The clinical outcome effectiveness of supervised exercise therapy and exercise oncology programs in the management of chronic diseases, including breast cancer, is well-established. Here is a review of two publications that analyze the cost-effectiveness of such programs.
The first publication is entitled, “A Review of the Cost-Effectiveness of Supervised Exercise Therapy for Adults with Chronic Conditions in the United States” by Chase, et al. The second publication is entitled, “Savings Analysis of an Individualized Exercise Oncology Program in Early-Stage Breast Cancer Survivors: A Randomized Clinical Control Trial”, by Wonders, et al.
As healthcare systems seek sustainable ways to improve outcomes and reduce costs, supervised exercise therapy (SET) has emerged as a promising intervention. The two articles reviewed here — one a systematic review of SET’s cost-effectiveness for various chronic conditions in the United States, and the other a randomized clinical trial assessing individualized exercise oncology in early-stage breast cancer survivors — converge on the conclusion that SET delivers significant clinical and economic benefits.
Overview of Supervised Exercise Therapy (SET) Across Chronic Conditions
The first article by Chase et al. (2025) is a systematic review evaluating the cost-effectiveness of SET programs for U.S. adults with chronic conditions, including cancer, diabetes, obesity, hypertension, depression/anxiety, and fall risk. The review synthesized findings from eight studies comprising randomized controlled trials, modeling studies, and a cohort study, covering intervention periods from 7 weeks to 3 years and various settings including community, assisted living, and hospital-based environments.
Key outcomes measured were healthcare costs, cost savings, return on investment (ROI), and clinical effectiveness. The results showed consistent cost savings ranging from $121 to $2,834 per participant, and ROI values between 1.15:1 and 1.7:1. These benefits were realized through reduced hospitalizations, emergency visits, and overall healthcare utilization. Additionally, SET led to improvements in clinical parameters such as reduced fall rates, better chronic disease control (e.g., glucose regulation in diabetes), and enhanced quality-adjusted life years (QALYs).
A central finding of the review was that group-based SET programs — especially those delivered by qualified professionals such as certified exercise physiologists, physical therapists, or trained nurses — produced better outcomes than non-supervised or usual care approaches. Importantly, despite the strong evidence, coverage for such programs remains limited in the U.S. healthcare system, except for certain conditions like peripheral artery disease and cardiac rehabilitation.
Individualized Exercise Oncology in Breast Cancer Survivors
The second article by Wonders et al. (2022) presents a randomized clinical trial evaluating an individualized 12-week exercise oncology program for early-stage breast cancer survivors (Stage I-II). Participants were randomly assigned to either a control group (CG; n=120), receiving standard care and a resource guide, or an intervention group (EX; n=123), undergoing supervised exercise aligned with American College of Sports Medicine (ACSM) guidelines.
Clinical and economic outcomes were assessed through fitness parameters, quality-of-life scores (FACT-B, SF-36), Eastern Cooperative Oncology Group (ECOG) performance scores, and unplanned healthcare utilization costs.
The findings were compelling:
- Clinical Benefits: The EX-group showed significant improvements in cardiorespiratory fitness, muscular endurance, flexibility, and ECOG scores. Fatigue, measured by the Brief Fatigue Inventory, was reduced by 4.2 points. Quality-of-life indices (physical, emotional, social, and functional well-being) improved significantly across all domains compared to controls.
- Economic Benefits: The EX-group had notably lower healthcare utilization, with mean costs of $6,356 versus $8,598 in the CG. The greatest cost driver was inpatient care, and the EX-group demonstrated a 58% reduction in healthcare encounters overall. These reductions were in unplanned or supportive healthcare events, not routine cancer treatment.
The high retention (over 95%) and adherence (also 95%) rates in the exercise group further affirm the feasibility of implementing such programs widely.
Comparative Insights and Integration
Both studies independently and jointly support the argument that supervised, structured exercise interventions can significantly improve health outcomes while also reducing the economic burden of chronic disease management.
Cost-Effectiveness and ROI
Across both studies, SET demonstrated a clear ROI. Chase et al. reported consistent cost savings and ROI exceeding 1.15:1 across various chronic conditions, while Wonders et al. showed a specific healthcare savings of over $2,200 per breast cancer survivor. These savings are especially noteworthy considering that they relate to unplanned healthcare utilization — an area that is both highly variable and expensive in chronic disease management.
Supervision and Individualization
A consistent theme in both publications is the value of supervision. Programs involving certified professionals who tailor interventions to the patient’s specific health profile yield the most benefit. In the breast cancer study, personalized plans addressed both physiological needs and comorbid conditions, which translated into fewer hospitalizations and improved well-being. Similarly, in the broader SET review, the interventions with detailed attention to structure, intensity, and delivery personnel showed the highest impact.
Broad Applicability Across Chronic Conditions
While the Wonders et al. study focused on breast cancer survivors, its results align with those observed in the more generalized chronic disease populations in the Chase et al. review. Improved outcomes and cost savings were documented in diverse groups: Parkinson’s disease patients, diabetics, the obese, and the elderly at risk of falls. This universality underscores SET’s potential as a core component of public health policy and population health management strategies.
Barriers and Implementation Challenges
Despite strong evidence, implementation barriers remain. Wonders et al. highlight that fewer than 5% of cancer patients are referred to exercise programs, a statistic that reflects both systemic issues and lack of awareness. Similarly, Chase et al. emphasize that SET is often excluded from standard insurance coverage unless proven cost-effective — a standard that exercise programs are increasingly meeting but are still seldom recognized.
Conclusion and Implications
Together, these studies reinforce the case for incorporating supervised exercise therapy as a standard of care across both general chronic disease management and oncology. The findings advocate for policy shifts, insurance coverage expansions, and integration of SET into routine healthcare delivery. Doing so could mitigate the economic pressures on healthcare systems while enhancing patient outcomes and quality of life.
Moving forward, a coordinated national strategy to support SET programs, invest in exercise professional training, and incentivize healthcare providers to refer eligible patients is essential. Future research should further standardize economic evaluation methods, explore long-term outcomes, and expand into underrepresented chronic conditions and underserved populations.
In summary, supervised exercise therapy is not merely an adjunct intervention — it is a clinically effective and economically sound strategy that deserves broader implementation in the American healthcare system.
References:
A Review of the Cost-Effectiveness of Supervised Exercise Therapy for Adults with Chronic Conditions in the United States: Paul J. Chase, Connor M. Owen, Amy Bantham, Mark Stoutenberg, Tiwaloluwa Ajibewa, Justin Barclay, Mu Huang, Jacob Kariuki, Grace McNamara, Lee Stoner, and Laurie P. Whitsel. Translational Journal of the ACSM, Volume 10, Number 3, Pages 1-10, Summer 2025.
Cost-Savings Analysis of an Individualized Exercise Oncology Program in Early-Stage Breast Cancer Survivors: A Randomized Clinical Control Trial: Karen Y. Wonders, PhD, Kathryn Schmitz, PhD, MPH, Robert Wise, BS, and Ronald Hale, MD. JCO Oncology Practice: 2022, Pages 1-9.
