Exercise for Older Cancer Survivors: Dispelling the Myths and Creating Guidance

For older adults who have survived cancer, exercise guidance is often constrained by over-cautiousness, limited age-specific evidence, and uncertainty about how to tailor programs to comorbidities and functional limitations. In this interview Dr. Kerri Winters-Stone, an Exercise Scientist and the Penny and Phil Knight endowed professor in Cancer Research Innovation at Oregon Health & Science University (OHSU), outlined why clinicians should treat exercise like a clinical intervention for older patients, how a multidisciplinary expert panel developed consensus recommendations, and what matters most: safety, functional independence, and quality of life.

Why Misconceptions Persist 

Dr. Winters-Stone’s research goal is to collect irrefutable evidence that exercise should be the standard of care for all people treated for cancer. For older adults in particular, misconceptions still shape referrals and conversations. “A lot of the misinformation is that exercise is unsafe or too risky for older individuals,” she explains, noting that those fears compound when cancer enters the picture. Patients and families often worry that activity is overly strenuous: “patients are concerned that exercise can be too hard and maybe too taxing, and then families and  providers get protective." 

Clinically, the stakes are high because despite broad inclusion of older adults in mixed-age trials, specific evidence on the safety and tolerance of exercise in older people with cancer is lacking. The result is a persistent gap in practical, age-specific guidance.

The Consensus Panel

Given the lag in definitive trials focused on older survivors, OHSU convened a multidisciplinary expert panel to produce consensus-based exercise guidelines. Dr. Winters-Stone explained, “These guidelines are based on any evidence that is already in existence, including opinions and experiences from broader groups of exercise and health professionals about their practice and relying on the expertise of our panel members.” 

The panel composition was composed of 16 members and was intentionally broad, including exercise scientists, physical therapists, medical oncologists, geriatricians, and a patient advocate. Notably, the advocate was both a prostate cancer survivor and a family medical physician.

The urgency was explicit: “we don’t want to wait until the evidence matures to be able to issue these recommendations, because then we’re going to kind of neglect the needs of this population for too long.”

What the Recommendations Exercise 

Among the panel’s 11 recommendations, one that particularly stands out is that older adults should not face extra, automatic gatekeeping. Dr. Winters-Stone described a central conclusion: “we don’t feel that older cancer survivors and cancer patients need additional medical clearance before they start an appropriately prescribed exercise program.” The group took into consideration that older people have more comorbidities, more chronic conditions, and potentially more health complexities, but ultimately prioritized removing friction by way of additional clearance and barriers.

Instead, the emphasis shifts to appropriate prescription and escalation when needed: “As long as an exercise program is appropriately prescribed, we think that it should be safe for most older patients to exercise. They can get specific medical approval from a provider as necessary.”

The guidance also re-centers assessment away from “traditional fitness” toward day-to-day capability: interpret benefits through preserving independence and maintaining functioning.

A Broader Exercise “Dose”

While aerobic and resistance training remain foundational, the panel pushed for a more complete program for older adults. Dr. Winters-Stone noted current that recommendations already prioritize resistance training and aerobic training but recommended the value of additional balance training and flexibility training. The clinical rationale is practical: these domains reduce fall risk and preserve mobility. 

Implementation details matter too. The panel addressed delivery considerations such as exercising in a space without excessive noise and lights, matching the cognitive abilities and the functional abilities of an older patient, as well as safety precautions if patients are exercising at home alone.

Independence as a Core Oncology Outcome

For many older adults, preserving autonomy can be as consequential as tumor response. Dr. Winters-Stone explained that “one of the most important goals for an older patient is their ability to maintain their independent functioning.” She emphasized why functional decline can alter choices: “sometimes if an older patient thinks that treatment will pose a threat to their independence, they may opt out of treatment.” 

Exercise, appropriately paired with treatment, may help keep options open: “We want them to be able to get the curative treatment that’s going to help them and then also prescribe exercise at the same time, so that they’re able to minimize the symptoms and side effects and optimize functioning.” Practically, that means training movements that translate directly into daily life, such as getting in and out of chairs, on and off toilets, and in and out of bed.

Personalizing Exercise Counseling

Clinicians can support personalization by integrating comorbidity awareness and tolerance monitoring. For a simple, memorable clinical anchor, the mantra is “start low and go slow.” The principle is pragmatic and safety-oriented: “If we start low and go slow, we can pretty much assure that most people can exercise safely, and we can always adjust upward if something isn’t challenging enough.”

Research Priorities

Looking forward, Dr. Winters-Stone called for trials designed specifically for older adults, with outcomes that match their priorities. She also highlighted an implementation-science challenge: older-adult exercise interventions require tailoring, but trials often avoid individual adjustments. Her call is for transparency that clinicians can trust and replicate: “We don’t want to pretend that our trial was perfect; I think we need to be a little bit more transparent so that we know the heterogeneity and the complexity of the population.”

Key Takeaways

• Older adults are often held back by the myth that exercise is too unsafe or risky for them.

• Consensus guidance was created so that older survivors’ needs aren’t neglected while the evidence matures.

• A pivotal recommendation aims to reduce barriers posed by additional medical clearance prior to starting an appropriately prescribed exercise program.

• Goals should prioritize function and independence, including training movements that support activities of daily living.

• Well-rounded programs include additional balance training and flexibility training, not only aerobic and resistance work.

• For personalization, counsel patients to start low and go slow.

• Encourage research and clinical programs that are transparent about tailoring. 

About Dr. Winters-Stone 

Kerri Winters-Stone, PhD, is the Penny and Phil Knight Endowed Professor in Cancer Research Innovation in the Division of Oncological Sciences at Oregon Health & Science University (OHSU). She is also the Co-Section Head of Cancer Population Sciences and the Co-Director of the Knight Community Partnership Program at the OHSU Knight Cancer Institute. Dr. Winters-Stone’s research focuses on the effects of cancer treatment and aging on musculoskeletal health and cancer recurrence risk and on the ability of exercise to improve health and longevity in cancer survivors.