Research has shown that exercise helps people living with and beyond cancer. Soon, exercise assessment and referral will be a routine part of accredited cancer care in the U.S.
On September 26, 2026, the American College of Surgeons Commission on Cancer (CoC) gave final approval to Standard 4.9: Exercise Oncology Services. The standard applies to the nearly 1,400 CoC-accredited hospitals and cancer centers, which treat about 70% of cancer patients in the U.S. It is currently set to take effect January 1, 2028.
“This is a landmark step toward making exercise assessment and referral a routine part of high-quality cancer care,” said ACSM Past President Kathryn Schmitz, PhD, MPH, FACSM.
What Standard 4.9 requires
During a patient’s first course of treatment, CoC-accredited cancer programs must assess the patient’s exercise needs and refer them. Depending on the assessment, a patient may be referred to:
- Oncology rehabilitation services
- Exercise oncology programs
- Community-based exercise programs
The assessment tools a program uses must help sort out which patients fit each type of service. Each program must also have a written protocol for exercise oncology assessment and referral, which will be reviewed during accreditation.
To find programs for their patients, hospitals will be able to reference the Moving Through Cancer directory. This national directory of exercise programs for people with cancer was built by the Moving Through Cancer program, which Dr. Schmitz founded within ACSM’s Exercise is Medicine initiative.
How it happened
- December 2025: Dr. Schmitz, serving as the ACSM representative on the CoC Accreditation Committee, drafted an exercise oncology standard and submitted it to the committee.
- The committee chair formed a working group, co-chaired by Dr. Schmitz, to review and refine the proposal.
- Summer 2026: The proposed standard underwent public comment and was further revised based on stakeholder feedback.
- September 26, 2026: The standard was approved by a vote of both the CoC’s Accreditation Committee and Executive Committee.
“This achievement reflects the efforts of many dedicated individuals over the past year,” noted Dr. Schmitz. “This is EIM at work.”
Why it matters
- For patients: Exercise assessment and referral will become a standard part of care at the cancer programs that treat most U.S. cancer patients. Today, whether a patient hears about exercise often depends on their doctor or where they live.
- For the evidence: Strong research evidence supports the benefits of routine exercise during and after cancer treatment, including ability to manage treatment side effects, recover strength and stamina, and reduce risk of cancer recurrence. Standard 4.9 moves that evidence into everyday practice.
- For cancer programs: Accredited programs will need written assessment protocols, clear referral pathways and qualified exercise professionals and programs to refer patients to.
- For ACSM members and certified professionals: Demand is likely to grow for professionals trained to work safely with people affected by cancer. This includes ACSM-ACS Cancer Exercise Specialists, clinical exercise physiologists and community fitness professionals.
What you can do now
- Get listed. If you or your facility offer exercise programs for people with cancer, register with the Moving Through Cancer directory.
- Get credentialed. Look into the ACSM-ACS Cancer Exercise Specialist credential and continuing education so you’re ready before 2028.
