tumors can develop anywhere along this pathway and often share biological and treatment characteristics, colon and rectal cancers are typically grouped together clinically.

Most colorectal cancers begin as polyps that form along the inner lining of the colon or rectum. Over time, some polyps may undergo malignant transformation.

Types of Polyps

Adenomatous polyps (adenomas)

• Considered precancerous
• Greater likelihood of progression to malignancy

Hyperplastic or inflammatory polyps

• More common
• Typically low malignant potential

Risk increases with:

• Polyps larger than 1 cm
• Multiple polyps
• Personal history of advanced adenomas

For fitness professionals, understanding polyp biology reinforces the importance of long-term lifestyle behaviors in cancer prevention and recurrence risk reduction.

Why This Matters for Fitness Professionals

Exercise is now recognized as a core component of both prevention and survivorship. Professionals must understand that:

• Clients may enter training during active treatment or early recovery.
• Younger populations with CRC may appear outwardly “fit” yet have significant physiological limitations.
• Surgical history and gastrointestinal function heavily influence exercise tolerance.

Screening guidelines have evolved, with many organizations recommending average-risk screening beginning at age 45, emphasizing earlier detection.

Surgical Interventions and Exercise Considerations

(From the not-yet released 15th Edition of the Cancer Exercise Specialist Handbook)

Colorectal cancer treatment frequently involves surgery. Each procedure carries specific rehabilitation implications.

Partial colectomy (segmental resection / hemicolectomy)
This is the most common surgery for colon cancer. The surgeon removes the portion of the colon containing the tumor, along with a margin of healthy tissue and nearby lymph nodes, and then reconnects the remaining ends of the bowel (anastomosis). This approach provides a balance between effective cancer removal and preservation of bowel function. The extent of resection depends on where the tumor is located.

Common types of colectomy include:

• Right hemicolectomy: removal of the ascending colon (right side) and part of the transverse colon.
• Left hemicolectomy: removal of the descending colon (left side).
• Sigmoid colectomy (sigmoidectomy): removal of the sigmoid colon, the S-shaped portion near the rectum.
• Transverse colectomy: removal of the middle section of the colon.
• Segmental colectomy: removal of a smaller segment within one of these sections when the tumour is localized.

Following a colectomy, recovery takes place gradually over several weeks as the body adapts to the loss of a portion or all of the colon and the bowel adjusts to its new function. Hospital stays typically range from 4 to 7 days for minimally invasive procedures such as laparoscopic or robotic colectomy and up to 10 days for open surgery or cases involving complications. During the hospital phase, the focus is on pain control, bowel function recovery, and prevention of complications such as infection, ileus (temporary paralysis of the bowel), or blood clots. Patients usually begin walking within 24 hours after surgery to promote circulation, reduce stiffness, and encourage intestinal movement. Once bowel sounds return and the patient can tolerate liquids and soft food, discharge is usually appropriate.

During the first four weeks at home, fatigue, abdominal soreness, and irregular bowel habits are common. It is normal for bowel movements to be loose or more frequent during this period as the remaining colon adapts. Activity should be limited to gentle walking and light daily movements, avoiding strain or twisting of the abdomen. Lifting, pushing, or pulling objects heavier than 5-10 pounds (2–4.5 kg) should be avoided to protect the abdominal incision and prevent hernias. Patients are encouraged to maintain upright posture, take frequent short walks, and rest between activities to promote healing. Driving, sexual activity, and returning to work should wait until pain has subsided and mobility has improved - usually by the end of the first month.

Between weeks five and eight, energy levels gradually improve, and most patients begin to resume light household tasks or return to part-time work. Walking distances can be increased, and simple stretching may be introduced to maintain flexibility. However, activities that cause abdominal pressure, such as lifting more than 15 pounds (7 kg), bending repeatedly, or high-impact exercise, should still be avoided. Patients with a temporary stoma may need to adjust their routines around stoma care and pouch management, ensuring hydration and nutrition are maintained.

By weeks nine through twelve, most individuals experience a noticeable return of strength and endurance. Bowel patterns usually stabilize, and abdominal discomfort continues to diminish. At this stage, light to moderate exercise can be resumed, including stationary cycling, gentle resistance work, and longer walks, provided there is no pain or fatigue. Heavy lifting, core-intensive training, and strenuous aerobic exercise should wait until at least 12 weeks post-surgery and only after clearance from the surgeon. Full recovery, meaning unrestricted activity, stable digestion, and complete tissue healing, typically takes three to six months, depending on the extent of surgery and the patient’s overall health.

