Purpose The GET FIT trial tested fall prevention exercise approaches in older (50-75 years) post-chemotherapy, postmenopausal cancer survivors. We describe recruitment, retention, and adherence patterns from GET FIT to inform future trials. Methods Participants were recruited through multiple strategies (e.g., cancer and research registries, clinician referral, outreach, electronic health record (EHR) screening) and were randomized to one of three supervised, facility-based, group exercise programs for six months. We compared effectiveness of accrual across recruitment strategies, examined characteristics of women who completed the interventions to those who withdrew, and women with good (≥ 50%) versus poor (<
50%) adherence to training. Results Of 1490 interested women, 442 women were eligible, randomized, and received the assigned intervention (30% accrual rate). Accrual was similar across recruitment strategies, except for EHR screening which yielded no accruals. Retention over 12 months was 87% with most dropouts occurring within the first month. There were no differences in baseline characteristics between women who did or did not drop out. Poor adherers (n = 60) had higher baseline BMI, comorbidities, pain, disability and lower physical functioning (p <
0.05) compared to more adherent women (n = 377). Conclusions A variety of recruitment strategies appear to be effective for enrolling older, postmenopausal cancer survivors into a facility-based exercise trial, except for directly approaching women identified through the EHR. Women with poorer health were at risk for study drop-out and poor adherence to exercise. Implications for Cancer Survivors: Women with poorer initial health may need additional retention strategies to help them stick with supervised, facility-based, group exercise.