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

Abstract PurposeIndividualized triage to exercise and rehabilitation is recommended to optimize health, functioning and well-being 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 defining characteristics of exercise/rehabilitation services and patient characteristics associated with safety and efficacy of each service. We developed a visual model to conceptualize need for high/low specialized care, then organized patient characteristics into a risk-stratified framework. We conducted an iterative review process with a multidisciplinary expert panel until consensus was reached for the preliminary algorithm. ResultsWe describe eight defining 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-stratified 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.