Total or Subtotal colectomy
Involves removal of nearly all or the entire colon, typically used when there are multiple tumors, diffuse disease, or a hereditary condition such as familial adenomatous polyposis. After removal, the surgeon connects the small intestine to the rectum or creates a stoma to divert waste. This operation sacrifices more bowel length but provides the most comprehensive tumor clearance.

Following a total or subtotal colectomy, recovery is generally more complex and prolonged than after a partial colectomy because a larger section - or the entire colon - has been removed. Hospital stays typically range from 5 to 10 days, depending on whether the surgery was performed laparoscopically or through an open incision, and on how quickly bowel function returns. During the hospital phase, patients are closely monitored for pain control, hydration, and early complications such as infection, bleeding, or anastomotic leakage. Walking is encouraged within 24 hours after surgery to prevent blood clots, stimulate bowel activity, and promote circulation. Because the small intestine must now adapt to handling most of the digestive process, bowel movements can be frequent and watery for several weeks. Once the patient can tolerate fluids and soft foods and the bowels are functioning, discharge is typically considered.

During the first month at home, fatigue and weakness are common, and it can take time for appetite and energy to return. Abdominal tenderness and changes in bowel habits - such as urgency, loose stools, or gas discomfort - are expected as the gastrointestinal tract adjusts. Activity should be limited to light walking and basic household tasks. Lifting, pushing, or pulling objects heavier than 5-10 pounds (2–4.5 kg) should be strictly avoided to protect the abdominal wall and internal sutures. Patients with a stoma require additional guidance on pouch care, hydration, and preventing skin irritation, as fluid loss and electrolyte imbalance can occur more easily after extensive colon removal.

Between weeks five and eight, strength gradually improves, and walking distances can increase at a comfortable pace. A regular eating pattern usually returns, though patients may need to eat smaller, more frequent meals and avoid high-fat or high-fiber foods until digestion stabilizes. Activities that create strain or abdominal pressure - such as lifting more than 15 pounds (7 kg), bending repeatedly, or high-impact movement - should still be avoided. Rest remains an important part of recovery, as fatigue can fluctuate daily.

By weeks nine through twelve, most individuals are capable of resuming moderate daily activities, including light exercise such as walking, stationary cycling, and gentle stretching. Patients with a stoma typically become more confident managing their appliance and can resume many normal routines. Strenuous activity, heavy lifting, abdominal workouts, or high-intensity training should not begin until after 12 weeks and only with the surgeon’s clearance. Full recovery - meaning stable bowel function, complete wound healing, and restored endurance - may take three to six months, depending on the patient’s overall health, the extent of surgery, and any underlying conditions.

Colectomy with stoma (colostomy or ileostomy)
When reconnection of the colon is not possible or safe, a stoma is created. The bowel is brought to the surface of the abdomen, and stool is collected in a pouch outside the body. This may be temporary, allowing the bowel to heal before reattachment, or permanent if reconnection is not feasible. It is used when there is significant inflammation, poor healing potential, or bowel obstruction.

Following a total or subtotal colectomy with a stoma (colostomy or ileostomy), recovery takes longer and requires additional adaptation - both physically and emotionally - as the body adjusts to a new way of eliminating waste. Hospital stays typically range from 7 to 10 days, depending on whether the surgery was performed laparoscopically or as an open procedure, and on how quickly bowel function stabilizes. During this period, the focus is on pain management, hydration, and learning how to care for the stoma. Nurses provide education on pouch changes, skin protection, and recognizing signs of infection or leakage. Patients begin walking within 24 hours after surgery to improve circulation, promote bowel movement through the small intestine, and reduce the risk of blood clots. Once oral intake is tolerated, the stoma is functioning, and the patient feels comfortable with stoma care, discharge is considered appropriate.

