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Cited by 789Cancer survivorship and carePhysical Activity and HealthMedical Practices and Rehabilitation

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

Open access
Schmitz, Kathryn H., Campbell, Anna M., Stuiver, Martijn M., Pinto, Bernardine M., Schwartz, Anna L., Morris, G. Stephen, Ligibel, Jennifer A., Cheville, Andrea +17 more·2019·CA: A Cancer Journal for Clinicians
DOI 10.3322/caac.21579PMC PMC7896280
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Abstract

Multiple organizations around the world have issued evidence‐based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health‐related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home‐based or community‐based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.

Integrity signals

Registry

Crossref · 10.3322/caac.21579

Cites

92 of 92 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 128 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The identified programs are located in South America, North America, Europe, Asia, Oceania, and the Middle East.

    “These programs are located in South America, North America, Europe, Asia, Oceania, and the Middle East.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Multiple organizations worldwide have issued evidence-based exercise guidance for patients with cancer and cancer survivors.

    “Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors.”
    • Also stated in: § Introduction · plain
      “Multiple US and international organizations have published exercise recommendations for patients living with and beyond cancer, including the American Cancer Society (ACS),1 the American College of Sports Medicine (ACSM),2 Exercise and Sports Science Australia,3 Cancer Care Ontario,4 and the Clinical Oncology Society of Australia.5”
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  • Premisecitation

    The majority of people living with and beyond cancer are not regularly physically active.

    “Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active.”
    • Also stated in: § Introduction · hedged
      “Despite the exercise recommendations noted above, an analysis of greater than 9000 cancer survivors from the ACS Study of Cancer Survivors II (SCS-II) cohort indicated that only between 30% and 47% met current physical activity guidelines.12,13”
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  • Premisecitation

    The American College of Sports Medicine recently updated its exercise guidance for cancer prevention and for prevention and treatment of various cancer health-related outcomes such as fatigue, anxiety, depression, function, and quality of life.

    “Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] source

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  • Premisecitation

    Current evidence indicates that exercise under supervision yields better outcomes.

    “current evidence indicates that exercise under supervision yields better outcomes.10,43-47”
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  • Classified as probably not a substantial claim. 19
  • May combine two claims. 22

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    As part of the efforts of the 2018 ACSM Roundtable, the authors have developed a registry with 150 programs from 25 countries.

    “As part of the efforts of the 2018 ACSM Roundtable, the authors have developed a registry with 150 programs from 25 countries, as described below.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    The registry at exerciseismedicine.org/movingthroughcancer suggests that qualified fitness professionals, coaches, exercise physiologists, or volunteers mostly provide exercise instruction in community settings.

    “The registry at exerciseismedicine.org/movingthroughcancer suggests that qualified fitness professionals, coaches, exercise physiologists, or volunteers mostly provide the exercise instruction in the community setting.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of 150 programs identified, 90 are HCP-supervised exercise programs and 60 are community programs.

    “Of the 150 programs identified through this process, 90 are HCP-supervised exercise programs, and 60 are community programs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The ACSM expert panel concluded that exercise prevents at least 7 types of cancer.

    “The ACSM expert panel concurred with other recent reviews, concluding that exercise prevents at least 7 types of cancer”
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    Premisecitation

    Observed barriers to clinicians referring patients to exercise programming include lack of awareness of the potential value of exercise in cancer populations, uncertainty regarding the safety or suitability of exercise for a particular patient, lack of awareness regarding available programs, need for education and skills development for making referrals, and a belief that referrals to exercise编程

    “Observed barriers to clinicians referring patients to exercise programming include lack of awareness of the potential value of exercise in cancer populations, uncertainty regarding the safety or suitability of exercise for a particular patient, lack of awareness regarding available programs to help facilitate exercise in cancer populations, need for education and skills development for making”
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    Premisecitation

    Reasons for a lack of regular exercise among people living with and beyond cancer are multifactorial, but multiple studies have documented a lack of recommendation from an oncology clinician.

    “Reasons for a lack of regular exercise among people living with and beyond cancer are multifactorial, but multiple studies have documented a lack of recommendation from an oncology clinician.15-17”
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    Interpretationreasoning

    The scientific evidence base supports exercise, and patients and clinicians generally agree that patients should be moving throughout their cancer therapy and survivorship.

