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Physical exercise training has been shown to be an effective component of comprehensive rehabilitation for some cancer patients and survivors. The purpose of this paper is to review the potential role of exercise training in the clinical setting and examine methods to deliver these services in the clinical setting. Noting the limited direct research on implementation of clinical exercise programs in the cancer setting, we review the literature and propose guidelines for: 1) goals of the prescribed physical activity or exercise program; 2) medical and pre-exercise evaluations; 3) recommendations for exercise programming; 4) safety considerations; 5) barriers to physical activity and exercise training in cancer patients; 6) self-directed and community based exercise programs; and 7) the role of medical and exercise professionals.