The Cancer Treatment No One Prescribed You
When you are diagnosed with cancer, you are handed a lot of information very quickly. Treatment protocols. Appointment schedules. Side effects to watch for. Who to call, and when.
One thing is almost never mentioned.
Nobody tells you to exercise.
If it comes up at all, it usually arrives as an afterthought. Something to think about later, once treatment is over and you are feeling more like yourself. Rest now. Move later.
The evidence does not support that order.
Most people are never told
This isn't anyone's fault. It's a gap between what the research shows and what has made its way into everyday practice.
Since 2018, the Clinical Oncology Society of Australia has held a formal position that exercise should be part of standard cancer care, not an optional extra, and that good care includes referring people to an exercise physiologist or physiotherapist experienced in cancer (1). The same statement points out that most people with cancer don't meet the exercise recommendations, even though they want to be active. They just need someone to show them how (1).
The most common reaction I see isn't doubt. It's frustration. People are upset, understandably, that nobody told them this was part of their treatment, and that something which could have helped them so much was never mentioned.
And when it is mentioned, the advice is usually wrong
On the occasions exercise does come up, it tends to arrive in one of two forms. Do a bit more walking. Or do some gentle exercise.
Both are well intentioned. Both are misleading.
Aerobic exercise genuinely matters, and some of the strongest evidence in this field comes from aerobic programs. But on its own it does very little for the two things cancer treatment strips fastest: muscle and bone. Bone responds to load. Muscle responds to resistance. Walking, however much of it you do, doesn't supply either signal in any meaningful amount.
"Gentle" is the bigger problem, because gentle isn't a dose. It's a word that sounds safe. The trials that produced the results further down this page worked because the exercise was demanding enough to count as a genuine training stimulus. Prescribed below that threshold, exercise isn't a careful version of treatment. It isn't treatment at all.
If that's where you are, the gap is in the system. It isn't something you missed.
We've been sold the wrong idea about exercise
For decades, exercise has been marketed as an appearance project. Weight. Tone. Getting your body back.
That framing is useless during cancer treatment. When your body has already changed in ways you didn't choose and can't control, an appearance goal isn't motivating. It's alienating.
So let's put it aside completely and ask a better question.
What is exercise actually doing inside your body?
What exercise is actually doing
Keeping your muscle
Cancer treatment strips muscle in several ways at once: you move less, the illness and treatment take a toll, and some hormone therapies directly reduce muscle mass (3).
Muscle isn't cosmetic. It's your reserve. It decides whether you can get out of a chair without pushing up on your arms, carry your own shopping, manage a flight of stairs, and handle the next round of treatment. Muscle lost during treatment doesn't just come back on its own afterwards, and the less you have to start with, the harder it is.
Loading your bones
Bone is living tissue. It responds to the physical forces you put through it, and nothing else sends that signal. Good nutrition and medication support your bones, but they don't load them.
This matters a lot in cancer care, because some treatments actively strip bone. Hormone therapy for prostate cancer (androgen deprivation therapy) causes loss of both bone density and muscle, which raises the risk of falls and fractures (4). Aromatase inhibitors, commonly used in breast cancer, raise similar concerns.
Here the research points to something quite specific rather than just "move more". For men on hormone therapy for prostate cancer, the most effective approach for bone density appears to be a combination of resistance training and impact loading, meaning exercise that puts controlled, weight-bearing force through the skeleton (5).
That difference matters. "Try to walk more" is advice. Resistance and impact loading, at the right dose for the right person, is treatment.
Helping you finish your treatment
Getting through your planned treatment on schedule matters, because the amount of chemotherapy you actually receive affects how well it works.
Oncologists track this as relative dose intensity: how much of the planned chemotherapy is actually delivered. When that figure drops below about 85%, usually because doses have been delayed or reduced, it's linked to poorer treatment results and poorer survival (6).
Exercise appears to help protect it. In one trial of women having chemotherapy for breast cancer, those doing resistance training received 90% of their planned treatment, compared with 84% in the group receiving usual care (7). A pooled analysis of two large trials also found that people who were fitter and stronger before chemotherapy started were more likely to complete it (8), which is a good argument for starting early where that's possible.
Not every trial has shown the same effect (9). But the direction is consistent, and the reason is simple. Exercise reduces the side effects that cause doses to be cut in the first place (6).
Changing the environment your treatment is working in
This is the most fascinating area in exercise oncology right now, and it comes with an important caveat.
