| Sumario: | Simple Summary: Current guidelines support integrating exercise into cancer care; however, the cancer diagnosis and treatment-related symptoms can make engagement difficult. The Alberta Cancer Exercise (ACE) hybrid effectiveness-implementation study examined a 12-week cancer-specific, community-based exercise supervised program and implemented a four-step screening process: (1) pre-screen for high-risk cancers, (2) intake form and physical activity readiness questionnaire, (3) clinical exercise physiologist (CEP)-led interview, and (4) baseline fitness assessment. Of 2596 individuals registered, 2570 (86.6%) consented; 877 (34.1%) were medically referred and 1693 (65.9%) self-referred to ACE. Following full screening, 209 (8.1%) required further medical clearance, with most having high-risk or metastatic disease. Many participants in ACE had multiple health and symptom issues related and unrelated to cancer, with common ones occurring in many different combinations. Findings highlight the multifaceted complexity of screening and triage, and the role of the CEP in medical clearance for exercise. 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.
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