ACE Cancer Exercise Specialist cheat sheet

TNM classification: T describes primary tumor size and invasion, N describes regional lymph node involvement, and M describes distant metastasis; stage grouping combines these with other prognostic factors.

Stage I–III generally denotes localized or regional disease managed with curative intent; stage IV generally denotes distant metastasis and is usually managed with systemic or palliative intent.

Neoadjuvant therapy is given before definitive surgery or radiation; adjuvant therapy is given after curative-intent local treatment to reduce recurrence risk.

Histologic grade, often scored 1–3, reflects tumor cell differentiation; higher grade indicates more aggressive biology and often worse prognosis.

ECOG performance status ranges from 0 (fully active) to 4 (completely disabled), with 5 indicating death; higher scores predict poorer treatment tolerance and survival.

Common systemic modalities include cytotoxic chemotherapy, endocrine therapy, targeted agents, immunotherapy, and antibody-drug conjugates, each with distinct toxicity profiles.

Treatment intent categories include curative, neoadjuvant, adjuvant, maintenance, and palliative; exercise goals should align with documented intent and expected toxicity timeline.

Molecular profiles such as hormone receptor status, HER2 amplification, and PD-L1 expression guide therapy selection and can signal cardiac, pulmonary, or immune-related risk.

Cancer-related fatigue is the most common treatment-related symptom; it is not reliably proportional to activity and may persist for months or years after therapy.

Anemia from marrow suppression or blood loss reduces oxygen-carrying capacity, raises heart rate at a given workload, and limits aerobic capacity; fatigue and dyspnea may worsen.

Anthracyclines and HER2-targeted therapies can cause left ventricular dysfunction; cumulative anthracycline dose is a key cardiotoxicity risk factor.

Taxanes and platinum agents commonly cause peripheral neuropathy, increasing fall risk and reducing proprioception, grip strength, and gait speed.

Cancer cachexia involves involuntary weight loss, systemic inflammation, and skeletal muscle wasting; it reduces strength, function, and treatment tolerance.

Lymphedema after lymph node surgery or radiation causes limb swelling, heaviness, and restricted range of motion; infection and obesity increase risk.

Radiation can cause localized fibrosis, contracture, skin fragility, and fatigue; effects may be acute or emerge months to years later.

Corticosteroids and endocrine therapies can cause muscle weakness, bone loss, weight gain, and metabolic changes that affect exercise capacity.

Screen for bone metastases with new, persistent, or night-time bone pain, pathologic fracture history, or imaging findings; unstable bone lesions require clinician clearance before loading.

Defer moderate-to-vigorous aerobic exercise when hemoglobin is below 8 g/dL or when symptomatic anemia causes resting tachycardia, dyspnea, or dizziness.

Avoid contact sports and heavy resistance training when platelet count is below 50,000/µL; individualize light activity with oncology guidance.

When absolute neutrophil count is below 500 cells/µL, avoid group exercise settings and shared equipment; fever or active infection contraindicates exercise.

Medical clearance is required for unstable cardiac disease, uncontrolled hypertension, severe thrombocytopenia, acute infection, or unresolved bone pain.

Use a validated screening tool such as the PAR-Q+ or an ACSM-based algorithm; any positive response triggers clinician review before an exercise program begins.

Risk stratification considers cancer type and stage, current treatment, comorbid disease, symptom burden, and exercise history; higher risk requires closer supervision.

Body temperature above 38°C (100.4°F), new confusion, or rapid clinical deterioration are reasons to postpone exercise and seek medical care.

Baseline assessment should cover aerobic capacity, strength, range of motion, balance, fatigue, pain, and patient-reported function; repeat testing at planned intervals.

The 6-minute walk test is a safe submaximal measure of functional capacity; record distance, symptoms, heart rate, and oxygen saturation if available.

Aerobic prescription follows FITT-VP: frequency, intensity, time, type, volume, and progression; gradually accumulate toward 150 minutes per week of moderate activity when tolerated.

Resistance training 2–3 days per week targeting major muscle groups improves strength and function; use controlled tempo and avoid breath-holding.

Estimate 1RM from submaximal repetitions or use a 10RM load in patients with bone lesions, neuropathy, or fatigue to reduce injury risk.

During active treatment, reduce exercise volume or intensity by roughly 20–50% during acute toxicity and prioritize maintenance of function over performance gains.

Prehabilitation before surgery or intensive therapy improves functional reserve; it typically combines aerobic, resistance, and breathing exercises with nutrition support.

In survivorship, progress toward general health guidelines with attention to late effects, lymphedema, cardiotoxicity, and bone health.

In palliative care, exercise goals shift to symptom control, mobility, and independence; low-volume, seated, or assisted activity may be appropriate.

Stop exercise immediately for chest pain, severe dyspnea, syncope, palpitations, new confusion, or focal neurologic deficits; arrange urgent medical assessment.

Avoid high-impact, twisting, and heavy compressive loads over known bone lesions; support the limb and use pain as a limit, not a target.

With lymphedema, monitor limb circumference, heaviness, and infection; progressive resistance is generally safe when introduced gradually and symptoms remain stable.

During radiation, avoid chlorine, hot tubs, friction, and sun on treated skin; stop if blistering, weeping, or severe pain develops.

Patients with indwelling catheters or ports should avoid resistance or contact that pulls on the device; follow oncology team restrictions.

In neutropenia, avoid crowded fitness facilities, shared equipment, and unhealed skin wounds; hand hygiene and fever reporting are essential.

Peripheral neuropathy increases fall risk; use stable support, good lighting, and balance training, and avoid unstable surfaces or fast direction changes.

Exercise in heat or dehydration can worsen fatigue and orthostatic symptoms; maintain hydration and modify the environment when temperature regulation is impaired.

Motivational interviewing uses open questions, affirmations, reflections, and summaries to explore ambivalence and strengthen the patient's own reasons for change.

The transtheoretical model stages change as precontemplation, contemplation, preparation, action, and maintenance; support should match the current stage.

Self-efficacy is strengthened by mastery experiences, vicarious modeling, verbal persuasion, and reduced physiological distress; it predicts exercise adherence.

SMART goals-specific, measurable, achievable, relevant, and time-bound-improve follow-through better than vague intentions.

Distress screening with validated tools identifies emotional, practical, and social needs that warrant referral to psychology, social work, or psychiatry.

Interprofessional collaboration includes oncology, nursing, physical therapy, occupational therapy, dietetics, and mental health; document exercise tolerance and adverse events.

Fear of recurrence, body image concerns, and fatigue are common barriers; address them with supportive counseling and realistic activity planning.

Shared decision-making aligns exercise intensity with patient values, treatment schedule, and caregiver support; reassess at transitions of care.