Exercise recommendations for older adults living with and beyond cancer: A consensus statement by the Advancing Capacity to Integrate Exercise Into the Care of Older Cancer Survivors expert panel

Kerri M Winters-Stone; Gabrielle Meyers; Elizabeth Eckstrom; Andrea Cheville; Jose M Garcia; Margaret L McNeely; Supriya Mohile; Karen Mustian; Sarah Neil-Sztramko; Laura Q Rogers; Kathryn H Schmitz; Anna Schwartz; Jessica Sitemba; Robert Smith; Kristin L Campbell

doi:10.1002/cncr.70252

Exercise recommendations for older adults living with and beyond cancer: A consensus statement by the Advancing Capacity to Integrate Exercise Into the Care of Older Cancer Survivors expert panel

Cancer. 2026 Jan 15;132(2):e70252. doi: 10.1002/cncr.70252.

Authors

Kerri M Winters-Stone¹, Gabrielle Meyers², Elizabeth Eckstrom³, Andrea Cheville⁴, Jose M Garcia^{5

6}, Margaret L McNeely⁷, Supriya Mohile⁸, Karen Mustian⁹, Sarah Neil-Sztramko^{10

11}, Laura Q Rogers¹², Kathryn H Schmitz¹³, Anna Schwartz¹⁴, Jessica Sitemba¹, Robert Smith², Kristin L Campbell¹⁵

Affiliations

¹ Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
² Division of Hematology/Oncology, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
³ Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon, USA.
⁴ Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA.
⁶ VA Puget Sound Health Care System, Seattle, Washington, USA.
⁷ Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁸ Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA.
⁹ Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA.
¹⁰ National Collaborating Centre for Methods and Tools, Hamilton, Ontario, Canada.
¹¹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
¹² Division of General Internal Medicine and Population Science, Department of Medicine, Heersink School of Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹³ Division of Hematology/Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA.
¹⁴ Coleman Health LLC, Parks, Arizona, USA.
¹⁵ Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Abstract

Background: The number of cancer survivors aged older than 65 years is rising rapidly. Current evidence-based exercise guidelines lack specific guidance for older cancer survivors as a result of insufficient evidence. An expert panel was convened to develop consensus-based recommendations for exercise in older cancer survivors.

Methods: The development of recommendations was guided by the Grading of Recommendations Assessment, Development, and Evaluation Evidence-to-Decision framework for good practice statements. The panel drew from the available literature, a Delphi survey of exercise and health professionals, other exercise guidelines, clinical and research expertise, and interest-holder input provided by a community advisory board of older cancer survivors and caregivers (n = 11). Recommendations had to be deemed accessible (i.e., no added barriers) to older cancer survivors and feasible to implement. The panel voted on the strength of the recommendation for or against each statement, with consensus set at 85% agreement.

Results: Consensus was reached on 11 recommendations covering the following areas: medical evaluation/clearance for exercise, pre-exercise assessment, exercise prescription, exercise tolerance and safety, exercise delivery, and behavioral support. The recommendations aimed to promote engagement in and uptake of appropriately prescribed exercise programming by older cancer survivors, while keeping barriers and risks as low as possible.

Conclusions: Older cancer survivors can benefit from appropriately prescribed exercise, which should be an essential component of their cancer care. Exercise and health professionals need to consider the unique needs of older cancer survivors to ensure that exercise is safe and effective for this population, while also reducing barriers to reach as many people as possible.

Keywords: cancer survivors; geriatrics; gerontology; physical activity; practice guideline; professional education.

Publication types

Consensus Statement

MeSH terms

Aged
Aged, 80 and over
Cancer Survivors*
Delphi Technique
Exercise Therapy* / methods
Exercise Therapy* / standards
Exercise*
Female
Humans
Male
Neoplasms* / rehabilitation
Neoplasms* / therapy

Abstract

Publication types

MeSH terms

Grants and funding