For decades, pediatric cancer care has focused appropriately on survival. But now that more than 80% of children and adolescents diagnosed with cancer in high-income countries survive long term, a new question becomes equally important:
How do we help them survive well?
A new American College of Sports Medicine (ACSM) Expert Consensus Statement delivers an important milestone for Exercise Oncology: the first formal exercise guidance developed specifically for children and adolescents during and after cancer treatment.
Exercise Is No Longer “Extra”—It Is Supportive Care
Children and adolescents with cancer often experience treatment-related declines in:
- Muscle mass and strength
- Physical function
- Cardiorespiratory fitness
- Energy levels
- Long-term metabolic and cardiovascular health
- Overall participation in normal childhood activities
The new ACSM guidance reframes exercise as more than recreation—it becomes a structured therapeutic strategy to preserve function and support lifelong health.
Importantly, the statement concludes that exercise can generally be performed safely in children and adolescents with cancer when appropriately supervised and individualized.
What Does the Evidence Actually Show?
After reviewing more than 12,000 studies and evaluating randomized controlled trials, the ACSM panel identified areas where exercise already has meaningful evidence.
1. Exercise Improves Muscle Strength
Moderate evidence supports combined aerobic + strength (“concurrent”) exercise to improve muscle strength during and after treatment.
Recommended starting framework:
- Frequency: 2–3 sessions/week
- Duration: ≥8 weeks
- Intensity: Moderate to vigorous
- Session length: 30–45 minutes
- Activities: Running, cycling, games, bodyweight exercise, resistance training
2. Exercise Improves Physical Function
Children participating in exercise demonstrated improvements in movement capacity and functional performance.
That matters because physical function influences:
- independence,
- return to school,
- confidence,
- participation in family life,
- and long-term survivorship outcomes.
3. Aerobic Exercise Improves Fitness After Treatment
For survivors—especially children treated for acute lymphoblastic leukemia (ALL)—aerobic exercise improved cardiorespiratory fitness after treatment completion.
A Critical Message for Cancer Survivorship
One of the most important observations in the publication extends beyond treatment.
Studies cited in the consensus show that childhood cancer survivors who maintain healthier lifestyles—including physical activity—have lower risks of long-term morbidity and health-related mortality. Low physiologic reserve, weakness, and inactivity predict worse outcomes later in life.
This aligns directly with the mission of Exercise Oncology:
Treat cancer. Preserve function. Build survivorship.
What This Means for CancerFitness.org
This publication represents a major advance because it moves pediatric exercise oncology from “exercise may help” to evidence-informed guidance.
Exercise should not wait until treatment ends.
Every pediatric oncology center should begin by asking:
- Is movement being discussed at diagnosis?
- Is physical function being measured?
- Are exercise professionals integrated into care?
- Are survivorship plans including structured exercise?
Children with cancer deserve more than cure.
They deserve the strongest possible future.
Call to Action
If you are a parent, survivor, oncologist, pediatrician, rehabilitation professional, or supporter of Exercise Oncology:
Start the conversation early. Ask where exercise fits into treatment—not after treatment.
CancerFitness.org supports a future where every child and adolescent facing cancer has access to safe, evidence-informed exercise programming as part of standard cancer care.
Movement is not a luxury in pediatric oncology. It is an investment in lifelong survivorship.
Reference: Initial Exercise Guidance for Children and Adolescents during and beyond Cancer Treatment: ACSM Expert Consensus Statement. MARTIN K. FRIDH, SABINE KESTING, MARIE A. NEU, PEDRO L. VALENZUELA, MATTHEW WOGKSCH, S. NICOLE CULOS-REED, KATHRYN H. SCHMITZ, et al. Medicine & Science in Sports & Exercise 0195-9131/2026/587-1615/1628 DOI: 10.1249/MSS.0000000000003958
