A commentary published this year in the Journal of Clinical Oncology opens with a line worth sitting with: “If exercise were a pill, we’d all prescribe it to patients with cancer. But it’s not.“
The authors, Kathryn Schmitz and Jennifer Ligibel, are two of the most influential researchers in exercise oncology. Schmitz also led the 2020 Moving Through Cancer initiative that set an agenda — with a target date of 2029 — to make exercise a standard part of cancer care. Their new commentary responds to the CHALLENGE trial, a randomized controlled study of 889 patients with stage II-III colon cancer that found a three-year supervised aerobic exercise program produced a 28% improvement in disease-free survival and a 37% improvement in overall survival compared to usual care, after patients had completed chemotherapy.
That’s not a modest finding. It’s one of the strongest pieces of evidence to date that structured movement, delivered consistently over time, can change cancer outcomes — not just quality of life during treatment, but survival itself.
Schmitz and Ligibel’s point is that evidence alone doesn’t get exercise to patients. A trial like CHALLENGE worked because it had infrastructure behind it: trained staff, a defined dose of activity, and a behavioral framework to keep participants engaged for three years. Most cancer centers don’t have that infrastructure. Their commentary lays out what needs to exist before exercise can move from “recommended” to “standard of care” — and it’s worth reading not just as researchers speaking to policymakers, but as a checklist we can hold up against what oncology yoga already does.
The Four Questions Schmitz and Ligibel Are Asking
The commentary organizes the problem into four pieces:
What counts as an evidence-based exercise program? They point to the 2018 ACSM Exercise and Cancer Roundtable, which established FITT prescriptions (frequency, intensity, time, type) for outcomes including fatigue, quality of life, anxiety, depression, physical function, breast cancer-related lymphedema, bone health, and sleep. For most of these, the benchmark is roughly 30 minutes of moderate-intensity aerobic activity three times a week, plus twice-weekly resistance work — and, critically, a program needs behavioral support built in, because control groups in trial after trial show that handing someone a brochure and telling them to exercise doesn’t work.
How do we connect the right patient to the right program? Not every survivor needs the same level of supervision. The authors describe the EXCEEDS triage tool, which sorts patients into oncology rehabilitation (physical therapy), supervised exercise with an oncology-trained professional, or community-based exercise with lighter supervision, based on a 19-question assessment of ability and symptoms.
How do we make this available regardless of income or insurance? They point to accreditation levers — like the 2024 National Accreditation Program for Breast Centers standard requiring documentation of exercise recommendations — and the much larger prize of a CMS-recognized billing code for exercise oncology services.
What’s the return on investment? They argue exercise oncology almost certainly costs a fraction of modern systemic therapy, but that case hasn’t been formally made yet, and needs to be.
Where Oncology Yoga Already Overlaps With This Agenda
Read closely, this commentary isn’t describing a future that oncology yoga has to catch up to. Several of its core principles are ones y4c has built its methodology around for years.
Credentialed, oncology-specific training. Schmitz and Ligibel are explicit that generalist fitness credentials aren’t sufficient — exercise professionals working with cancer patients need training that layers oncology, exercise science, and behavioral science together, and they cite the American College of Sports Medicine/American Cancer Society Cancer Exercise Specialist program as the model for this outside of licensed clinical roles. That’s the same underlying logic behind requiring oncology-specific certification for yoga teachers rather than relying on a standard 200-hour training: understanding treatment side effects, safe sequencing, and the physiological realities of active treatment isn’t optional context, it’s the difference between a class that helps and one that harms.
Dose recommendations that track closely with the research. The FITT prescriptions Schmitz and Ligibel cite — 30 minutes of moderate-intensity activity, several times weekly — line up with the guidance in y4c’s own research summary: at least two 60-75 minute active yoga classes per week, on an ongoing basis, not a six-to-eight week program that ends before treatment side effects do. Gentle or restorative-only practice has a place, but it isn’t sufficient on its own to meet the activity thresholds the evidence supports.
Adaptation as safety infrastructure, not an afterthought. The EXCEEDS tool exists because Schmitz and colleagues recognize that a cancer diagnosis changes what a body can safely do, sometimes week to week. That’s the entire premise behind teaching students to modify pose by pose based on where they are that day — energy, range of motion, neuropathy, surgical history, treatment stage. It’s a different tool solving a related problem: matching intervention intensity to a person’s current capacity.
Behavioral support as the thing that actually produces adherence. The CHALLENGE trial built in coaching grounded in the Theory of Planned Behavior because supervised sessions alone weren’t enough to sustain a three-year commitment. Community, accountability, and a sense of agency over one’s own recovery are exactly what keep survivors coming back to a weekly class rather than a program they try once and abandon — which is the reason ongoing, relationship-based teaching (not one-off workshops) has always been core to how y4c trains its teachers to build classes.
Where the Overlap Ends — and Why That Distinction Matters
It’s worth being precise about this, because overstating it doesn’t serve anyone. Schmitz and Ligibel’s triage framework places “supervised exercise with an oncology-trained professional” and “medicalized exercise under a physical therapist” as distinct tiers above community-based programming, reserved for patients with more significant impairment. Oncology yoga teachers are not exercise physiologists, physical therapists, or clinical triage providers, and no class, however well-adapted, replaces that level of care for a patient who needs it. Where y4c-trained teachers fit is the community-based tier the commentary describes as necessary but currently under-resourced — accessible, ongoing, oncology-literate movement that keeps survivors active between (or instead of) more intensive clinical interventions, and that knows when to refer someone up the chain rather than push through a limitation.
Why This Is Worth Paying Attention To Right Now
The reason this commentary matters beyond its content is timing. Schmitz and Ligibel are describing a field in the middle of building the accreditation and payment infrastructure that’s been missing for decades — citing the precedent of nutrition counseling becoming a required (if not separately billable) service at accredited cancer centers, and pointing toward a CMS billing code as the next real lever. That’s the direction the entire exercise oncology field, including movement-based modalities like yoga, needs the evidence base and workforce credibility to be ready for. Every time oncology yoga’s outcomes are documented, and every teacher who completes oncology-specific training rather than assuming general certification is enough, is part of what makes that case.
The CHALLENGE trial gave the field a number — a 37% improvement in overall survival — that’s hard to argue with. The work now is building the infrastructure to get there. That’s not a new mandate for oncology yoga teachers. It’s a description of work already underway.
FAQ
Does yoga count as “exercise” in the exercise oncology research? Active styles of yoga, such as vinyasa, can contribute toward the moderate-intensity activity thresholds cited in cancer exercise guidelines. Gentle or restorative-only practice offers real therapeutic value but isn’t, on its own, equivalent to the aerobic dose most guidelines are built around.
What did the CHALLENGE trial actually find? In a randomized trial of 889 patients with stage II-III colon cancer who had completed chemotherapy, a three-year supervised exercise program was associated with a 28% improvement in disease-free survival and a 37% improvement in overall survival compared to usual care (Courneya et al., N Engl J Med, 2025).
Are oncology yoga teachers part of a patient’s cancer care team? Oncology-trained yoga teachers provide community-based, adapted movement instruction. They are not a substitute for physical therapy, exercise physiology, or medical care, and appropriately trained teachers know to refer students to those providers when a need falls outside the scope of a yoga class.
Sources:
- Schmitz KH, Ligibel JA. “If exercise were a pill, we’d all prescribe it to patients with cancer. But it’s not.” J Clin Oncol. 2026;44(1):5-8.
- Schmitz KH, Stout NL, Maitin-Shepard M, et al. “Moving Through Cancer: Setting the Agenda to Make Exercise Standard in Oncology Practice.” Cancer. 2021;127(3):476-484.
- Courneya KS, Vardy JL, O’Callaghan CJ, et al. “Structured Exercise after Adjuvant Chemotherapy for Colon Cancer.” N Engl J Med. 2025.
- yoga4cancer. “Yoga Interventions for Cancer Patients and Survivors.” White paper, 2018.
