Operationalizing yoga as a quantifiable component of guideline-aligned multimodal exercise oncology care using RE-AIM.

Abstract

e13589 Background: Exercise oncology guidelines (ACSM/ACS) recommend ≥150 minutes/week of moderate-intensity aerobic activity plus resistance training; however, yoga remains inconsistently integrated into formal exercise prescriptions due to challenges defining frequency, intensity, time, and type (FITT), quantifying delivered dose, and standardizing safety and documentation. This gap limits inclusion of yoga within scalable, guideline-aligned multimodal exercise care, particularly for patients deconditioned during treatment. The CHALLENGE trial demonstrated survival benefits from structured exercise in colon cancer survivors, underscoring the importance of accurate exercise dose attribution. Methods: Guided by the RE-AIM framework, we developed an implementation-ready approach to operationalize yoga as a quantifiable, safe component of guideline-aligned multimodal exercise oncology care. To support Reach, relative intensity measures (rating of perceived exertion [RPE] and talk test) were used to accommodate treatment-related variability. To support Implementation, yoga sessions were decomposed using a predefined movement taxonomy (restorative/breathing, mobility, standing balance/strength, dynamic standing flow) to enable consistent dose attribution across instructors and sites, informed by the Compendium of Physical Activities metabolic equivalent of task (MET) values. Dose was operationalized through standardized estimated metrics, including moderate-intensity minutes, MET-minutes, and muscle-strengthening exposure defined by time-under-tension during loaded postures performed at ≥moderate relative effort. Safety was operationalized through standardized pre-exercise screening, symptom-guided modification, and explicit escalation pathways. Results: Dose Prescription (FITT): Frequency targeted 3–5 sessions/week. Intensity targeted moderate effort during flow-based segments (approximately 3–5 METs; RPE 3–4/10). Time was prescribed as 45–60 minutes/session, with ≥20–30 minutes of continuous standing flow. Type included standing flow for aerobic exposure, effort-qualified standing postures ≥2 days/week, and restorative components to support symptom management and exercise initiation. This structure was designed to yield approximately 60–150 minutes/week of moderate-intensity activity (180–600 MET-minutes) and was integrated with additional aerobic modalities as needed to meet guideline-based targets. Conclusions: This RE-AIM–aligned methods framework provides an implementation-ready care-delivery approach to standardize the integration, documentation, and safety of yoga within guideline-aligned multimodal exercise oncology care, enabling yoga to function as an entry point and complementary modality alongside traditional aerobic and resistance exercise.