One of the persistent challenges in Exercise Oncology is no longer proving that exercise can benefit people with cancer. The challenge is turning exercise into something patients can safely begin, enjoy, adhere to, and ultimately incorporate into their lives.
A new 2026 study from the University of Southern California offers an innovative approach: combine evidence-based exercise with golf, recreation, skill development, professional instruction, and social interaction.
Published in Frontiers in Oncology, the study evaluated the Golf Recreational Exercise for Enhanced Survivorship (GREENS) program for men with prostate cancer receiving hormone therapy. The investigators specifically examined safety, adherence, enjoyment, satisfaction, and participants’ experiences.
The results provide lessons extending well beyond golf. They offer a potentially important model for how we should think about organizing Exercise Oncology Programs.
Why Exercise Matters During Androgen Deprivation Therapy
Androgen deprivation therapy (ADT) can produce substantial physical and psychosocial consequences, including fatigue, loss of muscle, decreased bone density, anxiety, stress, and diminished quality of life. Exercise can help mitigate many of these effects.
Yet knowing that exercise works does not guarantee that patients will exercise. The authors identify familiar barriers to traditional programs: motivation, access, time, and lack of enjoyment.
GREENS was designed to address this gap by integrating evidence-based exercise into a supervised, group-based recreational experience rather than treating exercise as an isolated prescription.
What Did the GREENS Program Do?
Fifteen men were enrolled, 11 began the intervention, and 10 completed it. The intervention lasted 10 weeks, with participants attending two 90-minute sessions each week.
Sessions progressively combined dynamic warm-ups, body weight and resistance-band exercise, walking, balance and functional-strength activities with golf instruction and eventually on-course play.
Importantly, this wasn’t simply “go play golf.” It was a structured, supervised, multimodal exercise intervention built around an enjoyable recreational activity.
The Results Were Impressive
Among participants completing the program:
- Attendance was 90%.
- Within-session adherence was 98.9%.
- There were no Grade 2 or higher adverse events.
- Enjoyment scores were consistently high.
- Satisfaction scores were consistently high.
- Every participant gave the maximum 7/7 willingness-to-recommend score.
- The average likelihood of continuing a similar program was 6.4/7.
For Exercise Oncology, the adherence findings may be particularly noteworthy. The authors report that the 90% attendance and 98.9% within-session adherence were among the highest rates seen in exercise-intervention studies involving men with prostate cancer.
The Most Important Finding May Not Be About Golf
The deeper lesson from GREENS is that exercise adherence is influenced by the experience surrounding exercise.
Participants valued social support, camaraderie, professional instruction, skill development, belonging, accomplishment and personal growth, not merely the physical exercise itself.
The authors make an especially important observation for Exercise Oncology: exercise alone probably should not be the sole focus of these programs. Program design should also address psychosocial health, enjoyment, social interaction and camaraderie.
That represents an important shift:
From prescribing exercise to creating an environment in which patients want to exercise.
What This Means for Organizing Exercise Oncology Programs
This study has practical implications for CancerFitness.org’s broader goal of moving Exercise Oncology from research into routine cancer care.
Successful programs should certainly provide individualized, evidence-based exercise appropriate to cancer diagnosis, treatment, functional status and physical limitations. But GREENS suggests that program organizers should think beyond sets, repetitions and aerobic minutes.
Programs should also consider:
- Enjoyment as a clinical implementation objective. A physiologically excellent program accomplishes little if patients stop attending.
- Group participation and social connection. Peer relationships can transform exercise into a supportive survivorship experience.
- Activities patients find meaningful. Golf is one example. Other recreational or skill-based activities could potentially provide similar opportunities.
- Qualified supervision and structured progression. Participants specifically valued expert instruction and an organized program.
- Adaptability. Treatment-related fatigue, chronic conditions, injuries, medical appointments, work and family responsibilities must be anticipated rather than regarded simply as noncompliance.
- Measurement beyond fitness. Attendance, adherence, enjoyment, satisfaction and continued participation should be considered important program outcomes.
Indeed, the authors recommend structured, group-based programs incorporating a variety of activities to create a fun and social exercise experience that can improve motivation and adherence.
An Important Caution
GREENS was a small feasibility study, not a definitive clinical trial. Only 10 participants completed the intervention, there was no randomized comparison group, and participants who made it into the active intervention may have represented a particularly motivated and physically capable population.
The investigators appropriately conclude that the findings should primarily be interpreted as evidence of operational feasibility and acceptability, rather than proof of clinical efficacy.
Nevertheless, that is precisely why the study matters for program development.
The CancerFitness.org Perspective
Exercise Oncology must ultimately solve two different problems:
What exercise should we prescribe?
and
How do we create programs patients will actually continue doing?
The GREENS study helps address the second question.
The future of Exercise Oncology may include traditional resistance and aerobic training, but it may also include golf, walking groups, cycling, swimming, racquet sports and other recreational activities, provided they are appropriately screened, supervised, adapted and incorporated into evidence-based cancer care.
The goal should not simply be to get a patient through a 10-week exercise program.
The larger goal is to help that patient discover a safe, enjoyable and socially meaningful way to remain physically active for life.
Call to Action
Cancer centers developing Exercise Oncology Programs should broaden their definition of what an exercise intervention can be. Safety and evidence-based exercise prescription remain fundamental, but enjoyment, social connection, accessibility, skill development and long-term adherence should become equally intentional elements of program design.
The GREENS study gives us an important message: the best exercise program is not merely one that works physiologically, it is one that patients value enough to keep doing.
Reference: Feasibility of the Golf Recreational Exercise for Enhanced Survivorship in prostate cancer survivors undergoing hormone therapy. Guanrong Cai, Jacek Pinski, Lori A. Michener, E. Todd Schroeder, Daniel Kirages, Joy Tu, Kimiko Yamada and George Salem. Frontiers in Oncology. Published 11 August 2026 10.3389/fonc.2026.1844481
