Integrating Exercise and Rehabilitation into Breast Cancer Care: A New Frontier

A groundbreaking randomized controlled trial has recently illuminated the promising potential of a pioneering program designed to systematically connect breast cancer patients with tailored exercise and rehabilitation services, beginning at the point of diagnosis and continuing throughout their cancer treatment journey. This innovative approach represents a significant advancement in holistic cancer care, integrating physical activity and therapeutic interventions as essential components of patient management. Published in the prestigious peer-reviewed journal CANCER, the study marks a vital step towards embedding exercise and rehabilitation into the standard oncology clinical workflow, responding to growing evidence that these services enhance treatment outcomes and patient quality of life.

Breast cancer patients commonly face a multitude of functional impairments and physical challenges throughout their treatment trajectory. Exercise services have been shown to counteract these challenges by improving patients’ physical fitness, muscle strength, and overall functional capacity. Concurrently, rehabilitation services address specific neurological and musculoskeletal deficits often resulting from both the malignancy and its treatment, such as reduced shoulder mobility and peripheral nerve damage. Depending on their individual condition, patients might require either or both interventions—exercise and rehabilitation—either sequentially or in parallel to optimize recovery and long-term function.

The focus of this clinical trial was the implementation of CORE (Comprehensive Oncology Rehabilitation and Exercise), a clinical workflow algorithm specifically engineered to triage and guide newly diagnosed breast cancer patients through appropriate exercise and rehabilitation pathways. The trial spanned 24 weeks and enrolled 72 U.S.-based patients harboring stage I to III breast cancer, all scheduled to undergo surgery as their initial treatment modality. Participants were randomized in a 2:1 ratio to either receive CORE-guided services or continue with the institutional standard of care, allowing investigators to rigorously assess the feasibility and efficacy of this structured clinical strategy.

At the core of the program was a patient-centric triaging process that utilized detailed questionnaire responses to evaluate self-reported exercise habits alongside functional status metrics. This comprehensive assessment enabled the precise classification of patients into one of three groups: those requiring guided exercise services, those necessitating rehabilitation interventions, and those capable of managing physical activity independently under a self-management protocol. Patients fulfilling physical activity guidelines without noted functional deterioration were directed towards the exercise self-management group, effectively reserving clinical services for those demonstrating measurable need. The exercise service component was embedded within a hospital-based oncology exercise program designed to provide supervised, individualized physical conditioning. Meanwhile, rehabilitation services catered to patients exhibiting complex deficits across neurological, musculoskeletal, or cardiopulmonary domains and involved thorough assessments to determine physical therapy requirements.

Results from the trial revealed an impressive 93% completion rate of the triaging process among participants allocated to the CORE program, underscoring the clinical feasibility and acceptability of the workflow algorithm in real-world oncology settings. Moreover, among the subgroup triaged to receive targeted services—whether exercise or rehabilitation—62% successfully completed the recommended programs. This high adherence rate signifies strong patient engagement and suggests substantial acceptability of these intervention pathways when integrated as part of routine care.

Qualitative data gathered from study participant focus groups shed further light on the efficacy of the CORE program, revealing overwhelmingly positive patient experiences. Many patients attested to the significant alleviation of post-treatment symptoms achieved through continued access to exercise and rehabilitation services. Importantly, patients reported that participation in these programs fostered greater ongoing engagement in physical activity, which they identified as instrumental in maintaining and improving their physical function throughout and beyond their cancer treatment course.

According to Dr. Adriana M. Coletta, the senior author and an investigator at the Huntsman Cancer Institute at the University of Utah, the CORE algorithm represents a replicable and scalable model for integrating exercise and rehabilitation services longitudinally from diagnosis onwards. Dr. Coletta highlights the alignment of the study findings with broader national initiatives led by the American College of Sports Medicine, which advocate for embedding exercise and rehabilitation frameworks decisively into standard oncologic care pathways. She further recommends that cancer centers lacking existing on-site services consider adopting the CORE workflow in collaboration with the American College of Medicine’s Moving Through Cancer Exercise Program Directory to bridge these treatment gaps.

From a physiological and mechanistic standpoint, exercise interventions stimulate multiple beneficial pathways in cancer patients, including enhancement of cardiovascular endurance, muscle hypertrophy, and neuromuscular coordination. These effects collectively mitigate the declines in physical function often precipitated by chemotherapy, radiation, and surgery. Rehabilitation services, meanwhile, deploy specialized therapeutic modalities to address nerve injuries, joint contractures, and cardiopulmonary impairments, leveraging interventions such as manual therapy, targeted exercises, and electrotherapy to restore optimal functionality. By synchronizing these approaches via the CORE triaging system, patients receive precisely calibrated care that adapts dynamically in response to symptomatology and disease progression.

Implementing an integrated clinical workflow that seamlessly directs breast cancer patients toward customized exercise and rehabilitation regimens may also yield broader systemic benefits. For oncology institutions, it holds the promise of improved patient satisfaction, reduction in treatment-related complications, and potentially enhanced survival outcomes due to greater physical resilience. Furthermore, embedding such services early in the cancer care continuum aligns with emerging survivorship paradigms, which emphasize functional optimization and quality of life as vital endpoints alongside traditional clinical measures of remission and recurrence.

The innovation established by the CORE model stands to challenge existing clinical norms by positioning exercise and rehabilitation not merely as adjunctive options, but as essential, standardized components of multidisciplinary cancer care. This paradigm shift underscores an evolving recognition within oncology that treating the disease extends beyond tumor eradication to encompass proactive management of treatment sequelae and maintenance of long-term patient well-being. As further trials validate and refine such workflow algorithms, oncology care protocols may increasingly incorporate similar patient-centric, service-integrated approaches.

Looking ahead, the scalability of the CORE algorithm across diverse healthcare settings remains a critical area for ongoing inquiry. Variations in institutional resources, patient demographics, and healthcare infrastructure must be considered when adapting this model. Additionally, future research will be needed to quantify long-term clinical outcomes, cost-effectiveness, and potential impacts on healthcare disparities. Nevertheless, the current trial sets a robust precedent, demonstrating that thoughtfully designed clinical workflows can effectively bridge gaps in cancer care and empower patients through enhanced physical rehabilitation and exercise interventions.

In summary, the CORE clinical workflow embodies a successful integration of exercise oncology and rehabilitation medicine into breast cancer care, delivering a structured, evidence-based approach that is both feasible and well-received by patients. As the oncology community increasingly embraces holistic treatment models, initiatives like CORE illuminate the path toward comprehensive, patient-centered care that supports physical restoration and quality of life from the moment of diagnosis onward.

Subject of Research: Feasibility and acceptability of a clinical workflow algorithm integrating exercise and rehabilitation for breast cancer patients

Article Title: Feasibility and Acceptability of the Comprehensive Oncology Rehabilitation and Exercise (CORE) Clinical Workflow Algorithm in Newly Diagnosed Stage I-III Breast Cancer Patients with Surgery as First-Line Treatment

News Publication Date: April 28, 2025

Web References:

https://acsjournals.onlinelibrary.wiley.com/journal/10970142
http://dx.doi.org/10.1002/cncr.35798

References:
Haverbeck Simon L., Saviers-Steiger C., Dunston E.R., et al. (2025). Feasibility and Acceptability of the Comprehensive Oncology Rehabilitation and Exercise (CORE) Clinical Workflow Algorithm in Newly Diagnosed Stage I-III Breast Cancer Patients with Surgery as First-Line Treatment. CANCER. https://doi.org/10.1002/cncr.35798

Keywords: Breast cancer, Physical exercise, Cancer patients, Cancer treatments, Controlled trials

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