title: Development of a risk-screening tool for cancer survivors to participate in unsupervised moderate- to vigorous-intensity exercise: results from a survey study.
abstract: BACKGROUND
  The health benefits of exercise increase in dose-response fashion among cancer survivors. However, it is unclear how to identify cancer survivors who may require a pre-exercise evaluation before they progress from the common recommendation of walking to unsupervised moderate- to vigorous-intensity exercise.
  
  
  OBJECTIVE
  To clarify how to identify cancer survivors who should undergo a pre-exercise evaluation before they progress from the common recommendation of walking to unsupervised moderate- to vigorous-intensity exercise.
  
  
  METHODS
  Electronic survey.
  
  
  METHODS
  Forty-seven (n = 47) experts in the field of exercise physiology, rehabilitation medicine, and cancer survivorship.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  We synthesized peer-reviewed guidelines for exercise and cancer survivorship and identified 82 health factors that may warrant a pre-exercise evaluation before a survivor engages in unsupervised moderate- to vigorous-intensity exercise. The 82 health factors were classified into 3 domains: (1) clinical health factors; (2) comorbidity and device health factors; and (3) medications. We surveyed a sample of experts asking them to identify which of the 82 health factors among cancer survivors would indicate the need for a pre-exercise evaluation before they engaged in moderate- to vigorous-intensity exercise.
  
  
  METHODS
  The response rate to our survey was 75% (n = 47). Across the 3 domains of health factors, acute symptoms, comorbidities, and medications related to cardiovascular disease were agreed on to indicate a pre-exercise evaluation for survivors before they engaged in unsupervised moderate- to vigorous-intensity exercise. Other health factors in the survey included hematologic, musculoskeletal, systemic, gastrointestinal, pulmonary, and neurological symptoms and comorbidities. Eighteen experts (38%) said it was difficult to provide absolute answers because no 2 patients are alike, and their decisions are made on a case-by-case basis.
  
  
  CONCLUSIONS
  The results from this expert survey will help to identify which cancer survivors should undergo a pre-exercise evaluation before they engage in unsupervised moderate- to vigorous-intensity exercise.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(∗)(†)(‡).
authors.forename: Justin C
authors.initials: JC
authors.lastname: Brown
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(∗)(†)(‡).
authors.forename: Emily M
authors.initials: EM
authors.lastname: Ko
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(∗)(†)(‡). Electronic address: schmitz@mail.med.upenn.edu.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Schmitz
mesh_terms: D015444:Exercise; D006304:Health Status; D006801:Humans; D008403:Mass Screening; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D018579:Patient Selection; D010808:Physical Examination; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires