Exercise Assessment and Program Design Across the Cancer Continuum
Phase drives the prescription
Design follows treatment phase and goal, not a template. Prehabilitation before surgery or neoadjuvant therapy builds aerobic capacity and strength to reduce postoperative complications and functional decline. During treatment, the aim is to maintain function with moderate aerobic work and resistance training, autoregulated by symptoms. Post-treatment, rebuild capacity and address late effects. In advanced disease, the goal shifts toward function, independence, and symptom control.
The common target is 150 minutes per week of moderate aerobic activity plus two resistance sessions, but that is a destination, not an entry point. Use FITT-VP: frequency, intensity, time, type, volume, progression. Anchor intensity with the talk test and RPE 11–14 rather than heart rate alone, since beta-blockers and autonomic dysfunction distort the heart-rate response. Start low, progress roughly 5–10% per week, and deliberately reduce during expected treatment nadirs.
Assessment
Choose measures that are safe, feasible, and repeatable: 6-minute walk, 30-second sit-to-stand, grip strength, shoulder range of motion, and 1-RM only when appropriate. Avoid maximal testing with thrombocytopenia, painful bone lesions, or severe fatigue.
Traps
Applying 150 minutes rigidly to someone mid-chemotherapy; omitting resistance training; ignoring balance despite neuropathy; assuming lymphedema means the affected arm must never be loaded.
Worked example
Three weeks after mastectomy with no complications: start gentle shoulder mobility, walking, and light resistance; progress after wound healing and surgical clearance.
Rule of thumb
Prescribe the smallest dose that maintains function during treatment, then build after treatment ends.