A New Study Shows Why Building an Exercise Oncology Program Requires More Than Evidence, it Requires a System
The scientific case for exercise in cancer care is increasingly difficult to dispute. Exercise can benefit people before, during, and after cancer treatment, and professional recommendations increasingly call for exercise to become part of routine oncology care.
Yet knowing that exercise works and actually delivering exercise oncology are two very different things.
A 2026 study published in the Asia-Pacific Journal of Clinical Oncology, “It Will Only Work If Everyone is on Board”: A Needs and Context Assessment to Inform Exercise Oncology Implementation Within a Public Healthcare Organisation, addresses this critical research-to-practice gap. The investigators examined exercise oncology across a large Australian public healthcare organization, asking not simply whether clinicians and patients believe exercise is valuable, but whether the healthcare system is organized to deliver it.
For CancerFitness.org, this publication carries an especially important message: successful Exercise Oncology Programs must be designed as integrated healthcare delivery systems—not simply as exercise services.
Strong Belief in Exercise—but Weak Implementation
The study included 115 participants across 10 healthcare regions: 59 staff members and 56 people living with and beyond cancer. Both groups strongly supported exercise as part of cancer care. Yet that support frequently failed to translate into clinical action.
Only 54% of patients reported receiving a discussion about exercise, and just 13% received a formal exercise referral.
This is the central finding of the study. The problem was not primarily a lack of evidence or belief in exercise. It was the absence of the infrastructure necessary to turn that belief into routine care.
Among the recurring barriers were:
- absent or unclear referral pathways;
- insufficient onsite exercise professionals and programs;
- limited external exercise services;
- inadequate time, space, equipment, or funding in some locations;
- transportation and affordability problems;
- uncertainty about responsibilities and scope of practice; and
- poor communication among different sites within the same healthcare organization.
The study’s Figure 2 is particularly revealing. Referring clinicians generally agreed that exercise was evidence-based and safe, but many reported that exercise was not well integrated into routine clinical practice and that they did not know how to screen patients or where and how to refer them.
Having an Exercise Program Is Not Enough
One of the study’s most important lessons is that simply putting an exercise professional or exercise service into a cancer center does not solve the implementation problem.
Through the entire organization, only three onsite exercise oncology services in two regions were identified. Even where onsite services existed, however, they did not consistently produce higher rates of exercise discussions and referrals.
The authors conclude that onsite programs must be meaningfully integrated into cancer care. Without clear referral pathways, adequate staffing, and visibility to the oncology team, an exercise program can remain underutilized even when it is physically located within the healthcare system.
This distinction is extremely important.
Exercise oncology cannot function as an isolated department to which an occasionally motivated patient happens to find their way. It must become part of the clinical pathway.
The Patient Is Depending on the Oncology Team
The study also demonstrates a troubling disconnect between patient interest and healthcare delivery.
Patients largely believed exercise was beneficial and appropriate. Yet 48% did not feel adequately supported regarding exercise by their cancer care team, while 83% of staff believed improvements in exercise implementation were needed.
The authors describe what amounts to a chain of dependency: patients depend upon clinicians to initiate conversations and make referrals, while clinicians depend upon their organizations to provide the pathways, staffing, resources, and services necessary to make those referrals meaningful.
If any link in that chain is missing, exercise may never reach the patient.
Why This Study Is Important for Organizing Exercise Oncology Programs
This publication provides something close to a blueprint for organizations seeking to move exercise oncology from an aspiration to routine cancer care.
First, conduct a needs and context assessment before building the program. A model that succeeds at one hospital may not work at another—even within the same healthcare system. Patient populations, staffing, transportation, funding, facilities, leadership, and community resources differ. The study specifically warns against a “one-size-fits-all” implementation strategy.
Second, build a defined clinical workflow. Who discusses exercise? Who screens the patient? What triggers a referral? Who receives that referral? How is medical information transferred? How does the exercise professional communicate back to the oncology team? These questions need predetermined answers.
Third, make referral simple and visible. The presence of an exercise service accomplishes little if physicians, nurses, and allied-health professionals do not know it exists or cannot easily refer patients.
Fourth, engage leadership early. The authors emphasize that executives influence organizational readiness, funding, decision-making, and resource allocation. Interestingly, no executives completed the survey despite being invited, a limitation that illustrates how difficult leadership engagement can be. The investigators suggest that clinical champions and direct conversations may be more effective ways of reaching decision-makers.
Fifth, create multidisciplinary ownership. Exercise oncology cannot be the responsibility of the exercise physiologist or physical therapist alone. Medical oncologists, surgeons, radiation oncologists, nurses, rehabilitation specialists, exercise professionals, administrators, and patients all need defined roles.
Sixth, connect sites rather than allowing them to operate in silos. Staff in this study were frequently unaware of exercise oncology activity elsewhere in their own organization. Better communication can promote shared learning and prevent every location from having to “reinvent the wheel.”
Finally, measure implementation as well as patient outcomes. The investigators’ next phase is designed around three practical outputs: defining the exercise intervention or workflow, developing implementation strategies, and creating an implementation evaluation plan.
From “Exercise Is Medicine” to Exercise as Routine Cancer Care
Perhaps the most important conclusion from this publication is that the major challenge facing exercise oncology is changing.
We no longer need to demonstrate that exercise benefits people living with and beyond cancer. We must determine how to reliably deliver those benefits through real-world oncology systems.
The authors summarize the challenge clearly: knowledge and endorsement cannot produce change without the resources and workflows that allow clinicians to discuss exercise, make referrals, and deliver exercise oncology services.
For organizations developing Exercise Oncology Programs, that means the program should not begin with the question:
“Where should we put the exercise facility?”
It should begin with:
“How do we make exercise a routine part of the patient’s cancer-care pathway?”
The answer involves leadership, clinical champions, trained exercise professionals, patient participation, standardized screening and referral, communication, adequate resources, measurement, and adaptation to local circumstances.
The title of this publication captures the principle exceptionally well:
It will only work if everyone is on board.
CancerFitness.org Call to Action
Cancer centers, oncology practices, hospitals, health systems, rehabilitation programs, and survivorship programs should move beyond simply recommending exercise and begin building the organizational infrastructure required to deliver it.
CancerFitness.org encourages healthcare organizations developing Exercise Oncology Programs to start with a formal needs and context assessment, identify local barriers and resources, establish standardized screening and referral pathways, engage executive and clinical leadership, integrate qualified exercise professionals into multidisciplinary cancer care, and continuously evaluate whether patients are actually reaching the services created for them.
The next frontier in Exercise Oncology is implementation. Evidence tells us exercise belongs in cancer care. Our responsibility now is to build healthcare systems that make sure patients can receive it.
Reference: “It Will Only Work If Everyone is on Board”: A Needs and Context Assessment to Inform Exercise Oncology Implementation Within a Public Healthcare Organisation. Georgia L. White; Mary A. Kennedy; Bryan A. Chan; Hattie Wright; Grace L. Rose. Asia-Pacific Journal of Clinical Oncology, 2026; 0:1–11 https://doi.org/10.1111/ajco.70158.
