Community-based exercise programs for cancer survivors: a scoping review of practice-based evidence

  • Kelley R. CovingtonEmail author
  • Mary C. Hidde
  • Mackenzi Pergolotti
  • Heather J. Leach
Review Article



Based on randomized controlled trials, exercise is an efficacious strategy to improve quality of life (QOL) among cancer survivors. However, the effectiveness of exercise programs to improve QOL in real-world settings is unknown, as are factors related to external validity. This hinders dissemination and scalability. This scoping review synthesized published research on community-based exercise programs for cancer survivors and reported on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM).


A systematic literature search identified community-based exercise programs for adult cancer survivors (1980–March 2018), that met the following inclusion criteria: at least one face-to-face exercise session, the primary aim of program evaluation (i.e., feasibility/effectiveness), and pre/post measure of QOL. Data were coded using the RE-AIM framework. The effect size was calculated for overall QOL.


Electronic database search yielded 553 articles; 31 studies describing unique programs were included for review. All studies described at least one element of implementation and most (80.6%) reported a significant (p < .05) improvement in at least one subscale, or total QOL. Few studies reported on indicators of reach (16.1%), adoption (6.5%), individual (16.1%), or system-level maintenance (32.3%).


Community-based exercise programs are effective for improving QOL in adult cancer survivors. Recommendations are provided to improve reporting across RE-AIM dimensions, which is an important step to enhance the scalability of programs and thus, the potential for exercise to be fully integrated into system-level standard care for cancer survivors.

Implications for Cancer survivors

Community-based exercise programs are a resource to improve QOL for adult cancer survivors.


Cancer survivors Exercise Program evaluation Quality of life RE-AIM Scoping study 



The authors are grateful to Samantha M. Harden for her critique of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


Dr. Pergolotti is the Director of Research for ReVital Cancer Rehabilitation, Select Medical. Kelley Covington is a Research Assistant for ReVital Cancer Rehabilitation, Select Medical.


