Movement During Cancer Care: How Physical Therapy Can Help Patients Preserve Strength, Function, and Connection
A cancer diagnosis can change the way a person experiences their body.
Walking to the mailbox may suddenly feel like a workout. A previously simple flight of stairs may require planning. Fatigue may not improve after a full night of sleep. Surgery, chemotherapy, radiation therapy, immunotherapy, hormone therapy, and the cancer itself can affect strength, endurance, balance, mobility, sensation, breathing, continence, and confidence.
In these moments, movement should not become another demand placed on the patient.
It should become a conversation.
Physical therapy can help patients understand what their bodies are experiencing, identify meaningful functional goals, and develop a movement plan that is safe, adaptable, and connected to the rest of their cancer care.
The goal is not to tell every patient to “exercise more.”
The goal is to listen carefully and ask:
What does this person need movement to help them do today?
✨ Too Long Didn’t Read (TL;DR) / Summary
Physical therapy, movement, and appropriately prescribed exercise may help people diagnosed with cancer:
Preserve or improve strength and cardiorespiratory fitness.
Reduce deconditioning and support mobility.
Manage cancer-related fatigue.
Improve balance, confidence, and participation in daily activities.
Address treatment-related limitations such as restricted range of motion, soft-tissue changes, weakness, incontinence, and selected lymphedema-related concerns.
Prepare for surgery through prehabilitation.
Recover function following surgery or other cancer treatments.
Develop sustainable movement strategies during survivorship.
Exercise is not one-size-fits-all. A patient’s program should reflect the cancer diagnosis, treatment phase, current symptoms, medical history, laboratory findings when relevant, medications, patient preferences, functional goals, and risk factors.
For physical therapists, the work extends beyond sets and repetitions. It includes creating a relationship in which the patient feels safe reporting fatigue, pain, fear, nausea, dizziness, neuropathy, changes in function, or uncertainty.
Sometimes the most clinically appropriate intervention is exercise. Sometimes it is a lower dose of exercise. Sometimes it is education, pacing, positioning, breathing, mobility practice, or adaptive equipment. And sometimes it is pausing treatment and contacting the oncology team.
🧾 General Information
Cancer rehabilitation is not limited to survivorship
Rehabilitation may be useful throughout the cancer-care continuum, including:
Prehabilitation: preparing the patient physically and functionally before surgery or another treatment.
Active treatment: helping the patient maintain mobility, strength, endurance, and participation during chemotherapy, radiation therapy, or other interventions.
Immediate recovery: addressing postoperative mobility, breathing, pain-related movement limitations, weakness, and return to daily activity.
Long-term survivorship: managing persistent or late effects of cancer and its treatment.
Advanced or metastatic disease: supporting safety, comfort, independence, energy conservation, caregiver needs, and personally meaningful participation when medically appropriate.
Cancer rehabilitation is active and collaborative. It may restore function, prevent decline, teach compensatory strategies, or adapt the environment when full restoration is not possible.
What success looks like will vary.
For one patient, success may mean returning to work.
For another, it may mean independently getting out of bed.
For someone else, it may mean having enough energy to attend a family dinner.
These are all meaningful rehabilitation goals.
How cancer and its treatment may affect movement
People diagnosed with cancer may experience impairments related to the disease, its location, the selected treatment, preexisting conditions, or a combination of factors.
Common concerns encountered in rehabilitation may include:
Reduced strength.
Deconditioning.
Cancer-related fatigue.
Pain.
Restricted range of motion.
Soft-tissue restriction or fibrosis.
Balance impairment.
Gait changes.
Chemotherapy-induced peripheral neuropathy.
Lymphedema or risk of lymphedema.
Cardiopulmonary limitations.
Pelvic-floor dysfunction or urinary incontinence.
Changes in breathing mechanics.
Fear of movement or uncertainty about physical activity.
Difficulty returning to work, caregiving, recreation, or community roles.
In one study, involving outpatient oncology rehabilitation, strength and soft-tissue impairments were among the most common findings. The authors also emphasized diagnosis- and treatment-specific screening, including screening for lymphedema following breast cancer treatment, incontinence following genitourinary cancer treatment, and pain or fatigue following radiation therapy.
These findings should not be treated as universal prevalence estimates. They reinforce a broader clinical point:
The cancer history matters during every physical therapy examination.
A shoulder problem after breast cancer treatment may not be “just a shoulder problem.” Balance loss during chemotherapy may not be ordinary deconditioning. New back pain in a patient with a history of cancer requires thoughtful screening rather than an automatic musculoskeletal assumption.