During the first month at home, fatigue and abdominal tenderness are expected, and adjusting to stoma care can feel overwhelming. The abdomen and peristomal skin may be sensitive, and swelling around the stoma is common early on. Physical activity should be limited to short, slow walks and gentle daily movement. Lifting, pushing, or pulling anything heavier than 5-10 pounds (2–4.5 kg) should be strictly avoided to prevent strain on the abdominal incision and reduce the risk of developing a parastomal hernia. Hydration is critical - especially after an ileostomy - since the large intestine, which normally absorbs much of the body’s fluids, is no longer present. Small, frequent meals with moderate fiber are recommended while the digestive system adjusts. Rest periods throughout the day help manage fatigue and promote healing.

Between weeks five and eight, energy levels improve gradually, and walking distances can increase at a comfortable pace. By this stage, most patients can manage their stoma independently and resume basic household tasks, provided they avoid heavy lifting or twisting of the torso. Light stretching or range-of-motion exercises can be introduced, but abdominal and core work should still be avoided. Hydration and electrolyte balance continue to require attention, particularly for those with an ileostomy. Foods that cause gas, blockages, or odor should be introduced slowly, and medical follow-up is essential to assess stoma healing and pouch fit.

By weeks nine through twelve, strength and confidence typically improve, and most patients resume moderate daily activity, including light walking, stationary cycling, or gentle yoga. Stoma care becomes more routine, and bowel output patterns begin to stabilize. Heavy resistance training, running, or exercises that place pressure on the abdomen - such as planks, sit-ups, or weightlifting - should still be postponed until at least 12 weeks post-surgery, or longer if healing is incomplete. Core strengthening and higher-impact fitness can be gradually reintroduced under medical guidance, focusing on avoiding excessive strain near the stoma.

Full recovery after a total or subtotal colectomy with a stoma may take three to six months, depending on surgical complexity, individual healing, and adaptation to stoma care.

Laparoscopic or robotic colectomy (minimally invasive approach)
These methods use small incisions and specialized instruments guided by a camera or robotic system to perform the same procedures as traditional open colectomy. The benefits include less postoperative pain, smaller scars, faster recovery, and shorter hospital stays. This approach is suitable for most localized colon cancers when performed by experienced surgeons.

Following a laparoscopic or robotic colectomy, recovery is generally faster and less painful than with open surgery because the procedure uses several small incisions rather than one large one. Hospital stays typically last between 3 and 5 days, though many patients undergoing robotic-assisted surgery may be discharged even sooner if bowel function returns quickly. During hospitalization, the primary goals are pain management, gradual reintroduction of fluids and food, and early ambulation. Patients are encouraged to begin walking within 12 to 24 hours after surgery to reduce the risk of blood clots, stimulate bowel activity, and promote overall recovery. Once patients can tolerate a light diet and their bowel function begins to normalize, discharge is usually appropriate.

During the first month at home, most individuals experience mild fatigue, occasional abdominal discomfort, and changes in bowel habits, such as bloating or frequent stools. Physical activity should be limited to light, non-strenuous movements such as walking short distances several times per day. Lifting or carrying objects heavier than 10 pounds (about 4.5 kg) should be avoided to prevent stress on the healing incisions. Driving and returning to work should wait until pain is well controlled and reaction times have returned to normal - typically within 2 to 4 weeks, depending on the individual’s recovery and job demands.

Between weeks five and eight, energy levels generally improve, and patients can increase walking distances or begin light stretching and gentle mobility exercises. Most can resume household chores and desk work without restriction but should still avoid any motion that strains the abdominal muscles, including bending, twisting, or lifting weights over 15 pounds (7 kg). Bowel regularity usually stabilizes during this period, though diet adjustments may continue based on tolerance.

By weeks nine through twelve, most patients are capable of returning to normal routines, including moderate exercise such as brisk walking, low-resistance cycling, or gentle yoga. The small incisions are typically well healed, though deep internal tissues continue to strengthen. Heavy lifting, running, abdominal workouts, and high-impact exercise should be postponed until the three-month mark and only resumed once cleared by the surgeon. Complete recovery - defined by stable bowel function, restored strength, and full mobility - usually occurs within 8 to 12 weeks.

Emergency or palliative resections
In some advanced or complicated cases such as bowel obstruction, perforation, or uncontrollable bleeding - surgery may be performed to relieve symptoms rather than to cure the cancer. The surgeon may remove or bypass the tumor, create a colostomy, or perform limited resection. The intent is to improve comfort, prevent infection, and restore bowel function rather than achieve long-term remission.

