Pre-Exercise Screening, Medical Clearance, and Risk Stratification
Screening that changes the plan
Screening is not one form; it is a structured history plus targeted measurement. Cover cancer type, stage, and phase; current and prior treatments; comorbidities (cardiac, pulmonary, metabolic, orthopedic); medications (anticoagulants, steroids, antihypertensives); symptoms (dyspnea, pain, dizziness, swelling); recent labs (complete blood count, metabolic panel, cardiac function where relevant); bone health and metastatic sites; lymphedema risk; ostomies, ports, and catheters; and falls history.
Risk stratification asks three questions: Is there unstable disease (febrile neutropenia, uncontrolled cardiac symptoms, acute thromboembolism, severe anemia, an untreated bone lesion at risk of fracture)? Does this client need medical clearance before proceeding? What modifications are needed today? Clearance is typically sought for new or unstable cardiac symptoms, uncontrolled hypertension, recent myocardial infarction, symptomatic anemia, platelet counts below institutional thresholds, acute infection or fever, and unstable bone metastases. Routine mild-to-moderate exercise during treatment often does not require individualized clearance, but this is program- and institution-specific - verify your policy.
Scope traps
Exercise professionals screen and refer; they do not diagnose, interpret imaging, or clear anyone medically. A second trap is treating one abnormal value as an absolute bar without confirming with the oncology team.
Worked example
A new client has a platelet count of 45 × 10^9/L and an implanted port. Correct action: defer high-impact and contact activity, avoid loading or pressure on the port site, contact the oncology team, and document the decision.
Rule of thumb
If a finding would change today's session, stop and get an answer; if it changes the program over weeks, plan and document.