Tumours build their own blood supply, and they do it badly. The vessels are leaky, chaotic and poorly organised, which limits how well oxygen and drugs actually reach the tumour.
In animal studies, exercise appears to change that. Increased blood flow puts physical pressure on the vessel walls, which prompts them to remodel into something more stable and better organised. The result is better blood flow into the tumour, better oxygen supply, and better delivery of chemotherapy to where it needs to go (10). Exercise also appears to influence the immune system in ways that support its response to cancer, and there's growing interest in whether it improves how well immunotherapy works (11).
The caveat is important. Almost all of this research has been done in animals. One review of exercise and blood flow to tumours found seventeen animal studies and just one in humans (12). We can't yet say it works the same way in people.
But it points at something worth knowing. Exercise may not just be helping you get through treatment. It may be changing the conditions your treatment is working in.
Your mental health
This one is well established rather than emerging, and it goes further than most people expect.
Start with fatigue, because it's the effect people most often describe as the hardest to live with, and the one where the usual advice is most misleading. The instinct is to rest. But cancer-related fatigue doesn't behave like ordinary tiredness, and rest doesn't fix it.
A large analysis compared the four most commonly recommended treatments for cancer-related fatigue: exercise, psychological therapy, the two combined, and medication. Exercise and psychological therapy both outperformed the available drug options. The researchers' conclusion was that clinicians should prescribe exercise and psychological support as first-line treatment for it (13).
That's worth pausing on. For one of the most common and most disabling effects of cancer treatment, exercise isn't a supplementary option. It's the front-line treatment, ahead of medication.
Beyond fatigue, the international guidelines set out specific exercise prescriptions for anxiety, low mood, quality of life and physical function (3). Some of the benefit is physiological. Some of it is simpler than that. Exercise gives you structure in a period when very little is structured, a reason to leave the house, and regular contact with someone who is paying close attention to how you're actually tracking.
One thing to be clear about: this sits alongside psychological care, not instead of it. If you are struggling, a psychologist is the right person to see, and your treating team can arrange that referral. Exercise is one part of a bigger picture. It's just the part that routinely gets left out.
Feeling like your own body again
Cancer treatment is mostly something that happens to you. The protocol is set. The schedule is set. The side effects turn up uninvited. Very little of it is chosen.
Exercise is one of the few parts you genuinely direct.
What clients tell me, more than anything else, is that they feel strong again. Sometimes stronger than they have ever felt. That isn't a consolation prize. In a period defined by losing control of your own body, having that body become measurably more capable matters in its own right.
Why cancer isn't like other chronic conditions
Most chronic conditions give you a fairly stable starting point. Type 2 diabetes, osteoarthritis and high blood pressure change slowly and fairly predictably, so exercise can be prescribed against that stability.
Cancer doesn't offer that.
The clearest example is nerve damage caused by chemotherapy, known as chemotherapy induced peripheral neuropathy (CIPN). It's a common side effect of several chemotherapy drugs, and it causes numbness, tingling, burning and pain in the hands and feet, along with weakness and poor balance. How severe it gets depends partly on the drug and the dose, but also on factors nobody fully understands yet (13,14).
In practice, that means there's no reliable way to predict who will get it, or how badly. Two people on exactly the same treatment can have completely different experiences.
Two other things are worth knowing about it.
First, the medication options are limited. The usual drugs for nerve pain have shown little or no benefit for this particular problem, with duloxetine the only one showing a clear effect (15).
Second, exercise is one of the most promising treatments available for it, and almost nobody is told this. A trial of 170 people found that balance and coordination training combined with resistance training during chemotherapy reduced nerve symptoms in the feet (13). A study in women treated for ovarian cancer found significantly better neuropathy scores in those who exercised (16). A review pooling fifteen trials concluded that exercise reduces numbness and pain, and improves balance and quality of life (15).
The detail I come back to most often is a qualification in that first trial. The benefit was there as long as the exercise was hard enough to be a genuine training stimulus (13).
Which is the whole argument for prescribing exercise rather than just recommending it.
The same unpredictability shows up elsewhere: effects on the heart from certain drugs, cancer in the bones changing what's safe to lift, infection risk when immunity is low, restrictions after surgery, and the particular fatigue that comes with radiation (3). A program written in week one can be wrong by week three.
This is why individualising matters, and isn't just a marketing word. A review of the research found that adjusting the program between sessions, based on how the person actually turns up that day, made a real difference to fatigue (17).
