Purpose: Exercise enhances outcomes of people across the cancer continuum; however, referrals to exercise specialists are infrequent. Referral frequency and appropriateness could be improved by assessment-based triage pathways. However, it is unclear what tools have been used for triage to exercise services in practice. We systematically explored exercise triage tools used following a cancer diagnosis, to understand tool landscape, and which tools lead to best implementation outcomes and adhere to best practice.
Procedures: Three electronic databases were searched; controlled, comparison, and cohort studies that embedded a tool to triage adults following a cancer diagnosis to exercise services were included. The frequency of tool use, as well as which tool characteristic and implementation outcomes (e.g., reach, time taken, referral rates, tool inclusions) were synthesised.
Results: Of 23,332 articles identified, 15 articles that included a tool to triage to exercise services were included. All articles used a different exercise triage tool (n=15). Tools mostly measured physical function, physical activity and exercise risk, and led to a dichotomous (yes/no) triage decision. Few tools included biopsychosocial and behaviour change considerations alongside physical needs. Overall, the tools ‘my wellness check’ and modified ‘EXCEEDS’ had the best outcomes for time commitment and reach, and referral rates, and individualisation/ biopsychosocial considerations, respectively.
Conclusions and clinical implications: Fifteen different exercise triage tools exist, delivered in a variety of contexts and to a variety of cancer streams, thus limiting their direct comparison. However, EXCEEDS and ‘My Wellness Check’ tools appear to be most suitable for exercise triage within available evidence, and have been validated for use in a broad oncology population. Ultimately, use of such tools enables better identification and targeting of people most likely to benefit from exercise referrals and interventions, to ensure all people receive an appropriate referral to exercise after a cancer diagnosis.