Comment on: “Exercise Recommendations for Older Adults Living With and Beyond Cancer: A Consensus Statement by the Advancing Capacity to Integrate Exercise into the Care of Older Cancer Survivors Expert Panel”

In a couple of decades, 73% of cancer survivors will be older than the age of 65 , with many surviving 5 or more years. Both cancer diagnosis and increasing age elevate the risk of dependence and disability, as well as pain or depression and social isolation, which can negatively impact cognition. Age-specific interventions, therefore, represent an opportunity to improve the quality of life for older adults living with or after a cancer diagnosis. This article is a consensus statement of recommendations from the Advancing Capacity to Integrate Exercise into the Care of Older Cancer Survivors (ACES) initiative to create guidelines for professionals to use when structuring programs for older cancer survivors based on available evidence. The ACES panel was comprised of experts with experience either as older cancer survivors or caring for older cancer survivors, including a community advisory board (CAB) of survivors and caregivers. These recommendations were designed to complement the 2019 American College of Sports Medicine (ACSM) exercise guidelines for cancer survivors. A Delphi survey was used to develop consensus statements with an international panel of health and exercise professionals, and a scoping review of randomized controlled trials, as well as existing guidelines from various professional organizations was incorporated into these statements. Consensus was reached on 11 statements. These included (1) additional medical evaluation is not required beyond current recommendations before beginning an exercise program, (2) functional assessments including Timed Up and Go, Short Physical Performance Battery, and tests of static and dynamic balance are recommended before beginning an exercise program, (3) exercise programs should include balance training, including 1 or 2 sets of 4 to 10 different balance exercises 3 days a week, (4) flexibility training should also be included, with stretches targeting major muscle-tendon units between 2 and 7 days a week, (5) a professional should participate in routine monitoring for joint pain, fatigue, vertigo or dizziness, nausea, palpitations, chest pain or heaviness, muscle pain/weakness, shortness of breath, and incontinence, (6) a professional should consider environmental factors that may affect the delivery of an exercise program, (7) individuals who assist with prescription and delivery or exercise programs to these patients should have empathy and patience as well as an ability to modify and tailor exercises to the individual, (8) other considerations for professionals should include behavioral techniques such as goal setting or incentives, education, initial starting volume and progression, social support, caregiver support, and any potential barriers, (9) significant deficits in strength, mobility or balance should be addressed first before aerobic capacity, (10) personal characteristics should be considered when determining amounts of required supervision, and (11) if unsupervised exercise is unsafe for an individual, exercises should be modified and/or a caregiver, family member or friend should be involved to assist with performance and supervision. This is an initial effort to develop guidelines and recommendations for older adults. Future efforts to revise these recommendations may benefit from the involvement of more experts from differing regions of the world, as well as the inclusion of recommendations for caregivers of older cancer survivors. (Summarized from Winters-Stone KM, Meyers G, Eckstrom E, et al. Exercise recommendations for older adults living with and beyond cancer: a consensus statement by the Advancing Capacity to Integrate Exercise into the Care of Older Cancer Survivors expert panel. Cancer. 2026;132:e70252. doi: 10.1002/cncr.70252)