Following an emergency or palliative colectomy, recovery varies widely depending on the reason for surgery, the patient’s overall condition, and whether complications such as bowel perforation, obstruction, or bleeding were present before the operation. Hospital stays are typically longer than for planned procedures, often ranging from 7 to 14 days or more, since patients undergoing emergency surgery are frequently weaker or have other health issues that delay recovery. During hospitalization, the primary focus is stabilizing vital signs, controlling infection or inflammation, and ensuring the bowel and surrounding tissues heal properly. Pain management, hydration, and gradual reintroduction of oral intake are closely monitored. Walking is encouraged as soon as safely possible - usually within the first 48 hours - to promote circulation, reduce stiffness, and prevent pneumonia or blood clots.

The first month at home is focused on regaining basic strength and preventing complications such as wound infection, hernias, or dehydration. Activity should remain light, limited to slow walking and essential daily tasks. Lifting or carrying objects heavier than 5-10 pounds (2–4.5 kg) should be avoided to reduce abdominal strain. Depending on the extent of surgery, some patients may have a temporary or permanent stoma and will require time and education to adjust to stoma care. Those recovering from emergency operations may also be coping with malnutrition or fatigue from prior illness, making rest and gradual progression especially important.

Between weeks five and eight, most patients begin regaining energy and can increase walking distance and frequency. Diet and bowel function gradually stabilize, though irregularities such as loose stools or mild cramping are common. Gentle stretching and breathing exercises may be helpful for mobility, but heavy exertion, twisting, or lifting more than 15 pounds (7 kg) should still be avoided. Emotional recovery is also an important part of this phase, especially for individuals living with advanced disease or a new stoma.

By weeks nine through twelve, strength and endurance typically improve, allowing patients to return to light daily activities. For those who underwent surgery with palliative intent, exercise is guided more by comfort and energy levels than by strict progression. Gentle, low-impact movement - such as walking, easy cycling, or basic mobility exercises - can support circulation, mood, and independence. High-intensity activity, core strain, or weightlifting should be avoided indefinitely unless the patient has made exceptional progress and receives medical clearance.

Overall, recovery after an emergency or palliative resection focuses less on physical performance and more on restoring function, managing symptoms, and maintaining quality of life. Healing may take several months, and pacing activity to match individual tolerance - alongside emotional and nutritional support - is essential for optimal recovery and comfort.

Low Anterior Resection (LAR)
A low anterior resection involves removing the rectosigmoid portion of the colon and upper part of the rectum, where the tumor is located, while preserving the anal sphincter and normal bowel continuity. The healthy ends of the colon and rectum are then reconnected (anastomosed). This approach allows the patient to maintain normal bowel control and avoid a permanent colostomy.

The operation may be done through open, laparoscopic, or robotic-assisted approaches, depending on surgeon expertise and tumor characteristics. Minimally invasive methods have become more prevalent due to their lower complication rates, faster recovery, and similar long-term oncologic outcomes.

Following a low anterior resection (LAR), recovery tends to be gradual, as the body heals from both the bowel resection and the reattachment of the colon to the remaining rectum. Hospital stays typically last between 5 and 7 days for minimally invasive procedures, and up to 10 days for open surgeries or more complex cases. The focus during hospitalization is on controlling pain, monitoring bowel function, and ensuring the anastomosis (bowel connection) heals properly. A temporary diverting ileostomy is often created to protect the reconnected section of the bowel, and patients receive instruction on stoma care if one is present. Early ambulation - beginning within 24 hours - is strongly encouraged to reduce the risk of blood clots, improve circulation, and promote return of bowel activity. Once the patient can tolerate fluids and a soft diet and bowel movement resumes, discharge is considered appropriate.

During the first month at home, fatigue and changes in bowel habits are common. Patients may experience urgency, frequency, or partial incontinence as the rectum and bowel adjust. It is important to avoid straining or sitting for prolonged periods. Activity should focus on gentle walking and light daily movement, avoiding lifting more than 5-10 pounds (2-4.5 kg) or engaging in any activity that increases abdominal pressure. Rest is essential, and hydration should be maintained to support healing and bowel function. Driving, sexual activity, and returning to work should wait until pain is well managed and energy levels improve - usually by 4 to 6 weeks.