    “In summary, the scientific evidence base supports exercise, and patients and clinicians generally agree that patients should be moving throughout their cancer therapy and survivorship.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the Health Information National Trends Survey cohort, approximately 45% of cancer survivors reported regular physical activity, varying by tumor site (32% vs 53% in breast cancer vs prostate cancer survivors, respectively).

    “In the Health Information National Trends Survey (HINTS) cohort, approximately 45% of cancer survivors reported regular physical activity, although this varied by tumor site (32% vs 53% in breast cancer vs prostate cancer survivors, respectively).9”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The 2018 review retained the conclusions from the 2010 Roundtable that exercise training and testing was generally safe for cancer survivors and that every survivor should avoid inactivity.

    “This 2018 review of evidence retained the conclusions from the 2010 Roundtable that exercise training and testing was generally safe for cancer survivors and that every survivor should “avoid inactivity.”2”
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  • May combine two claims.

    Premisecitation

    A meta-analysis of 14 randomized controlled trials among breast cancer survivors found that, although large effects on physical activity were reported by programs that provided more supervision, interventions by telephone or email were also effective.

    “A meta-analysis of 14 randomized controlled trials among breast cancer survivors found that, although large effects on physical activity were reported by programs that provided more supervision, interventions by telephone or email were also effective.44”
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  • Classified as probably not a substantial claim.

    Premisecitation

    The ACSM expert panel concluded there is sufficient evidence to support the efficacy of specific doses of exercise training to address cancer-related health outcomes including fatigue, quality of life, physical function, anxiety, and depressive symptoms.

    “The ACSM expert panel concluded that there is sufficient evidence to support the efficacy of specific doses of exercise training to address cancer-related health outcomes, including fatigue, quality of life, physical function, anxiety, and depressive symptoms.10”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    A major barrier to implementing the approach of hiring exercise professionals to work alongside physicians and nurses in oncology practices is that there is no payment model that would support it.

    “A major barrier to implementing this approach is that, at present, there is no payment model that would support it.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    To date, the EIM approach has been adopted in several primary health care clinics as well as broadly across 3 large health care systems in the United States.

    “To date, the EIM approach has been adopted in several primary health care clinics31 as well as broadly across 3 large health care systems in the United States.32-35”
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    Premisecitation

    Although there are many competing considerations during oncology visits, particularly for patients undergoing treatment, the steps in recommending exercise do not require much time or skill by the oncology clinician and have been successfully integrated into cancer care follow-up visits.

    “Although there are many competing considerations during oncology visits, particularly for patients undergoing treatment, the steps in recommending exercise do not require much time or skill by the oncology clinician and have been successfully integrated into cancer care follow-up visits.67”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Data from the United Kingdom indicated that 31% of people living with and beyond cancer are completely inactive.

    “Data from the United Kingdom indicated that 31% of people living with and beyond cancer are completely inactive.14”
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    Premisecitation

    There is consistent evidence that supervised exercise is more effective but that there is still benefit to home-based exercise.

    “There is consistent evidence that supervised exercise is more effective but that there is still benefit to home-based exercise.10”
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    Premisecitation

    Another review concluded that interventions that have used behavioral theory tend to produce the largest overall effect size for behavior change.

    “Another review concluded that interventions that have used behavioral theory tend produce the largest overall effect size for behavior change.64”
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  • May combine two claims.

    Premisecitation

    Studies suggest that 9% of nurses and from 19% to 23% of oncology physicians refer patients with cancer to exercise programming.

    “studies suggest that 9% of nurses and from 19% to 23% of oncology physicians refer patients with cancer to exercise programming.13,17,21,22”
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    Premisecitation

    The LIVESTRONG at the YMCA program adheres to ACSM guidelines and has served over 60,600 people in 707 communities.

    “The LIVESTRONG at the YMCA program adheres to ACSM guidelines for survivors engaging in exercise and has currently served over 60,600 people in 707 communities.81”
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    Premisecitation

    OncoMove costs $53 per patient, whereas OnTrack costs $866 per patient.

    “For example, OncoMove, a homebased, self-managed exercise program, costs $53 per patient, whereas OnTrack, a physical therapist-supervised, facility-based exercise program, costs $866 per patient.85”
    Quote in the paperSubstantial claim0 of 1 sources checked
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    Premisecitation

    LIVESTRONG at the YMCA costs less than OnTrack at $500 per patient, partially because it relies on exercise trainers rather than physical therapists.

