**1. Introduction**

The American Cancer Society recommends that exercise serve as an important part of an individual's cancer care plan, asserting that exercise will decrease feelings of fatigue both during and after treatment, and improve an individual's feeling of control and hope [5]. This is in light of more than two decades of research [6-9, 11, 19, 22], which support a link between a physically active lifestyle and positive physiological changes in cancer survivors. These include improvements in VO2max, blood volume, and gas exchange [13], improvements in muscular strength and endurance [14], fatigue reduction [15 – 19], and improvements in quality of life [19; 20; 23], anxiety [21, 22] depression [21; 24] body image [25], immune function [26], and emotional well-being [22].

According to ACSM (Schmitz et al., 2010), the general objectives for exercise training among cancer survivors are as follows:


**8.** To improve the physiologic and psychological ability to withstand any current or future cancer treatments.

With the right program, remaining physically active during and after cancer treatment will have a favorable effect on symptom management and quality of life. As such, we wish to present a step-by-step guide intended to assist an exercise trainer when working with a client who has been diagnosed with cancer. This guide will begin with pre-participation paperwork and will cover all pertinent information through exercise program development. Presented are guidelines for both facility-based settings and a home-based setting. These techniques have been employed by Maple Tree Cancer Alliance, a non-profit organization in southwest Ohio whose mission is to improve the physical and spiritual well-being of individuals battling cancer.

It is important to mention, however, that "cancer" is a broad term. No two cancer diagnoses are alike. Similarly, no two patients are alike. With so many different forms of cancer existing, each with its own treatment regimen, it is vital for the exercise trainer to remain in communi‐ cation with the patient's physician. Equally important, is the need to personalize each exercise program to the ever-changing needs of the patient. Therefore, the guidelines described in this book are just that – guidelines. Adjustments can and should be made accordingly, where appropriate.