Between weeks five and eight, most individuals begin to regain strength and confidence in movement. Walking distances can be increased gradually, and light stretching or gentle yoga may be introduced if cleared by the surgeon. If a temporary stoma is present, this period also allows for adaptation to stoma care and routine management. Bowel control continues to improve, but irregularity is still expected. Activities involving bending, twisting, or lifting more than 15 pounds (7 kg) should still be avoided.

By weeks nine through twelve, most patients experience better energy, reduced discomfort, and improved bowel regulation. Moderate activities such as longer walks, stationary cycling, and gentle resistance exercises may be resumed, provided there is no pain or fatigue. Core or abdominal strengthening and high-impact activity should be delayed until at least 12 weeks post-surgery and only after medical clearance, as the anastomosis and pelvic floor continue to heal.

Full recovery after a low anterior resection typically occurs over 3 to 6 months, depending on surgical complexity and whether an ileostomy was created. Bowel patterns may take several months to stabilize, and patients often benefit from dietary adjustments and pelvic floor retraining to improve function. The focus during the first three months is gradual reconditioning, avoiding abdominal strain, and allowing both physical and bowel function to recover safely.

Abdominoperineal Resection (APR)
An abdominoperineal resection removes the rectum, anal canal, and surrounding tissue, including the sphincter muscles. The colon is then brought through the abdominal wall to form a permanent colostomy. This procedure is performed when there is no safe way to reconnect the bowel while preserving continence, typically because the tumor is too close to or involves the anal sphincter.

Following an abdominoperineal resection (APR), recovery typically requires more time and care than other colorectal surgeries because it involves both an abdominal incision and a perineal wound. Hospital stays generally range from 7 to 10 days, although this can vary depending on the patient’s health, the surgical approach (open vs. laparoscopic), and whether complications such as infection or delayed healing occur. During hospitalization, the focus is on pain control, wound management, and learning how to care for the permanent colostomy. The perineal incision can cause discomfort when sitting, so patients are encouraged to use cushions and change positions frequently. Walking usually begins within 24 hours after surgery to promote circulation, prevent clots, and aid bowel function through the remaining intestine. Discharge occurs once the stoma is functioning, pain is manageable, and patients are confident with basic stoma care.

The first four weeks at home are focused on rest, gradual mobility, and wound care. Fatigue, soreness, and drainage from the perineal wound are common. Walking is the safest form of exercise during this period, starting with short, slow sessions several times per day. Lifting, pushing, or pulling anything heavier than 5-10 pounds (2-4.5 kg) should be avoided to protect both incisions and prevent hernias near the stoma. Sitting for long periods should be minimized until the perineal area heals, and a soft cushion should be used for comfort. Maintaining hydration and a low-fiber diet early on helps prevent straining and allows the digestive system to adjust to colostomy function.

Between weeks five and eight, energy levels improve, and walking distances can increase at a steady pace. Most patients can perform light household tasks, provided they avoid bending, twisting, or heavy lifting. Gentle stretching may be introduced to restore mobility, but anything that places pressure on the perineum or abdomen should be postponed. Stoma management typically becomes easier during this time, and the perineal incision continues to close and strengthen.

By weeks nine through twelve, most individuals experience noticeable gains in strength and independence. Moderate activity such as walking longer distances, gentle yoga, or stationary cycling may be resumed as long as it does not cause pain or fatigue. High-impact movements, abdominal exercises, and lifting more than 15-20 pounds (7-9 kg) should still be avoided to prevent strain or hernia formation. Sitting comfort gradually improves, but full perineal healing can take several months.

Complete recovery from an abdominoperineal resection typically occurs within three to six months, though adaptation to a permanent colostomy may take longer.

Pelvic Exenteration
Pelvic exenteration is a far more extensive operation involving the removal of multiple pelvic organs - such as the rectum, bladder, reproductive organs, and sometimes part of the bony pelvis - to achieve complete removal of locally advanced or recurrent cancer. The procedure may be total, anterior, or posterior, depending on which structures are removed. Although pelvic exenteration carries high morbidity and a long recovery, it remains a potentially curative option for select patients with no distant metastases. Improvements in imaging, patient selection, reconstructive surgery, and perioperative care have led to better survival and quality-of-life outcomes in recent years.