    “The LIVESTRONG at the YMCA program costs less than OnTrack at $500 per patient, partially because of its reliance on exercise trainers rather than physical therapists.86”
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    Interpretationcitation

    It is unclear whether multidimensional programs are more cost-effective compared with monodimensional programs.

    “It is as yet unclear whether such programs are more cost-effective compared with monodimensional programs.90”
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    • The authors state this as an assumption: It is often assumed that multidimensional programs offer larger benefits.

  • May combine two claims.

    Premisecitation

    A skilled community exercise workforce trained in cancer is relatively inexpensive and accessible compared with physical or occupational therapists or clinical exercise physiologists.

    “This skilled workforce is relatively inexpensive and accessible compared with physical or occupational therapists or clinical exercise physiologists.76”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [76] source

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  • May combine two claims.

    Premisecitation

    OnTrack had an incremental cost-effectiveness ratio compared with usual care of €26,916 per quality-adjusted life-year, within some endorsed willingness-to-pay thresholds.

    “OnTrack, in contrast, had an incremental costeffectiveness ratio compared with usual care of €26,916 per quality-adjusted life-year, which falls within some endorsed willingness-to-pay thresholds.85”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The net pros and cons of relying on EMRs to automate aspects of care historically restricted to in-person, clinic-based delivery are not known.

    “However, the net pros and cons of relying on EMRs to automate aspects of care that have historically been restricted to in-person, clinic-based delivery are not known.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Current-generation EMRs have unprecedented capability to collect and synthesize diverse patient information and can populate algorithms that drive interfaces and automated delivery.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Waiting to start referrals until the full infrastructure is in place misses the opportunity for a greater proportion of patients to become active through the admittedly imperfect infrastructure that currently exists.

    “Waiting to start referrals until the full infrastructure is in place misses the opportunity for a greater proportion of patients to become active through the admittedly imperfect infrastructure that currently exists.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Premisenone given

    Changing behavior is complex and depends on personal, social, and environmental factors as well as individual and community resources.

    “Changing behavior is complex and depends on personal, social, and environmental factors as well as individual and community resources.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    MoveMore is based on guidelines stating that support should be provided for at least 1 year to bring about long-term behavior change, with regularity and format informed by individual needs and preferences.

    “MoveMore is based on guidelines stating that support should be provided for at least 1 year to bring about long-term behavior change, and the regularity and format of that support is informed by the individual’s personal needs and preferences.80”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • Classified as probably not a substantial claim.

    Interpretationnone given

    The successful promotion of exercise programming along the cancer continuum requires behavior change for many people affected by cancer.

    “The successful promotion of exercise programming along the cancer continuum requires behavior change for many people affected by cancer.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Both MoveMore and LIVESTRONG at the YMCA have been independently evaluated and shown to significantly improve self-reported physical activity, quality-of-life physical function, and cardiorespiratory fitness.

    “Both MoveMore and the LIVESTRONG at the YMCA programs have been independently evaluated and shown to be effective in significantly improving self-reported physical activity levels, quality-of-life physical function, and cardiorespiratory fitness.76,82”
    Quote in the paperSubstantial claim0 of 2 sources checked
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  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Exercise is only effective in improving clinical outcomes if the patient fills the script (does the exercise program).

    “Exercise is only effective in improving clinical outcomes if the patient “fills the script” (does the exercise program).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    It is currently unclear who should be in charge of the referral and triage process; who should begin the process; or who should be reimbursed or rewarded for actions related to assessment, advice, and referral to exercise and rehabilitative programming.

    “In particular, it is currently unclear who should be in charge of the referral and triage process; who should begin the process; or who should be reimbursed or rewarded for actions related to assessment, advice, and referral to exercise and rehabilitative programming.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Community-based programs are generally perceived to be more accessible and affordable and to reduce barriers of distance, cost, and time compared with HCP-supervised exercise programs.

    “Community-based programs are generally perceived to be more accessible and affordable and reduce the barriers of distance, cost, and time compared with participation in HCP-supervised exercise programs.74,75”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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  • May combine two claims.

    Premisecitation

    The exponential growth of exercise oncology research has driven the need for revised cancer exercise guidelines and a roadmap for oncology clinicians.