  1. 1.
    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30. CrossRefGoogle Scholar
  2. 2.
    Rathod S, Livergant J, Klein J, Witterick I, Ringash J (2015) A systematic review of quality of life in head and neck cancer treated with surgery with or without adjuvant treatment. Oral Oncol 51(10):888–900. CrossRefGoogle Scholar
  3. 3.
    Wu HS, Harden JK (2015) Symptom burden and quality of life in survivorship: a review of the literature. Cancer Nurs 38(1):E29–E54. CrossRefGoogle Scholar
  4. 4.
    Duncan M, Moschopoulou E, Herrington E, Deane J, Roylance R, Jones L, Bourke L, Morgan A, Chalder T, Thaha MA, Taylor SC, Korszun A, White PD, Bhui K, SURECAN Investigators (2017) Review of systematic reviews of non-pharmacological interventions to improve quality of life in cancer survivors. BMJ Open 7(11):e015860. CrossRefGoogle Scholar
  5. 5.
    Gerritsen JK, Vincent AJ (2016) Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 50(13):796–803. CrossRefGoogle Scholar
  6. 6.
    Ferrer RA, Huedo-Medina TB, Johnson BT, Ryan S, Pescatello LS (2011) Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes. Ann Behav Med 41(1):32–47. CrossRefGoogle Scholar
  7. 7.
    Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T et al (2017) Exercise for people with cancer: a systematic review. Curr Oncol (Toronto, Ont) 24(4):e290–e315. CrossRefGoogle Scholar
  8. 8.
    Phillips SM, Alfano CM, Perna FM, Glasgow RE (2014) Accelerating translation of physical activity and cancer survivorship research into practice: recommendations for a more integrated and collaborative approach. Cancer Epidemiol Biomark Prev 23(5):687–699. CrossRefGoogle Scholar
  9. 9.
    Roux G, Solari-Twadell A, Ackers S (2015) Community interventions for survivors and their families: a literature synthesis. Clin J Oncol Nurs 19(3):E63–E69. CrossRefGoogle Scholar
  10. 10.
    Musanti R, Murley B (2016) Community-based exercise programs for cancer survivors. Clin J Oncol Nurs 20(6 Suppl):S25–s30. CrossRefGoogle Scholar
  11. 11.
    Swartz MC, Lewis ZH, Lyons EJ, Jennings K, Middleton A, Deer RR, Arnold D, Dresser K, Ottenbacher KJ, Goodwin JS (2017) Effect of home- and community-based physical activity interventions on physical function among cancer survivors: a systematic review and meta-analysis. Arch Phys Med Rehabil 98(8):1652–1665. CrossRefGoogle Scholar
  12. 12.
    Glasgow RE, Vinson C, Chambers D, Khoury MJ, Kaplan RM, Hunter C (2012) National Institutes of Health approaches to dissemination and implementation science: current and future directions. Am J Public Health 102(7):1274–1281. CrossRefGoogle Scholar
  13. 13.
    Hellerstein DJ (2008) Practice-based evidence rather than evidence-based practice in psychiatry. Medscape J Med 10(6):141Google Scholar
  14. 14.
    Harden SM, Smith ML, Ory MG, Smith-Ray RL, Estabrooks PA, Glasgow RE (2018) RE-AIM in clinical, community, and corporate settings: perspectives, strategies, and recommendations to enhance public health impact. Front Public Health 6:71. CrossRefGoogle Scholar
  15. 15.
    Glasgow RE, Vogt TM, Boles SM (1999) Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health 89(9):1322–1327CrossRefGoogle Scholar
  16. 16.
    Armstrong R, Hall BJ, Doyle J, Waters E (2011) ‘Scoping the scope’ of a cochrane review. J Public Health 33(1):147–150. CrossRefGoogle Scholar
  17. 17.
    Arksey H, O’Malley L (2005) Scoping studies: towards a methodological framework. Int J Soc Res Methodol 8(1):19–32. CrossRefGoogle Scholar
  18. 18.
    Levac D, Colquhoun H, O'Brien KK (2010) Scoping studies: advancing the methodology. Implement Sci 5:69. CrossRefGoogle Scholar
  19. 19.
    Christopher KA, Morrow LL (2004) Evaluating a community-based exercise program for women cancer survivors. Appl Nurs Res 17(2):100–108CrossRefGoogle Scholar
  20. 20.
    Capozzi LC, Boldt KR, Easaw J, Bultz B, Culos-Reed SN (2016) Evaluating a 12-week exercise program for brain cancer patients. Psycho-oncology. 25(3):354–358. CrossRefGoogle Scholar
  21. 21.
    De Jesus S, Fitzgeorge L, Unsworth K, Massel D, Suskin N, Prapavessis H et al (2017) Feasibility of an exercise intervention for fatigued breast cancer patients at a community-based cardiac rehabilitation program. Cancer Manag Res 9:29–39. CrossRefGoogle Scholar
