Purpose <p>To examine the effects of a 12-week rehabilitation program of exercise combined with diet education on the quality of life (QOL) and symptoms (anxiety, depression, rest/activity circadian rhythm (RACR), and sleep) of patients with esophageal cancer.</p> Methods <p>We used a two-parallel-arms randomized controlled trial. The experimental group (EG) participated in a 12-week program involving walking exercise and diet education. The control group (CG) received standard care. The primary outcome was QOL, measured using the European Organisation for Research and Treatment of Cancer QOL core questionnaire (QLQ-C30) and esophageal module 18 (EORTC QLQ-OES18). Secondary outcomes were anxiety, depression, RACR, and sleep characteristics. Measurement time points were baseline and 3, 6, and 12&#xa0;months after recruitment.</p> Results <p>Of 85 enrolled patients with esophageal cancer (EG = 43, CG = 42), the majority were male, 59&#xa0;years old on average, and had received surgery. The EG recorded significantly better 24-h autocorrelation coefficient (0.06 to 0.24, <i>p</i> = 0.002; Cohen’s <i>d</i> = 0.98) of rest/activity rhythms parameters at 6&#xa0;months. In the EG, total sleep time significantly increased at 3&#xa0;months (16.36 to 86.07, <i>p</i> = 0.004; Cohen’s <i>d</i> = 0.86).</p> Conclusions <p>The intervention improved the RACR and sleep of patients with esophageal cancer. Healthcare professionals may consider incorporating this rehabilitation program into routine care alongside cancer treatment for patients with esophageal cancer.&#xa0;</p> Trial registration <p>Clinicaltrials.gov (registration number: NCT03161535). Prospectively registered on 17 May 2017.&#xa0;</p>