Cancer

Cancer rehabilitation does not treat cancer. Chemotherapy, radiotherapy, surgery and immunotherapy belong to your oncology team, and nothing in this programme replaces, delays or interferes with them.

What it treats is what the disease and the treatment leave behind: exhaustion that sleep does not fix, muscle lost during months of treatment, reduced fitness, numb or painful hands and feet after chemotherapy, restricted shoulder movement after breast surgery, swelling, and the loss of confidence that comes with all of it.

These are often dismissed as the price of survival. Most of them are treatable, and several respond better to exercise than to anything else available.

For a long time people in cancer treatment were told to rest and conserve energy. That advice has been reversed by a substantial body of evidence, and the reversal has not reached every clinic or every patient.

International consensus guidance now holds that exercise improves physical fitness, physical function, quality of life and cancer-related fatigue, and that the general population activity targets are appropriate for most cancer survivors — around 150 minutes of aerobic activity a week, resistance training on two or more days, and daily stretching, adapted for treatment side effects 1.

Rest has its place during the worst days of a chemotherapy cycle. As a general instruction across months of treatment, it produces deconditioning that is then mistaken for the cancer.

Cancer-related fatigue is not ordinary tiredness. It is disproportionate to effort, not relieved by sleep, and it is the symptom patients most often rate as the one that ruined their quality of life — frequently more than pain or nausea.

It is also the symptom where exercise has the strongest evidence of any intervention, including medication. This is counter-intuitive to nearly every patient who arrives, because the instinct when exhausted is to rest, and resting makes it worse.

The programme therefore starts lower than patients expect and progresses more steadily than they want. Getting this wrong in either direction — too gentle, or too aggressive on a bad week — is the most common failure in cancer rehabilitation.

Some chemotherapy agents damage peripheral nerves, leaving numbness, tingling, burning or clumsiness in the hands and feet. It affects balance, walking and fine tasks like buttons and keys, and it is frequently under-treated because it is regarded as permanent.

It often improves slowly over months, and balance training, strengthening and task practice improve function even where the sensation itself does not fully return. Falls risk rises when the feet cannot feel the floor, so balance work is part of the programme rather than an optional extra.

Many patients with bone metastases are told to avoid activity entirely. Expert consensus does not support that: the standard exercise recommendations continue to apply, with greater emphasis on postural alignment, controlled movement and correct technique, and with the programme adapted to the location and behaviour of the lesions.

What changes is how, not whether. Loading is chosen carefully, high-impact and heavy axial loading are avoided where the lesion makes that unwise, and safe movement patterns for daily activities — how to get out of bed, how to lift, how to turn — are taught to everyone.

This requires the imaging and the oncology team's input before the programme starts, which is why we ask for both.

Shoulder movement, chest wall tightness, cording and scar restriction are common after breast surgery and radiotherapy, and they respond well to targeted therapy. Left alone, restricted shoulder movement becomes a long-term problem in its own right.

Where lymphoedema is present or the arm is at risk, it is managed through the lymphoedema programme, which is a separate and more specialised pathway.

Sessions are monitored for joint pain, unusual fatigue, dizziness, palpitations, muscle pain or weakness, breathlessness and any incontinence with movement. Exercise tolerance is reassessed continually rather than fixed at the start — because it genuinely changes week to week during treatment.

Blood counts matter: sessions are adapted around low haemoglobin, low platelets and neutropenia rather than pushed through them. We ask for recent results and we ask again during the block.

Three to six weeks, two to four hours a day — shorter than the neurological programmes because fatigue governs the schedule. Prescribed aerobic and resistance training, balance work where neuropathy is present, shoulder and scar work after surgery, aquatic sessions, breathing work, and dietitian assessment where weight or muscle loss is a concern.

The programme is coordinated with your oncology treatment schedule rather than around ours, and the discharge document goes back to your oncology team.