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Exercise Testing in Cancer Survivors


It is important that fitness professionals understand secondary conditions associated with cancer treatments such as increased risk of fractures, cardiovascular events, neuropathy, musculoskeletal morbidities, among others.  Certain cancer sites or types may require graded exercise testing prior to beginning an exercise program.  The following guidelines relate to medical assessment and exercise testing in cancer survivors.

Medical Assessment prior to Exercise

  • Individuals with known metastatic disease to the bone require medical evaluation before starting an exercise program
  • Individuals with known cardiac conditions require medical assessment before starting an exercise program
  • Fitness professionals may want to consult with the individual’s medical team about metastasis to the bone or cardiac toxicity if not detected
  • For breast cancer survivors, evaluation for arm/shoulder morbidity is recommended before upper body exercise
  • For prostate cancer survivors, evaluation of muscle strength and atrophy is recommended
  • For colon cancer survivors, an established and proactive infection prevention strategy must be in place before engaging in exercise more than a walking program
  • For gynecologic cancer survivors, medical assessment is recommended to determine the safety of activity in morbidly obese patients

Graded Exercise Testing Prior to Exercise

  • No exercise testing is required for a walking, flexibility, or resistance program
  • One-rep max testing is safe for breast cancer survivors
  • Follow ACSM Guidelines for Exercise Testing when determining if a test is needed, testing mode/intensity, and contraindications when testing⁴

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