    “The exponential growth of exercise oncology research has driven the need for revised cancer exercise guidelines10 and a roadmap for oncology clinicians to follow to improve physical and psychological outcomes from cancer diagnosis and for the balance of life.”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In 2014, US fitness industry revenues topped $24 billion, and memberships are increasing steadily.

    “In 2014, revenues in the US fitness industry topped $24 billion, and memberships are increasing steadily.97”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    At 16 million survivors in the United States, cancer survivors might be prevalent enough to form a niche for the fitness industry.

    “At 16 million survivors in the United States, cancer survivors might be prevalent enough to form a niche (or 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Current practice is failing those diagnosed with cancer.

    “Current practice is failing those diagnosed with cancer.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Current practice is failing those diagnosed with cancer.
37 of 37

  • The paper relies on this without support.

    A lack of clarity among oncology clinical staff about their role in assessing, advising, and referring patients to exercise is among the reasons most people living with and beyond cancer are not regularly physically active.

    “Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise.”

  • The paper relies on this without support.

    Enacting the proposed practice changes will require care coordination with appropriate professionals and changes in the behaviors of clinicians, patients, and exercise/rehabilitation providers.

    “To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming.”

  • The paper relies on this without support.

    Behavior change is one of many challenges to enacting the proposed practice changes.

    “Behavior change is one of many challenges to enacting the proposed practice changes.”

  • The paper relies on this without support.

    Implementation challenges include capacity for triage and referral, need for a program registry, costs and compensation, and workforce development.

    “Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development.”

  • The paper relies on this without support.

    Transitions between HCP-supervised exercise programs and community programs are notoriously challenging.

    “Transitions between HCP-supervised exercise programs and community programs are notoriously challenging.”

  • The paper relies on this without support.

    The majority of programs require physician approval before patient participation.

    “The majority of programs require physician approval before patient participation; hence, the behaviors of oncology clinicians (eg, medical, surgical, or radiation oncologists; oncology nurse practitioners; oncology nurses; allied health professionals) are key to patients being informed about and eligible to participate in programs and ongoing support for engagement in exercise programs.”

  • The paper relies on this without support.

    The steps in recommending exercise do not require much time or skill by the oncology clinician.

    “the steps in recommending exercise do not require much time or skill by the oncology clinician”

  • The paper relies on this without support.

    Adverse event reporting in exercise oncology is not standardized.

    “In truth, adverse event reporting in the field of exercise oncology is not standardized.”

  • The paper relies on this without support.

    The cancer population is shifting to be more geriatric and multimorbid, and therapeutic arsenal is expanding with extended late-stage survival, taxing human and institutional resources.

    “This all occurs within the setting of demographic shifting to a more geriatric and multimorbid cancer population, as well as an expanding therapeutic arsenal and extended, late-stage survival that collectively tax the human and institutional resources devoted to cancer care.”

  • The paper relies on this without support.

    Providers are tasked with addressing multiple health conditions in addition to exercise counseling during visits of shrinking duration.

    “Furthermore, providers are being tasked with addressing multiple health conditions among patients with cancer in addition to exercise counseling (eg, fertility preservation, distress screening and management, and survivorship care planning). All of these health conditions are to be addressed during patient visits of shrinking duration.”

  • The paper relies on this without support.

    Current-generation EMRs have unprecedented capability to collect and synthesize diverse patient information and can populate algorithms that drive interfaces and automated delivery.

    “Current-generation EMRs have unprecedented capability to collect and synthesize diverse sources of information related to patients’ function, physical activity (self-report and from wearables), and adherence. By triangulating patient-reported outcome, performance, and clinical data, EMRs can populate algorithms that drive important dimensions of patient-EMR and provider-EMR interfaces, including”

  • The authors state this as an assumption.

    It is often assumed that multidimensional programs offer larger benefits.

    “Although it is often assumed that multidimensional programs offer larger benefits, they are also inherently more expensive.”

  • The paper relies on this without support.

    The current system for education and training in oncology exercise and rehabilitation is more aligned with continuing education than with standardized curriculum content and board specialty training and certification.

    “The current system for education and training in the specialty practice of oncology exercise and rehabilitation, however, is more aligned with health care and medical continuing education programming rather than codified in standardized medical, nursing, and physical therapy curriculum content and board specialty training and certification.”

  • The paper relies on this without support.

    In community settings, the workforce most likely to work with the cancer population are fitness instructors/personal trainers based in community halls, gyms, and leisure centers.

