As cancer survival improves and the population ages, oncology is caring for a rapidly growing number of older adults whose health cannot be understood by looking at their cancer diagnosis alone. Two recent reports in JAMA make an important point that should resonate throughout oncology: physical function, frailty, cognition, and resilience should become part of routine clinical assessment—and they can help guide individualized interventions.
Although these reports focus primarily on older adults and cardiovascular medicine rather than cancer, their implications for Exercise Oncology are substantial.
Physical Fitness Predicts More Than We May Realize
One report describes a study involving approximately 13,400 adults aged 65 years or older who underwent objective assessments of cardiorespiratory fitness, muscular strength, flexibility, balance, and agility. Participants performed practical tests including chair stands and step tests and were followed for a median of seven years.
The results were striking: higher physical fitness was associated with lower all-cause mortality. Balance and agility showed the strongest associations with lower mortality risk, followed by lower-body strength and cardiorespiratory fitness. The investigators concluded that incorporating fitness assessment into routine geriatric care could improve risk stratification and help clinicians prescribe individualized, function-oriented interventions.
This concept has direct relevance to older cancer patients.
Chronologic age alone tells us relatively little about an individual’s ability to tolerate cancer treatment. Two 75-year-old patients may have profoundly different levels of strength, mobility, balance, aerobic capacity, independence, and physiologic reserve. Measuring function gives us information that age alone cannot.
Cardiology Is Moving Beyond the Heart – Oncology Should Move Beyond the Tumor
The accompanying JAMA report discusses a new American College of Cardiology scientific statement recommending that clinicians caring for older cardiovascular patients consider frailty and cognitive impairment, particularly among patients 75 years and older. The statement emphasizes modifiable risk factors, simple cognitive and functional assessments, individualized decision-making, and interventions designed to build resilience.
The reasoning behind this approach is especially relevant to oncology.
Aging-related diseases share biological processes including chronic inflammation, endothelial dysfunction, vascular stiffness, and impaired repair mechanisms. Importantly, these processes do not affect a single organ. They can simultaneously contribute to cardiovascular disease, cognitive decline, frailty and sarcopenia.
Cancer and cancer treatment are layered on top of these age-related vulnerabilities. For an older cancer patient, maintaining muscle strength, mobility, balance, cardiorespiratory fitness, and independence may therefore be critical components of successful cancer care.
Simple Functional Testing Can Change the Conversation
One of the most practical lessons from these reports is that functional assessment does not necessarily require an elaborate laboratory.
The cardiovascular statement discusses simple measurements such as gait speed and grip strength. Even observing whether a patient has difficulty rising from a chair can provide useful information about functional status. A four-meter gait-speed test can serve as a screening tool for ambulatory patients, while grip strength can be considered when walking assessments are not possible.
For Exercise Oncology programs, this reinforces an important principle:
Assess first. Prescribe second. Reassess over time.
Older cancer patients could benefit from standardized evaluation of domains such as aerobic capacity, lower- and upper-body strength, mobility, balance and agility, and functional independence. These measurements can help identify vulnerabilities that may not be apparent during a conventional oncology office visit.
They can also provide a baseline against which changes during chemotherapy, radiation therapy, endocrine therapy, surgery, or survivorship can be measured.
From Frailty to Resilience
Perhaps the most important concept in the cardiovascular statement is the goal of building resilience rather than simply treating disease.
The statement recommends physical and cognitive activity, appropriate nutrition, smoking cessation, and attention to polypharmacy. It also describes modern cardiac rehabilitation—which increasingly incorporates aerobic exercise, strength, balance, mobility, nutrition, and social support—as a central strategy for maintaining function and independence in older adults.
There is a clear parallel with Exercise Oncology.
A comprehensive Exercise Oncology program should not simply tell an older cancer patient to “exercise.” It should assess the patient’s functional status, identify deficits, establish an individualized exercise prescription, supervise or monitor the intervention when appropriate, and periodically reassess function.
The objective is not athletic performance. The objective is physiologic reserve and independence.
For an older patient undergoing cancer treatment, that may mean maintaining the strength to rise from a chair, the balance to avoid a fall, the endurance to walk through a hospital or grocery store, or the functional reserve necessary to recover after surgery or tolerate systemic therapy.
A Broader Definition of Successful Cancer Care
The ACC statement acknowledges that adding assessments of cognition, frailty, and body composition creates additional demands on already busy clinicians. Its larger recommendation, however, is that health systems should develop ways to integrate these assessments rather than placing the entire responsibility on an individual physician.
That lesson applies equally well to cancer centers.
Exercise Oncology programs can provide the infrastructure that oncology practices often lack for systematically assessing and addressing physical function. They can help transform exercise from general lifestyle advice into a measurable component of supportive cancer care.
For older adults with cancer, we should increasingly ask not only:
“How old is this patient?”
but also:
“How fit is this patient—and what can we do to preserve or improve that fitness?”
The distinction matters. Fitness and functional capacity are potentially modifiable. Identifying declining strength, balance, mobility, or aerobic capacity creates an opportunity to intervene rather than simply document deterioration.
The CancerFitness.org Takeaway
These publications were not written specifically as Exercise Oncology recommendations, and the fitness study was not limited to cancer patients. We therefore should not assume that every mortality association demonstrated in the general older population automatically translates into improved cancer-specific survival.
But the broader clinical message is highly relevant: objective physical function deserves to be measured, monitored, and acted upon in older adults.
CancerFitness.org believes this principle should become an increasingly important part of caring for older cancer patients. Functional fitness assessment can help identify frailty and loss of physiologic reserve early—and individualized exercise interventions offer a practical way to target strength, balance, mobility, cardiorespiratory fitness, and independence.
Call to Action: Make Fitness Part of the Cancer Vital Signs
Cancer centers should consider incorporating baseline and longitudinal functional fitness assessment into the care of older adults with cancer, with referral to qualified Exercise Oncology programs when deficits or risks are identified.
We routinely measure blood pressure, weight, laboratory values, and treatment response. For the growing population of older cancer patients, it is time to give physical function and fitness a similarly prominent place in comprehensive cancer care.
Reference: Physical Fitness and All-Cause Mortality in Older Adults. Min-Chen Wu, PhD; Chen-Te Hsu, PhD, MPH; Hsiu-Tao Hsu, PhD; Chien-Chang Ho, PhD; et al. JAMA Network Open. 2026;9(8):e2628227. doi:10.1001/jamanetworkopen.2026.28227
Cardiovascular Care Should Incorporate Cognition and Frailty, Heart Group Says in New Statement. Jennifer Abbasi. JAMA Published online August 28, 2026.
