{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:13:37Z","timestamp":1787062417845,"version":"build-2736575974"},"reference-count":62,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Alberta Innovates Cancer Prevention Research Opportunity (CPRO)"},{"name":"Alberta Cancer Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Current guidelines endorse the integration of exercise into cancer care. The diagnosis of cancer and its treatment, however, may introduce factors that make exercise engagement difficult, especially for individuals with advanced stages of disease. In this paper, we describe the baseline screening and triage process implemented for the Alberta Cancer Exercise (ACE) hybrid effectiveness-implementation study and share findings that highlight the multifaceted complexity of the process and the direct role of the clinical exercise physiologist (CEP). Methods: ACE was a hybrid effectiveness-implementation study examining the benefit of 12-week cancer-specific community-based exercise program. The ACE screening process was developed by integrating evidence-based guidelines with oncology rehabilitation expertise to ensure safe and standardized participation across cancer populations. The screening process involved four steps: (1) a pre-screen for high-risk cancers, (2) completion of a cancer-specific intake form and the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), (3) a CEP-led interview to further evaluate cancer status, cancer-related symptoms and other health issues (performed in-person or by phone), and (4) a baseline fitness assessment that included measurement of vital signs. Results: A total of 2596 individuals registered and underwent prescreening for ACE with 2570 (86.6%) consenting to participate. After full screening including the baseline fitness testing, 209 participants (8.1%) were identified as requiring further medical clearance. Of these, 191 (91.4%) had either a high-risk cancer, metastatic disease or were in the palliative end-stage of cancer, and 161 (84.3%) reported cancer-related symptoms potentially affecting their ability to exercise. In total, 806 (31.4%) participants were triaged to CEP-supervised in-person programming, 1754 (68.2%) participants to ACE community programming, and 8 (0.3%) specifically to virtual programming (post-COVID-19 option). Conclusions: The findings highlight the complexity and challenges of the screening and triage process, and the value of a highly trained CEP-led iterative approach that included the application of clinical reasoning.<\/jats:p>","DOI":"10.3390\/cancers17172873","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T14:02:46Z","timestamp":1756735366000},"page":"2873","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Role of Qualified Exercise Professionals in Medical Clearance for Exercise: Alberta Cancer Exercise Hybrid Effectiveness-Implementation Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4376-4847","authenticated-orcid":false,"given":"Margaret L.","family":"McNeely","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada"},{"name":"Department of Oncology, University of Alberta, 11560 University Avenue NW, Edmonton, AB T6G 1Z2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Williamson","sequence":"additional","affiliation":[{"name":"Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirin M.","family":"Shallwani","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Ternes","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Sellar","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil Abraham","family":"Joy","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Alberta, 11560 University Avenue NW, Edmonton, AB T6G 1Z2, Canada"},{"name":"Medical Oncology, Cross Cancer Institute, 11560 University Ave, Edmonton, AB T6G IZ2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0947-933X","authenticated-orcid":false,"given":"Harold","family":"Lau","sequence":"additional","affiliation":[{"name":"Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada"},{"name":"Arthur J. E. Child Comprehensive Cancer Centre, 3395 Hospital Drive NW, Calgary, AB T2N 5G2, Canada"},{"name":"Department of Oncology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5270-1050","authenticated-orcid":false,"given":"Jacob","family":"Easaw","sequence":"additional","affiliation":[{"name":"Medical Oncology, Cross Cancer Institute, 11560 University Ave, Edmonton, AB T6G IZ2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9677-3918","authenticated-orcid":false,"given":"Kerry S.","family":"Courneya","sequence":"additional","affiliation":[{"name":"Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB T6G 2H9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Nicole","family":"Culos-Reed","sequence":"additional","affiliation":[{"name":"Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Oncology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"ref_1","first-page":"223","article-title":"Nowcasting and forecasting global aging and cancer burden: Analysis of data from the GLOBOCAN and Global Burden of Disease Study","volume":"4","author":"Li","year":"2024","journal-title":"J. Natl. 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