Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm

Abstract

Individualized triage to exercise and rehabilitation is recommended to optimize health, functioning and wellbeing across the cancer continuum. However, ability to identify and triage the right survivor to the right exercise or rehabilitation service at the right time is a barrier. We developed an evidence-based algorithm to identify survivors' need for pre-exercise medical clearance and support individualized triage to appropriate exercise/rehabilitation care. MethodsFrom literature review, we synthesized de ning characteristics of exercise/rehabilitation services and patient characteristics associated with safety and e cacy of each service. We developed a visual model to conceptualize need for high/low specialized care, then organized patient characteristics into a risk-strati ed framework. We conducted an iterative review process with a multidisciplinary expert panel until consensus was reached for the preliminary algorithm. ResultsWe describe eight de ning features of the four levels of exercise/rehabilitation and provide a conceptual model of need for high/low specialized care across the cancer continuum. The preliminary Exercise in Cancer Evaluation and Decision Support (EXCEEDS) Algorithm includes a risk-strati ed series of eleven dichotomous questions, organized in two sections and ten domains. ConclusionsThe EXCEEDS algorithm provides an evidence-based solution to facilitate integration of exercise into routine oncology care via a common language to describe exercise/rehabilitation services, a practical model to conceptualize an individual's need for specialized care, and step-by-step decision support guidance.

Multimodal Physical Exercise and Functional Rehabilitation Program in Oncological Patients with Cancer-Related Fatigue—A Randomized Clinical Trial

“…Furthermore, a direct relationship was established between this symptomatic improvement and an improvement in terms of dependency. An analysis of the existing literature shows that this correlates directly with studies by Campbell, Covington, and Sleight and his collaborators [ 16 , 41 , 42 ].…”

Multimodal physical exercise and functional rehabilitation program in oncological patients with cancer-related fatigue. A randomized clinical trial

“…Furthermore, a direct relationship has been established between this symptomatic improvement and an improvement in terms of dependency. Analyzing the existing literature, we can see how this correlates directly with studies by Campbell, Covington or Sleight and his collaborators [43][44][45].…”

A Qualitative Study of Patient and Healthcare Provider Perspectives on Building Multiphasic Exercise Prehabilitation into the Surgical Care Pathway for Head and Neck Cancer

“…Despite these limitations, the current qualitative findings, in conjunction with the quantitative findings [ 23 ] support the role of a multiphasic exercise prehabilitation program across HNC clinical care. To support implementation, screening, triage, and referral pathways across the HNC continuum may support earlier access to evidence-based exercise resources for patients, as well as support better adherence to exercise programming [ 19 , 42 , 43 , 44 ]. In addition, supporting exercise adherence needs to extend beyond the individual.…”