  22. 22.
    Foley MP, Hasson SM, Kendall E (2017) Effects of a translational community-based multimodal exercise program on quality of life and the influence of start delay on physical function and quality of life in breast cancer survivors: a pilot study. Integr Cancer Ther 1534735417731514:337–349. Google Scholar
  23. 23.
    Knobf MT, Thompson AS, Fennie K, Erdos D (2014) The effect of a community-based exercise intervention on symptoms and quality of life. Cancer Nurs 37(2):E43–E50. CrossRefGoogle Scholar
  24. 24.
    Andersen AH, Vinther A, Poulsen LL, Mellemgaard A (2013) A modified exercise protocol may promote continuance of exercise after the intervention in lung cancer patients--a pragmatic uncontrolled trial. Support Care Cancer 21(8):2247–2253. CrossRefGoogle Scholar
  25. 25.
    Carter CL, Onicescu G, Cartmell KB, Sterba KR, Tomsic J, Alberg AJ (2012) The comparative effectiveness of a team-based versus group-based physical activity intervention for cancer survivors. Support Care Cancer 20(8):1699–1707. CrossRefGoogle Scholar
  26. 26.
    Cheifetz O, Park Dorsay J, Hladysh G, Macdermid J, Serediuk F, Woodhouse LJ (2014) CanWell: meeting the psychosocial and exercise needs of cancer survivors by translating evidence into practice. Psycho-oncology. 23(2):204–215. CrossRefGoogle Scholar
  27. 27.
    De Backer IC, Van Breda E, Vreugdenhil A, Nijziel MR, Kester AD, Schep G (2007) High-intensity strength training improves quality of life in cancer survivors. Acta Oncol (Stockholm, Sweden) 46(8):1143–1151. CrossRefGoogle Scholar
  28. 28.
    Foley MP, Barnes VA, Hasson SM (2015) Effects of a community-based multimodal exercise program on physical function and quality of life in cancer survivors: a pilot study. Physiother Theory Pract 31(5):303–312. CrossRefGoogle Scholar
  29. 29.
    Kirkham AA, Klika RJ, Ballard T, Downey P, Campbell KL (2016) Effective translation of research to practice: hospital-based rehabilitation program improves health-related physical fitness and quality of life of cancer survivors. J Natl Compr Cancer Netw 14(12):1555–1562CrossRefGoogle Scholar
  30. 30.
    Kirkham AA, Neil-Sztramko SE, Morgan J, Hodson S, Weller S, McRae T et al (2016) Fee-for-service cancer rehabilitation programs improve health-related quality of life. Curr Oncol (Toronto, Ont) 23(4):233–240. CrossRefGoogle Scholar
  31. 31.
    Leach HJ, Danyluk JM, Nishimura KC, Culos-Reed SN (2015) Evaluation of a community-based exercise program for breast cancer patients undergoing treatment. Cancer Nurs 38(6):417–425. CrossRefGoogle Scholar
  32. 32.
    Losito J, Murphy S, Thomas M (2006) The effects of group exercise on fatigue and quality of life during cancer treatment. Oncol Nurs Forum 33(4):821–825. CrossRefGoogle Scholar
  33. 33.
    Ng AV, Cybulski AN, Engel AA, Papanek PE, Sheffer MA, Waltke LJ, Tjoe JA (2017) Triathlon training for women breast cancer survivors: feasibility and initial efficacy. Support Care Cancer 25(5):1465–1473. CrossRefGoogle Scholar
  34. 34.
    Noble M, Russell C, Kraemer L, Sharratt M (2012) UW WELL-FIT: the impact of supervised exercise programs on physical capacity and quality of life in individuals receiving treatment for cancer. Support Care Cancer 20(4):865–873. CrossRefGoogle Scholar
  35. 35.
    Nock NL, Owusu C, Flocke S, Krejci SA, Kullman EL, Austin K et al. A community-based exercise and support group program improves quality of life in African-American breast cancer survivors: a quantitative and qualitative analysis. International journal of sports and exercise medicine. 2015;1(3)Google Scholar
  36. 36.
    Rajotte EJ, Yi JC, Baker KS, Gregerson L, Leiserowitz A, Syrjala KL (2012) Community-based exercise program effectiveness and safety for cancer survivors. J Cancer Surviv Res Pract 6(2):219–228. CrossRefGoogle Scholar
  37. 37.
    Reynolds J, Thibodeaux L, Jiang L, Francis K, Hochhalter A (2014) Fit & strong! Promotes physical activity and well-being in older cancer survivors. Front Public Health 2:171. Google Scholar
  38. 38.
    Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R (2007) Cancer treatment-induced alterations in muscular fitness and quality of life: the role of exercise training. Ann Oncol 18(12):1957–1962. CrossRefGoogle Scholar
  39. 39.
