Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 1;17(17):2873.
doi: 10.3390/cancers17172873.

Role of Qualified Exercise Professionals in Medical Clearance for Exercise: Alberta Cancer Exercise Hybrid Effectiveness-Implementation Study

Margaret L McNeely  1   2 , Tanya Williamson  3 , Shirin M Shallwani  1 , Leslie Ternes  1 , Christopher Sellar  1 , Anil Abraham Joy  2   4 , Harold Lau  3   5   6 , Jacob Easaw  4 , Adam Brown  1 , Kerry S Courneya  7 , S Nicole Culos-Reed  3   6
Affiliations

Role of Qualified Exercise Professionals in Medical Clearance for Exercise: Alberta Cancer Exercise Hybrid Effectiveness-Implementation Study

Margaret L McNeely et al. Cancers (Basel). .

Abstract

Background: Current guidelines endorse the integration of exercise into cancer care. The diagnosis of cancer and its treatment, however, may introduce factors that make exercise engagement difficult, especially for individuals with advanced stages of disease. In this paper, we describe the baseline screening and triage process implemented for the Alberta Cancer Exercise (ACE) hybrid effectiveness-implementation study and share findings that highlight the multifaceted complexity of the process and the direct role of the clinical exercise physiologist (CEP).

Methods: ACE was a hybrid effectiveness-implementation study examining the benefit of 12-week cancer-specific community-based exercise program. The ACE screening process was developed by integrating evidence-based guidelines with oncology rehabilitation expertise to ensure safe and standardized participation across cancer populations. The screening process involved four steps: (1) a pre-screen for high-risk cancers, (2) completion of a cancer-specific intake form and the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), (3) a CEP-led interview to further evaluate cancer status, cancer-related symptoms and other health issues (performed in-person or by phone), and (4) a baseline fitness assessment that included measurement of vital signs.

Results: A total of 2596 individuals registered and underwent prescreening for ACE with 2570 (86.6%) consenting to participate. After full screening including the baseline fitness testing, 209 participants (8.1%) were identified as requiring further medical clearance. Of these, 191 (91.4%) had either a high-risk cancer, metastatic disease or were in the palliative end-stage of cancer, and 161 (84.3%) reported cancer-related symptoms potentially affecting their ability to exercise. In total, 806 (31.4%) participants were triaged to CEP-supervised in-person programming, 1754 (68.2%) participants to ACE community programming, and 8 (0.3%) specifically to virtual programming (post-COVID-19 option).

Conclusions: The findings highlight the complexity and challenges of the screening and triage process, and the value of a highly trained CEP-led iterative approach that included the application of clinical reasoning.

Keywords: cancer survivorship; exercise; implementation; knowledge translation; physical activity; screening; triage.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow of Participants through the Screening and Triage Process.
Figure 2
Figure 2
Process and Participant Flow across Screening Stages.
See this image and copyright information in PMC

References

    1. Li L., Shan T., Zhang D., Ma F. Nowcasting and forecasting global aging and cancer burden: Analysis of data from the GLOBOCAN and Global Burden of Disease Study. J. Natl. Cancer Cent. 2024;4:223–232. doi: 10.1016/j.jncc.2024.05.002. - DOI - PMC - PubMed
    1. Caswell-Jin J.L., Sun L.P., Munoz D., Lu Y., Li Y., Huang H., Hampton J.M., Song J., Jayasekera J., Schechter C., et al. Analysis of Breast Cancer Mortality in the US-1975 to 2019. JAMA. 2024;331:233–241. doi: 10.1001/jama.2023.25881. - DOI - PMC - PubMed
    1. Firkins J., Hansen L., Driessnack M., Dieckmann N. Quality of life in “chronic” cancer survivors: A meta-analysis. J. Cancer Surviv. 2020;14:504–517. doi: 10.1007/s11764-020-00869-9. - DOI - PubMed
    1. Tometich D.B., Hyland K.A., Soliman H., Jim H.S.L., Oswald L. Living with Metastatic Cancer: A Roadmap for Future Research. Cancers. 2020;12:3684. doi: 10.3390/cancers12123684. - DOI - PMC - PubMed
    1. Smith A.K., White D.B., Arnold R.M. Uncertainty—The other side of prognosis. N. Engl. J. Med. 2013;368:2448–2450. doi: 10.1056/NEJMp1303295. - DOI - PMC - PubMed

LinkOut - more resources