The following recommendations for aerobic, resistance, and flexibility training are derived from Table 4. Review of US DHHS Physical Activity Guidelines (PAG) for Americans and alterations needed for cancer survivors in the ACSM Roundtable on Exercise Guidelines for Cancer Survivors.²

Aerobic Exercise Training

• Recommendations are the same as age-appropriate PAG for Americans
• Lighter intensity and lower progression recommended for Adult HSCT
• For gynecologic cancers, morbidly obese women may require additional supervision or adapted programming
• In breast cancer survivors, be aware of fracture risk
• In prostate cancer survivors, be aware of increase potential for fracture
• For colon cancer survivors, physician permission is recommended before participation in contact sports
• In adult cancer survivors with HSCT, avoid overtraining in vigorous exercise
• For gynecologic cancer survivors, a secondary condition may be peripheral neuropathy in which a stationary bike may be preferred to weight-bearing activity

Resistance Training

• Recommendations are the same as age-appropriate PAG for prostate, colon,  and adult hematologic with or without HSCT
• For breast cancer survivors, start with a supervised program of at least 16 sessions with very low resistance; progress resistance in small increments and watch for arm/shoulder symptoms
• For individuals who received a bone marrow transplant, resistance training might be more important than aerobic training
• For gynecologic cancer survivors, proceed with caution if lymph node removal and/or radiation to lymph nodes in the groin has occurred

Flexibility Training

• Recommendations are the same as age-appropriate PAG for Americans
• Stretch major muscle groups and tendon on days that other exercises are performed
• In colon cancer survivors, avoid excessive intra-abdominal pressure for patients with ostomies