In a milestone decision for oncology and sports medicine, exercise is set to transition from an optional recommendation to a mandatory component of accredited cancer care across the United States.
On September 26, 2026, the American College of Surgeons Commission on Cancer (CoC) officially approved Standard 4.9: Exercise Oncology Services. Scheduled to take effect on January 1, 2028, the standard will apply to nearly 1,400 CoC-accredited hospitals and health systems, which collectively treat approximately 70% of all cancer patients in the U.S.
Bridging Research and Clinical Practice
An extensive body of clinical research demonstrates that structured exercise during and after cancer treatment effectively helps patients manage treatment-related side effects, restore physical strength, improve functional stamina, and potentially lower the risk of cancer recurrence. Despite these proven benefits, patient access to exercise counseling has historically been fragmented and largely dependent on individual clinician awareness or geographic location.
Standard 4.9 directly addresses this gap by integrating systematic physical activity evaluation into standard clinical workflows.
“This is a landmark step toward making exercise assessment and referral a routine part of high-quality cancer care,” said Kathryn Schmitz, PhD, MPH, FACSM, Past President of the American College of Sports Medicine (ACSM). “This achievement reflects the efforts of many dedicated individuals over the past year. This is Exercise Is Medicine® at work.”
Core Implementation Requirements
Under Standard 4.9, accredited cancer programs will be required to assess every patient’s physical activity status and specific exercise needs during their first course of treatment. Based on standardized assessment tools, clinicians will triaging and refer patients to appropriate care pathways:
Oncology Rehabilitation Services: Specialized care for patients with significant functional impairments or complex clinical needs.
Targeted Exercise Oncology Programs: Structured, clinical- or hospital-based fitness programs tailored for oncology populations.
Community-Based Exercise Programs: Safe, accessible fitness initiatives designed for lower-risk patients or long-term survivors.
To maintain accreditation, cancer centers must establish formal, written protocols outlining their exercise screening and referral mechanisms. Facilities will leverage the Moving Through Cancer directory—a national registry established under ACSM’s Exercise is Medicine initiative—to connect patients with verified local and regional resources.
Legislative & Policy Timeline
The approval process followed a structured multi-phase review over a ten-month period:
December 2025: Dr. Schmitz, acting as the ACSM representative to the CoC Accreditation Committee, drafted and submitted the initial proposal.
Early 2026: A dedicated working group co-chaired by Dr. Schmitz was established to refine the operational and clinical details of the standard.
Summer 2026: The proposal underwent a public comment phase to incorporate feedback from clinical stakeholders and healthcare providers nationwide.
September 26, 2026: Standard 4.9 received final, joint approval from both the CoC Accreditation Committee and Executive Committee.
Industry Impact and Clinical Outlook
For Patients: Standardized screening ensures equitable access to exercise interventions regardless of location or primary care provider.
For Health Systems: Hospitals must build structured multidisciplinary workflows, establishing clear referral loops between oncologists, physical therapists, and clinical exercise specialists.
For Workforce and Fitness Professionals: The mandate is expected to generate significant demand for specialized healthcare professionals, including ACSM-ACS Certified Cancer Exercise Specialists, Clinical Exercise Physiologists, and credentialed community fitness instructors.
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