    Swenson KK, Nissen MJ, Knippenberg K, Sistermans A, Spilde P, Bell EM, Nissen J, Chen C, Tsai ML (2014) Cancer rehabilitation: outcome evaluation of a strengthening and conditioning program. Cancer Nurs 37(3):162–169. CrossRefGoogle Scholar
  40. 40.
    Skinner TL, Peeters G, Croci I, Bell KR, Burton NW, Chambers SK et al (2016) Impact of a brief exercise program on the physical and psychosocial health of prostate cancer survivors: a pilot study. Asia-Pac J Clin Oncol 12(3):225–234. CrossRefGoogle Scholar
  41. 41.
    Smith TM, Broomhall CN, Crecelius AR (2016) Physical and psychological effects of a 12-session cancer rehabilitation exercise program. Clin J Oncol Nurs 20(6):653–659. CrossRefGoogle Scholar
  42. 42.
    Browning KK, Kue J, Lyons F, Overcash J (2017) Feasibility of mind-body movement programs for cancer survivors. Oncol Nurs Forum 44(4):446–456. CrossRefGoogle Scholar
  43. 43.
    Haas BK, Kimmel G, Hermanns M, Deal B (2012) Community-based FitSTEPS for life exercise program for persons with cancer: 5-year evaluation. J Oncol Pract 8(6):320–324, 2 p following 4. CrossRefGoogle Scholar
  44. 44.
    Santa Mina D, Au D, Brunet J, Jones J, Tomlinson G, Taback N, Field D, Berlingeri A, Bradley H, Howell D (2017) Effects of the community-based wellspring cancer exercise program on functional and psychosocial outcomes in cancer survivors. Curr Oncol 24(5):284–294. CrossRefGoogle Scholar
  45. 45.
    Van Gerpen RE, Becker BJ (2013) Development of an evidence-based exercise and education cancer recovery program. Clin J Oncol Nurs 17(5):539–543. CrossRefGoogle Scholar
  46. 46.
    Young-McCaughan S, Mays MZ, Arzola SM, Yoder LH, Dramiga SA, Leclerc KM et al (2003) Research and commentary: change in exercise tolerance, activity and sleep patterns, and quality of life in patients with cancer participating in a structured exercise program. Oncol Nurs Forum 30(3):441–454; discussion −54. CrossRefGoogle Scholar
  47. 47.
    Irwin ML, Cartmel B, Harrigan M, Li F, Sanft T, Shockro L, O'Connor K, Campbell N, Tolaney SM, Mayer EL, Yung R, Freedman RA, Partridge AH, Ligibel JA (2017) Effect of the LIVESTRONG at the YMCA exercise program on physical activity, fitness, quality of life, and fatigue in cancer survivors. Cancer. 123(7):1249–1258. CrossRefGoogle Scholar
  48. 48.
    Schmitt J, Lindner N, Reuss-Borst M, Holmberg HC, Sperlich B (2016) A 3-week multimodal intervention involving high-intensity interval training in female cancer survivors: a randomized controlled trial. Physiol Rep 4(3).
  49. 49.
    Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, Venner PM, Quinney HA, Jones LW, Slovinec D’Angelo ME, Wells GA (2003) Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 21(9):1653–1659. CrossRefGoogle Scholar
  50. 50.
    Capozzi L, Boldt K, Lau H, Shirt L, Bultz B, Culos-Reed S (2015) A clinic-supported group exercise program for head and neck cancer survivors: managing cancer and treatment side effects to improve quality of life. Support Care Cancer 23(4):1001–1007. CrossRefGoogle Scholar
  51. 51.
    Foley MP, Hasson SM (2016) Effects of a community-based multimodal exercise program on health-related physical fitness and physical function in breast cancer survivors: a pilot study. Integr Cancer Ther 15(4):446–454. CrossRefGoogle Scholar
  52. 52.
    Haas BK, Kimmel G (2011) Model for a community-based exercise program for cancer survivors: taking patient care to the next level. J Oncol Pract 7(4):252–256. CrossRefGoogle Scholar
  53. 53.
    Leach H, Danyluk J, Nishimura K, Culos-Reed S, Leach HJ, Danyluk JM et al (2016) Benefits of 24 versus 12 weeks of exercise and wellness programming for women undergoing treatment for breast cancer. Support Care Cancer 24(11):4597–4606. CrossRefGoogle Scholar
  54. 54.
    Leach HJ, Danyluk JM, Culos-Reed SN (2014) Design and implementation of a community-based exercise program for breast cancer patients. Curr Oncol (Toronto, Ont) 21(5):267–271. CrossRefGoogle Scholar
  55. 55.
    Anderson RT, Peres LC, Camacho F, Bandera EV, Funkhouser E, Moorman PG et al (2019) Individual, social, and societal correlates of health-related quality of life among African American survivors of ovarian cancer: results from the African American Cancer Epidemiology Study. J Women's Health (2002) 28(2):284–293. CrossRefGoogle Scholar
