Background <p>Physical activity (PA) plays an important role in physical health and well-being for cancer survivors. However, cancer survivors demonstrate low adherence to cancer PA guidelines. Research is needed to understand how to optimize delivery of cancer PA programs to enhance participation and adherence. In this study, we conducted an instrumental qualitative case study of a clinical cancer exercise recovery program (CERP) demonstrating high adherence (over 90% session completion), with the goal of understanding implementation strategies that patients link to higher program adherence.</p> Methods <p>Semi-structured interviews were conducted with 18 CERP patients (<i>n</i> = 18; <i>n</i> = 13 women) with diverse cancer diagnoses and treatments. To gain further insight into program delivery components discussed by patients, we conducted further interviews with CERP program trainers (<i>n</i> = 2). Data were analyzed using thematic analysis.</p> Results <p>Two overarching themes were identified representative of delivery strategies that can optimize program participation and adherence: (1) creation of the gym culture; and (2) addressing the burden of cancer and cancer barriers through program and gym logistics.</p> Conclusions <p>Findings highlight the need to consider tailoring of PA program delivery for cancer survivors at all levels from program environment, administration, and logistics through to personnel training and PA protocols. Implementation of the identified delivery strategies may support health care providers and exercise professionals in the development of cancer PA programming that promotes quality participation experiences and high program adherence, allowing cancer survivors to experience the benefits of PA post-treatment.</p>