Prescribing exercise in cancer care is an ongoing process, not a document you hand over.
Why this belongs in your treatment plan, not after it
In 2025, a trial called CHALLENGE produced the strongest evidence yet that exercise affects cancer outcomes, not just how you feel.
It was a large, high-quality randomised trial in people with stage III or high-risk stage II bowel cancer. Half received a structured three-year exercise program starting soon after their chemotherapy finished. Five years on, 80.3% of that group were still free of cancer, compared with 73.9% of those who didn't receive the program. The results also pointed to improved overall survival (18,19).
The researchers' conclusion was blunt. Health systems should make structured exercise standard care for these patients (19).
That's one cancer type, in one situation. It isn't a claim about every cancer. But it's the first trial of its kind, and it moves exercise well beyond general wellbeing advice.
Exercise belongs in your treatment plan from diagnosis. Prescribed, not suggested.
What the guidelines do and don't say
The published guidelines recommend avoiding inactivity and working towards roughly 150 minutes of moderate aerobic exercise a week, plus two to three resistance sessions (1,3).
It's worth understanding what those numbers are. They're recommendations designed for a whole population, safe for a very wide range of people, often doing it without supervision. They have to be cautious, because they can't take any one person's situation into account.
They're a starting point, not a ceiling.
The same expert panels concluded that exercise is generally safe for people with cancer, with medical clearance only needed in specific situations (3,20). More recent recommendations for older adults with cancer went further, noting that asking for extra clearance beyond the standard guidelines can itself become a barrier for someone who is ready to start (21).
In practice, when someone is properly assessed, monitored and progressed by a practitioner who knows what to watch for, they can often work harder than they expected to, safely. In the CHALLENGE trial, muscle and joint problems occurred in 18.5% of the exercise group compared with 11.5% of the control group, and only around 10% of those in the exercise group were considered related to the exercise itself (19).
The risk nobody talks about isn't that people with cancer will do too much. It's that they'll do far too little, lose muscle and bone they didn't need to lose, and finish treatment in much worse shape than they had to.
Why it matters who prescribes it
The COSA position statement doesn't just recommend exercise. It specifies referral to an exercise physiologist or physiotherapist with experience in cancer care (1).
That last part is doing a lot of work.
Prescribing safely here means knowing which drug someone is on and what it does, where they are in their treatment cycle, what their blood results show, what their scans say about their bones, what their surgery restricts, and how today compares with last week. It also means keeping up with research that's moving quickly. Advice that was standard five years ago has since changed.
A general exercise professional isn't failing at anything. This just sits outside their scope, in the same way any complex medical situation calls for specific expertise.
I work in full communication with a client's whole medical team, including oncologists, surgeons, GPs, nurses and other allied health professionals, with complete transparency and regular updates. Exercise in cancer care should never happen in isolation from the rest of your treatment.
What it actually looks like
It starts with a proper assessment: your diagnosis, treatment and stage, medications, relevant blood results, what you can currently do, and what actually matters to you.
From there, the program is adjusted session to session based on how you turn up on the day.
On a hard day, whether that's heavy fatigue, nausea, or the days straight after an infusion, the session changes rather than disappears. Specifically, we dose down without losing the point of it. We usually keep the weight the same, because the weight is what drives the benefit, and we change the number of repetitions instead. The work still happens. It just looks different.
That's exactly what the neuropathy research pointed to. The benefit depends on the exercise being a real stimulus. Scaling everything back on a hard day is easy. Knowing what to protect and what to let go is the clinical skill.
The short version
Exercise during cancer treatment is one of the best-evidenced supportive treatments available. It protects muscle and bone, helps you complete your treatment, improves fatigue, nerve symptoms and mental health, and on current evidence may influence outcomes themselves.
It works best when it's prescribed properly: assessed, individualised, monitored and adjusted.
If you're in treatment, recently finished, or supporting someone who is, and nobody has talked to you about exercise, that conversation is worth having.
I welcome referrals from oncologists, oncology nurses, care coordinators, GPs and allied health colleagues, and I'm just as happy to hear directly from anyone who'd like to talk it through.
Meg Sharman is an Accredited Exercise Physiologist based in the Sutherland Shire, working with clients across the wider Sydney metro area through home visits, community sessions and telehealth. She has experience and expertise in oncology exercise and is currently completing a Masters in cancer research.
References
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