    “In a community setting, the workforce most likely (knowingly or unknowingly) to work with the cancer population are fitness instructors/personal trainers based in locally funded community halls and gyms and in privately funded gyms and leisure centers.”

  • The paper relies on this without support.

    There are few validated training pathways for preparing fitness instructors or volunteers to safely and effectively provide exercise programming to the cancer population in community settings.

    “There are few validated training pathways for preparing fitness instructors or volunteers to safely and effectively provide exercise programming to the cancer population in the community setting.”

  • The paper relies on this without support.

    Current practice is failing those diagnosed with cancer.

    “Current practice is failing those diagnosed with cancer.”
16 of 16

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. World Cancer Research Fund/American Institute for Cancer Research, 2018, Diet, Nutrition, Physical Activity and Cancer: A Global Perspective. Continuous Update Project Expert Report
  2. 2018 Physical Activity Guidelines Advisory Committee, 2018, 2018 Physical Activity Guidelines Advisory Committee Scientific Report
  3. Glynn TJ, 1989, How to Help Your Patients Stop Smoking. A National Cancer Institute Manual for Physicians
  4. Danish Cancer Society, 2010, Strategic Presentation on Cancer Rehabilitation
  5. Rogers A, 2014, LIVESTRONG at YMCA helps cancer patients move toward fitness, The Spokesman‐Review

Cited by

Sorted by citations

Related

Authors
Schmitz, K. H., Campbell, A. M., Stuiver, M. M., Pinto, B. M., Schwartz, A. L., Morris, G. S., Ligibel, J. A., Cheville, A., Galvão, D. A., Alfano, C. M., Patel, A. V., Hue, T., Gerber, L. H., Sallis, R., Gusani, N. J., Stout, N. L., Chan, L., Flowers, F., Doyle, C., Helmrich, S., Bain, W., Sokolof, J., Winters‐Stone, K. M., Campbell, K. L., & Matthews, C. E.
Affiliations
  • Pennsylvania State University (US)
  • Edinburgh Napier University (GB)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • University of South Carolina (US)
  • Northern Arizona University (US)
  • Wingate University (US)
  • Dana-Farber Cancer Institute (US)
  • Mayo Clinic (US)
  • Exercise Medicine Research Institute, Edith Cowan University Joondalup Western Australia Australia
  • American Cancer Society (US)
  • University of California, San Francisco (US)
  • George Mason University (US)
  • Kaiser Permanente (US)
  • Penn State Cancer Institute (US)
  • National Institutes of Health (US)
  • Macmillan Cancer Support (GB)
  • Patient Advocate Berkeley California
  • Sunflower Wellness San Francisco California
  • NYU Langone Health (US)
  • Oregon Health & Science University (US)
  • University of British Columbia (CA)
  • National Cancer Institute (US)
Corresponding author
Schmitz, Kathryn H.
ORCID
Venue
CA: A Cancer Journal for Clinicians
Publisher
Wiley
Published
2019-10-16
Volume
69
Issue
6
Pages
468-484
ISSN
  • 0007-9235 (ISSN-L)
  • 1542-4863
DOI
10.3322/caac.21579
PMC
PMC7896280
OpenAlex
W2980368443
Cited by
789
References
92
Citations by year
2026: 66 · 2025: 141 · 2024: 132 · 2023: 84 · 2022: 135 · 2021: 141 · 2020: 85 · 2019: 4
FWCI
38.14
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • CA A Cancer Journal for Clinicians (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (acceptedVersion, cc-by)
  • PubMed Central (acceptedVersion)
  • Australasian Journal of Paramedicine (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • eScholarship (California Digital Library) (submittedVersion)
  • Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by)
  • Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, other-oa)
Funders
  • Macmillan Cancer Support
  • American College of Sports Medicine
  • American Cancer Society
  • American Physical Therapy Association
  • Koninklijk Nederlands Genootschap voor Fysiotherapie
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords
Exercise is Medicine, cancer survivors, cancer prevention, physical activity, clinician engagement, exercise referral, home-based exercise, community-based exercise, cancer rehabilitation, behavior change, implementation barriers, care coordination
MeSH terms
Community Health Services, Exercise Therapy, Humans, Medical Oncology, Neoplasms, Practice Guidelines as Topic, Delivery of Health Care, Integrated

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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