Development of a Risk-Screening Tool for Cancer Survivors to Participate in Unsupervised Moderate-to Vigorous-Intensity Exercise: Results From a Survey Study

Background: The health benefits of exercise increase in dose-response fashion among cancer survivors. However, it is unclear how to identify cancer survivors who may require a pre-exercise evaluation before they progress from the common recommendation of walking to unsupervised moderate-to vigorous-intensity exercise. Objective: To clarify how to identify cancer survivors who should undergo a pre-exercise evaluation before they progress from the common recommendation of walking to unsupervised moderate-to vigorous-intensity exercise. Design: Electronic survey. Participants: Forty-seven (n = 47) experts in the field of exercise physiology, rehabilitation medicine, and cancer survivorship. Setting: Not applicable. Methods: We synthesized peer-reviewed guidelines for exercise and cancer survivorship and identified 82 health factors that may warrant a pre-exercise evaluation before a survivor engages in unsupervised moderate-to vigorous-intensity exercise. The 82 health factors were classified into 3 domains: (1) clinical health factors; (2) comorbidity and device health factors; and (3) medications. We surveyed a sample of experts asking them to identify which of the 82 health factors among cancer survivors would indicate the need for a pre-exercise evaluation before they engaged in moderate-to vigorous-intensity exercise. Main Outcome Measurements: The response rate to our survey was 75% (n = 47). Across the 3 domains of health factors, acute symptoms, comorbidities, and medications related to cardiovascular disease were agreed on to indicate a pre-exercise evaluation for survivors before they engaged in unsupervised moderate-to vigorous-intensity exercise. Other health factors in the survey included hematologic, musculoskeletal, systemic, gastrointestinal, pulmonary, and neurological symptoms and comorbidities. Eighteen experts (38%) said it was difficult to provide absolute answers because no 2 patients are alike, and their decisions are made on a case-by-case basis. Conclusions: The results from this expert survey will help to identify which cancer survivors should undergo a pre-exercise evaluation before they engage in unsupervised moderate-to vigorous-intensity exercise.