How we treat the effects of cancer and its treatment

Intensity and volume are set from assessment and written down, then adjusted against how you actually respond. "Try to stay active" is advice; a prescription is a dose, a frequency and a progression, and only the second one produces measurable change in fatigue.

Aerobic and resistance work are both included, because the evidence supports the combination rather than either alone.

Chemotherapy has good weeks and bad weeks and they are predictable. The schedule is built around your cycle so that harder work lands where you can do it and lighter work covers the rest.

Blood counts are checked and sessions are modified around anaemia, low platelets and neutropenia rather than pushed through them.

Every session is monitored for joint pain, disproportionate fatigue, dizziness, palpitations, breathlessness, new muscle weakness and incontinence with movement. Any of these changes the session rather than being noted afterwards.

Where bone metastases are present, technique, posture and load selection are the priority, and safe movement patterns for daily life are taught explicitly.

We ask for your oncology team's contact details and we write to them. Rehabilitation that runs in ignorance of the oncology plan is a risk rather than a service.

Where lymphoedema is involved, it moves to the lymphoedema programme, which has a different assessment and a different set of measurements.