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

Sep 30, 2026

Background: The number of cancer survivors older than 65 is rising, yet evidence-based exercise guidelines lack age-specific direction for this group due to limited data. Methods: An expert panel used the GRADE Evidence-to-Decision framework, drawing on literature, a Delphi survey, existing guidelines, and clinical expertise, plus input from a community advisory board (n=11). Panel voting set consensus at 85% agreement. Results: Eleven recommendations address evaluation, pre-exercise assessment, prescription, tolerance and safety, delivery, and behavioral support.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Need for age-specific interventions

Limitations of existing guidelines

Purpose and ACES initiative

DOI: 10. 1002/cncr.70252 CONSENSUS STATEMENT 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 PhD1 | Gabrielle Meyers MD2 | Elizabeth Eckstrom MD, MPH3 | Andrea Cheville MD, MSCE4 | Jose M. Garcia MD, PhD5,6 | Margaret L. McNeely PhD7 | Supriya Mohile MD8 | Karen Mustian PhD, MPH9 | Sarah Neil-Sztramko PhD10, 11 | Laura Q. Rogers MD, MPH12 | Kathryn H. Schmitz PhD, MPH13 | Anna Schwartz PhD14 | Jessica Sitemba MS1 | Robert Smith MD2 | Kristin L. Campbell PhD 15 Correspondence Kerri M. Winters-Stone, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, USA. [Email:](Email: wintersk@ohsu.edu)[ wintersk@ohsu.edu](Email: wintersk@ohsu.edu) Funding information National Cancer Institute, Grant/Award Number: 1R21CA280996 Abstract Background: The number of cancer survivors aged older than 65years 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. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2026 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society. Cancer. 2026;e70252. [https://doi.org/10.1002/cncr.70252](https://doi.org/10.1002/cncr.70252) wi[leyonlinelibrary.com/journal/cncr](leyonlinelibrary.com/journal/cncr) 1 of 12 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 INTRODUCTION By 2040, the proportion of cancer survivors aged older than 65 years in the United States will be 73%, with most surviving 5 years or longer.1 Cancer and aging are risks for dependence and disability, escalating pain and depressive symptoms, and social isolation that worsen physical and cognitive functioning.2 There is an urgent need for age-specific interventions to address the unique physiological, functional, and psychosocial needs in older adults (aged

FAQs

Why are age-specific exercise recommendations needed for older cancer survivors?

The proportion of survivors aged over 65 is increasing, and cancer plus aging can worsen disability, pain, depressive symptoms, and social isolation. Evidence-based guidelines for general cancer survivors do not provide specific guidance for older adults because evidence was insufficient when current guidelines were developed.

How were the consensus recommendations developed?

The panel used the GRADE Evidence-to-Decision framework for good practice statements. It incorporated available literature, a Delphi survey, other exercise guidelines, clinical and research expertise, and input from a community advisory board of older survivors and caregivers (n=11). Consensus required 85% agreement.

What areas do the final recommendations cover?

The panel reached consensus on 11 recommendations covering medical evaluation/clearance, pre-exercise assessment, exercise prescription, exercise tolerance and safety, exercise delivery, and behavioral support.

Sep 30, 2026

Uploaded by anakgang17