  56. 56.
    Yedjou CG, Tchounwou PB, Payton M, Miele L, Fonseca DD, Lowe L et al (2017) Assessing the racial and ethnic disparities in breast cancer mortality in the United States. Int J Environ Res Public Health 14(5).
  57. 57.
    Vick AD, Hery DN, Markowiak SF, Brunicardi FC (2019) Closing the disparity in pancreatic cancer outcomes: a closer look at nonmodifiable factors and their potential use in treatment. Pancreas. 48(2):242–249. CrossRefGoogle Scholar
  58. 58.
    Courneya KS, Forbes CC, Trinh L, Sellar CM, Friedenreich CM, Reiman T (2013) Patient satisfaction with participation in a randomized exercise trial: effects of randomization and a usual care posttrial exercise program. Clin Trials 10(6):959–966. CrossRefGoogle Scholar
  59. 59.
    Kaya H, Aydin GO, Kucuk L, Asti TA, Turan N, Pallos A et al (2018) Self-efficacy level and patient satisfaction with healthcare in chronic obstructive pulmonary diseases. Int J Med Res Health 7(7):1–9Google Scholar
  60. 60.
    Heston AH, Schwartz AL, Justice-Gardiner H, Hohman KH (2015) Addressing physical activity needs of survivors by developing a community-based exercise program: LIVESTRONG(R) at the YMCA. Clin J Oncol Nurs 19(2):213–217. CrossRefGoogle Scholar
  61. 61.
    Jankowski CM, Ory MG, Friedman DB, Dwyer A, Birken SA, Risendal B (2014) Searching for maintenance in exercise interventions for cancer survivors. J Cancer Surviv Res Pract 8(4):697–706. CrossRefGoogle Scholar
  62. 62.
    Nock NL, Dimitropoulos A, Rao SM, Flask CA, Schluchter M, Zanotti KM, Rose PG, Kirwan JP, Alberts J (2014) Rationale and design of REWARD (revving-up exercise for sustained weight loss by altering neurological reward and drive): a randomized trial in obese endometrial cancer survivors. Contemp Clin Trials 39(2):236–245. CrossRefGoogle Scholar
  63. 63.
    Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579. CrossRefGoogle Scholar
  64. 64.
    Ferrell BR, Grant M (1999) Quality of life, patient version, psychometric and scoring information. City of Hope National Medical Center, Duarte, CAGoogle Scholar
  65. 65.
    Ware JEJ, Kosinski M, Keller SD (1994) SF-36 physical & mental subscales: a user’s manual. Boston, MA, The Health Institute, New England Medical CenterGoogle Scholar
  66. 66.
    Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton symptom assessment scale. Cancer. 88(9):2164–2171CrossRefGoogle Scholar
  67. 67.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376CrossRefGoogle Scholar
  68. 68.
    Avis NE, Smith KW, McGraw S, Smith RG, Petronis VM, Carver CS (2005) Assessing quality of life in adult cancer survivors (QLACS). Qual Life Res 14(4):1007–1023CrossRefGoogle Scholar
  69. 69.
    van Andel G, Bottomley A, Fossa SD, Efficace F, Coens C, Guerif S et al (2008) An international field study of the EORTC QLQ-PR25: a questionnaire for assessing the health-related quality of life of patients with prostate cancer. Eur J Cancer (Oxford, England : 1990) 44(16):2418–2424. CrossRefGoogle Scholar
  70. 70.
    Stewart-Brown S, Tennant A, Tennant R, Platt S, Parkinson J, Weich S (2009) Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish health education population survey. Health Qual Life Outcomes 7:15. CrossRefGoogle Scholar
  71. 71.
    Eaton T, Young P, Fergusson W, Garrett JE, Kolbe J (2005) The Dartmouth COOP Charts: a simple, reliable, valid and responsive quality of life tool for chronic obstructive pulmonary disease. Qual Life Res 14(3):575–585CrossRefGoogle Scholar
  72. 72.
    Schag CA, Ganz PA, Heinrich RL (1991) CAncer rehabilitation evaluation system--short form (CARES-SF). A cancer specific rehabilitation and quality of life instrument. Cancer. 68(6):1406–1413CrossRefGoogle Scholar
  73. 73.
    Ferrans CE, Powers MJ (1985) Quality of life index: development and psychometric properties. ANS Adv Nurs Sci 8(1):15–24CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Occupational TherapyColorado State UniversityFort CollinsUSA
  2. 2.ReVital Cancer RehabilitationMechanicsburgUSA
  3. 3.Department of Health and Exercise ScienceColorado State UniversityFort CollinsUSA
  4. 4.Colorado School of Public HealthAuroraUSA

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