Exercise During Chemotherapy and in Older Cancer Survivors: A Randomized Trial and Consensus Recommendations

Physical therapists and physical therapist assistants who see people during active cancer treatment or in survivorship, including outpatient, acute care, home health, and older-adult practice settings. Physical therapist assistants work under the direction of a physical therapist; the evaluation and plan-of-care decisions described in the source documents belong to the supervising therapist.

Physical therapists and physical therapist assistants in oncology rehabilitation, acute care, outpatient, home health, and geriatric settings.

Intended audience

Physical Therapy

Level

Intermediate

Delivery format

Online, asynchronous, self-paced course: interactive reading with audio or video, and a scored post-test.

Based on

Kjeldsted E, Ammitzbøll G, Lænkholm AV, Rasic D, Ceballos SG, Jørgensen LB, Skou ST, Bojesen RD, Lodin A, Tolver A, Rosthøj S, Jack S, Gehl J, Dalton SO. Effects of Supervised Exercise during Neoadjuvant Chemotherapy on Tumor Response in Patients with Breast Cancer (Neo-train): A Randomized Controlled Trial. Clin Cancer Res. 2025;31(20):4265–4277. doi:10.1158/1078-0432.CCR-25-0416

Winters-Stone KM, Meyers G, Eckstrom E, Cheville A, Garcia JM, McNeely ML, Mohile S, Mustian K, Neil-Sztramko S, Rogers LQ, Schmitz KH, Schwartz A, Sitemba J, Smith R, Campbell KL. Exercise recommendations for older adults living with and beyond cancer: A consensus statement by the Advancing Capacity to Integrate Exercise Into the Care of Older Cancer Survivors expert panel. Cancer. 2026;132(2):e70252. doi:10.1002/cncr.70252

After completing this course, you will be able to:

1. State what the Neo-train randomized controlled trial reported about tumor response, chemotherapy delivery, hospital stay, fitness, and patient-reported outcomes when supervised exercise was added during neoadjuvant chemotherapy for breast cancer.
2. Describe the consensus recommendations issued by the Advancing Capacity to Integrate Exercise Into the Care of Older Cancer Survivors expert panel for medical clearance, pre-exercise assessment, exercise prescription, delivery, and behavioral support in older adults living with and beyond cancer.
3. Distinguish what a single randomized trial can establish from what an expert consensus statement asserts, and explain where the two documents agree and where they diverge on what exercise during and after cancer treatment should look like.

1. Start Here: The Clinical Question and How This Course Is Built
2. Part One: Supervised Exercise During Neoadjuvant Chemotherapy for Breast Cancer
3. Who Took Part: Women Beginning Neoadjuvant Chemotherapy in One Danish Region
4. How the Trial Was Run: Interval Cycling, Progressive Resistance Training, and Usual Care
5. What the Trial Found: Tumor Response, Chemotherapy Delivery, and Days in Hospital
6. What the Trial Could and Could Not Show About Exercise During Treatment
7. Part Two: Consensus Recommendations for Older Adults Living With and Beyond Cancer
8. Who the Recommendations Are About: Survivors Aged 65 and Older
9. How Consensus Was Reached: Expert Panel, Delphi Survey, and Community Advisers
10. The Eleven Recommendations: Clearance, Testing, Prescription, Delivery, and Support
11. What the Panel Acknowledged It Could Not Yet Prove
12. Bringing It Together
13. Where the Trial and the Consensus Statement Agree
14. Where They Diverge and Which Paper Reported What
15. What the Two Documents Support at the Treatment Table
16. What Remains Open for Research and for Practice
17. Key Takeaways
18. Post-Test and Course Evaluation

Quinn Millington, PT, DPT, ECS is the instructor of record: the licensed clinician who reviewed this course and signed off on it. The name and credentials print on the certificate.

Disclosures. This course was developed by The ConEd Solution, which has a financial interest in its sale. No outside funding or sponsorship was received. The instructor of record has no affiliation with the authors of the source publication or their institutions.

This course awards 1.0 contact hour (60 min). How you earn them:

1. Complete the course. Every lesson, in order.
2. Pass the post-test. Score 80% or higher. Retakes are allowed.
3. Complete the evaluation. A short form rating each learning objective and the course.
4. Download your certificate. It is issued on completion and stays available in My Account.

The episode time is its measured length. Reading, post-test and evaluation times are estimates.

This course is designed to satisfy the quality requirements state boards set for continuing education. Requirements vary by state, and confirming that a course fits your renewal is up to you. Each state’s own acceptance statement is in the credit panel on this page.

1. Kjeldsted E, Ammitzbu00f8ll G, Lu00e6nkholm AV, Rasic D, Ceballos SG, Ju00f8rgensen LB, Skou ST, Bojesen RD, Lodin A, Tolver A, Rosthu00f8j S, Jack S, Gehl J, Dalton SO. Effects of Supervised Exercise during Neoadjuvant Chemotherapy on Tumor Response in Patients with Breast Cancer (Neo-train): A Randomized Controlled Trial. Clin Cancer Res. 2025;31(20):4265-4277. doi:10.1158/1078-0432.CCR-25-0416
2. Winters-Stone KM, Meyers G, Eckstrom E, Cheville A, Garcia JM, McNeely ML, Mohile S, Mustian K, Neil-Sztramko S, Rogers LQ, Schmitz KH, Schwartz A, Sitemba J, Smith R, Campbell KL. Exercise recommendations for older adults living with and beyond cancer: A consensus statement by the Advancing Capacity to Integrate Exercise Into the Care of Older Cancer Survivors expert panel. Cancer. 2026;132(2):e70252. doi:10.1002/cncr.70252