March 14, 2026 · Andrew Wilson · 2 min read
Movement Is Medicine — and It's Being Prescribed Too Little
Fewer than one in five cancer patients hears the word "exercise" from their oncologist. That has to change — and it can.
The gap between evidence and practice
Over 2,800 randomized controlled trials 1 have established what happens when cancer patients move: fatigue drops by up to 50%, 6 muscle mass is preserved, 7 depression lifts, 9 and in several major cancers, recurrence and mortality decline. 11
And yet — only 15% of cancer patients receive an exercise referral. 3
That statistic is not a function of disbelief. 90% of oncologists say they would refer patients if they had somewhere to refer them to. 3 It is a function of infrastructure: the referral pathway does not exist in most EHRs, the certified workforce does not exist in most cities, 12 and the billing pathway does not exist in most payer contracts. 20
What "medicine" actually means here
When ASCO says exercise is medicine, 5 that is not rhetoric. It is a claim that exercise, delivered under a protocol by a qualified professional, produces outcomes comparable to — and in the case of cancer-related fatigue, superior to — the best pharmaceuticals we have.
Let that sit for a moment. For the most common, most debilitating side effect of cancer treatment, the most effective intervention we have discovered is structured exercise. Not a drug. Not a device. Movement, delivered with intention. 6
What we learned from the Hillman pilot
The EXCEEDS model at Hillman Cancer Center — developed by Dr. Kathryn Schmitz and colleagues — achieved a 45% patient connection rate to exercise services using 3–5 minutes of staff time per patient. 19 That is not a small number. It is an order of magnitude larger than the national baseline.
What Hillman proved is that the referral problem is solvable with a specific, low-cost triage workflow embedded at the point of care. The technology exists. The evidence exists. What has been missing is a delivery organization that takes the workflow, the technology, and the workforce, and makes them available to every cancer center in the country.
That is the problem memios is built to solve.
What you can do today
If you are a patient: ask your oncologist for an exercise referral. If they do not have one, ask them to consult the ASCO guidelines. 5 Then reach out to a certified Cancer Exercise Specialist directly. You do not have to wait.
If you are a clinician: download the EXCEEDS triage protocol. 19 Identify one care pathway — breast, colorectal, or prostate — where exercise integration would be most impactful at your center. Pilot it for 90 days. Measure the referral rate, the engagement rate, and the documented outcomes.
If you are a professional: get certified. The demand is outpacing the supply in every major market. memios is placing Cancer Exercise Specialists into hospital roles in all 50 states.
We do not need more evidence. We need delivery.
References
- 1Campbell KL, Winters-Stone K, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51:2375–2390.2,800+ RCT figure cited within ASCO/ACSM guideline literature.
- 3Ligibel JA, Pierce LJ, Bender CM, et al. Attention to diet, exercise, and weight in oncology care: results of an ASCO national patient survey. Cancer. 2022;128:2817–2825.Source for 15% referral rate and 90% of oncologists needing more knowledge.
- 5Ligibel JA, Bohlke K, May AM, et al. Exercise, diet, and weight management during cancer treatment: ASCO guideline. J Clin Oncol. 2022;40:2491–2507.ASCO mandate that medical oncologists should refer all patients to exercise oncology programming.
- 6Campbell KL et al. (ACSM 2019) and supporting FACIT-Fatigue meta-analyses. Up to 50% reduction in cancer-related fatigue severity with structured exercise vs. control conditions. ACSM / FACIT-Fatigue meta-analyses Exercise outperforms all pharmaceutical interventions studied for cancer-related fatigue.
- 7Rock CL, Thomson CA, Sullivan KR, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin. 2022;72:230–262.Resistance training preserves lean body mass and prevents sarcopenia during treatment.
- 9Campbell KL et al. (ACSM 2019) and PHQ-9/GAD-7 outcomes in exercise oncology RCTs. Exercise reduces depression and anxiety scores with effectiveness comparable to pharmacological and psychotherapeutic interventions in cancer populations. Exercise oncology RCT meta-analyses Comparable effect sizes to medication and therapy.
- 11Rock CL et al. (ACS 2022). Post-diagnosis physical activity associated with reduced recurrence and mortality in breast, colorectal, and prostate cancer. CA Cancer J Clin. Breast cancer meta-analysis: 31% reduced cancer-specific mortality, 22% reduced recurrence, 45% reduced all-cause mortality.Meeting exercise guidelines in survivorship is associated with reduced recurrence and improved disease-free survival.
- 12Schmitz KH, Demanelis K, Crisafio ME, et al. Proximity to cancer rehabilitation and exercise oncology by geography, race, and socioeconomic status. Cancer. 2025;131:e35515.Geospatial analysis: 2,100+ programs mapped; 162 US cities of 50,000+ with no ORE program.
- 19Schmitz KH, Chongaway A, Saeed A, et al. An initiative to implement a triage and referral system to make exercise and rehabilitation referrals standard of care in oncology. Support Care Cancer. 2024;32:259.Hillman Cancer Center: 45% patient connection rate using EXCEEDS model; 3–5 minutes of staff time per patient.
- 20Kennedy MA, Potiaumpai M, Maitin-Shepard M, et al. Looking back: a review of policy implications for exercise oncology. J Natl Cancer Inst Monogr. 2023:140–148.Policy review: comparison with Diabetes Prevention Program, peripheral artery disease supervised exercise; payer coverage pathway analysis.