Following a pelvic exenteration, recovery is extensive and requires a multidisciplinary approach to address both the physical and emotional challenges of such a major operation. Hospital stays typically range from 10 to 21 days, depending on the extent of the surgery and whether it involved removal of adjacent organs such as the bladder, reproductive organs, or part of the bony pelvis. The immediate postoperative focus is on pain management, infection prevention, and monitoring for complications such as bleeding, wound breakdown, or abscess formation. Patients are closely observed in a high-dependency or intensive care unit during the first few days, as multiple surgical sites and drains require careful management. Nutrition is reintroduced slowly - usually starting with clear fluids and progressing to soft foods once bowel activity resumes. Patients often have one or more stomas (colostomy, ileostomy, or urostomy), and stoma education begins as soon as they are stable enough to participate. Gentle assisted walking usually starts within 48 to 72 hours to improve circulation, reduce stiffness, and prevent clots.

During the first month at home, recovery remains slow and focused on wound care, energy conservation, and learning to manage new bodily functions. Patients often experience fatigue, abdominal and pelvic tenderness, and significant adjustments to body image and daily routines, especially if permanent stomas are present. Physical activity should be minimal and limited to short, gentle walks several times a day, gradually increasing in duration as tolerated. Lifting, bending, twisting, or carrying objects heavier than 5-10 pounds (2-4.5 kg) should be strictly avoided to prevent wound separation or hernia formation. Hydration and nutrition are essential for healing, and small, frequent meals are often better tolerated. Emotional and psychological support are equally important during this phase, as patients adapt to major lifestyle changes.

Between weeks five and eight, energy levels begin to improve, and walking distances can be increased at a slow, steady pace. Light household activities may be resumed if they do not involve strain or fatigue. Some patients begin gentle stretching or physical therapy to restore mobility and prevent stiffness in the hips and lower back. Any exercise involving the abdominal or pelvic region should be avoided, as deep tissue healing continues. Wound sites, particularly perineal or pelvic incisions, often take several months to fully close and must be kept clean and dry to prevent infection.

By weeks nine through twelve, most individuals experience gradual increases in stamina and a greater ability to perform daily activities. Low-impact exercises such as walking, light stationary cycling, or gentle range-of-motion exercises can usually be performed without discomfort. However, heavy resistance training, running, or any movement that increases intra-abdominal pressure should be postponed until at least 12 to 16 weeks post-surgery and only after medical clearance. Adaptation to stoma care and urinary diversion continues during this period, with support from wound and ostomy care nurses.

Full recovery following a pelvic exenteration can take six months to a year, depending on surgical complexity, reconstruction, and the patient’s baseline health. Many patients benefit from ongoing physical therapy, nutritional counseling, and psychological support.

Programming Considerations for Exercise Specialists

Fitness professionals working with CRC clients must prioritize progression over performance.

Key Guidelines

• Walking is the foundational movement during early recovery.
• Monitor gastrointestinal symptoms closely; hydration and electrolyte balance are critical.
• Avoid heavy loading, intense core work, or aggressive flexion/rotation early post-surgery.
• Pelvic floor integration and breathing mechanics are essential.
• Fatigue may fluctuate dramatically due to chemotherapy, radiation, or altered nutrient absorption.

Red Flags and Safety Considerations

Exercise professionals should pause training and refer clients to medical providers if the following occur:

• Persistent diarrhea or vomiting - no exercise for at least 24-48 hours and until hydration is restored
• Fever, chills, or significant abdominal pain
• Sudden swelling or signs of lymphedema
• Severe fatigue disproportionate to activity level

If lymph nodes were removed or irradiated:

• Obtain baseline limb measurements
• Begin sessions with gentle lymphatic drainage exercises
• Ensure prescribed compression garments are used during exercise when indicated

The Role of the Modern Fitness Professional in Colorectal Cancer Care

The evolving landscape of colorectal cancer - particularly the rise in younger diagnoses - positions fitness professionals as essential members of the extended oncology care team.

Exercise programming should aim to:

• Preserve functional independence
• Support metabolic health
• Improve treatment tolerance
• Reduce recurrence risk factors
• Restore confidence in movement after surgery

In 2026, oncology-informed exercise is no longer a niche specialty. It is rapidly becoming a necessary competency for professionals working with general populations, aging adults, and active survivors alike.