1. Exercise may help preserve cardiorespiratory fitness
Chemotherapy and reduced activity can contribute to declining cardiorespiratory fitness. This can affect walking tolerance, stair negotiation, household activity, work, and basic daily function.
A 2024 systematic review and network meta-analysis found that moderate- to high-intensity aerobic exercise, with or without resistance training, produced short-term improvements in cardiorespiratory fitness among patients receiving chemotherapy.
This does not mean every patient receiving chemotherapy should immediately begin high-intensity exercise.
The review had important limitations. Much of the evidence involved women with breast cancer, intervention designs varied, and the overall evidence quality was low. Make sure that aerobic conditioning is appropriate for the patient in front of you - the findings should support clinical reasoning—not replace it.
The appropriate intensity for a specific patient may depend on:
Baseline fitness.
Cancer type and stage.
Treatment cycle and symptom pattern.
Cardiovascular history.
Pulmonary status.
Blood counts.
Bone health and metastatic involvement.
Neuropathy and fall risk.
Nutritional status.
Current fatigue.
Patient goals and preferences.
For one patient, moderate intensity may involve cycling for several minutes.
For another, it may involve repeated sit-to-stands with rest breaks.
Intensity must be individualized to the person in front of us.
2. Movement may help with cancer-related fatigue
Cancer-related fatigue is different from ordinary tiredness. It can involve physical, cognitive, and emotional exhaustion that is disproportionate to recent activity and may not resolve with rest.
This distinction is important because patients are sometimes given conflicting messages:
“Rest more.”
“Push through it.”
“Exercise will fix it.”
None of those statements captures the complexity of cancer-related fatigue.
Appropriately prescribed physical activity may help some patients feel better and improve energy during or after treatment. Guidance from the National Cancer Institute encourages patients to discuss an individualized activity plan with their health care team or physical therapist.
However, exercise should not be used to dismiss or explain away significant fatigue.
Fatigue can also be influenced by:
Anemia.
Infection.
Dehydration.
Malnutrition.
Sleep disturbance.
Pain.
Medication effects.
Endocrine dysfunction.
Depression or anxiety.
Cardiopulmonary complications.
Cancer progression.
A patient reporting a major or unexplained change in fatigue may need medical assessment before exercise is progressed.
The physical therapist’s role includes screening, measuring, observing trends, modifying activity, and communicating concerns—not independently diagnosing the medical cause of fatigue.
Screening and assessing fatigue
The American Physical Therapy Association (APTA) Oncology clinical practice guideline recommends regular screening for cancer-related fatigue and identifies several supported tools.
The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 received a grade A recommendation as a screening tool. Other Grade A assessment options included:
Piper Fatigue Scale–Revised.
Functional Assessment of Chronic Illness Therapy–Fatigue.
PROMIS Fatigue Short Forms.
A simple numeric fatigue question may be clinically useful, but a number alone is not the whole story.
Consider asking:
“What does fatigue stop you from doing?”
“Does rest improve it?”
“When is your energy usually best?”
“Has this changed since your last treatment?”
“Is the fatigue physical, mental, emotional, or a combination?”
“Are you becoming short of breath, dizzy, or unusually weak?”
“Are you able to eat and drink normally?”
“Does your oncology team know about this change?”
These questions turn screening into a conversation—and that conversation may reveal information a scale cannot.
3. Resistance exercise may support strength and function
Cancer and cancer treatment can contribute to reduced muscle strength through inactivity, systemic effects, treatment toxicity, pain, hospitalization, or nutritional changes.
Resistance exercise may help preserve or rebuild the capacity needed for:
Transfers.
Stair climbing.
Carrying groceries.
Returning to work.
Lifting a child.
Maintaining balance reactions.
Participating in household and community activities.
The program does not need to look like a traditional gym workout.
Resistance may come from:
Body weight.
Resistance bands.
Free weights.
Machines.
Functional lifting.
Sit-to-stand practice.
Step-ups.
Bed mobility.
Caregiver-assisted functional activity.
The starting point should be based on examination findings and patient tolerance—not on what the patient “should” be able to do.
Progression may involve increasing resistance, repetitions, sets, range of motion, movement complexity, or frequency. It may also involve using the same exercise with less assistance or fewer rest breaks.
During periods of increased symptoms, maintaining function may be a more appropriate goal than progressing load.
4. Mobility and prehabilitation may improve readiness for treatment
Prehabilitation begins before a planned cancer treatment and may include:
Aerobic exercise.
Strengthening.
Breathing exercises.
Mobility training.
Functional task practice.
Education.
Caregiver preparation.
Strategies to support nutrition or psychological readiness through appropriate referrals.
A 2025 clinical practice guideline for people with lung cancer recommends combined aerobic exercise with strengthening and/or breathing exercise to improve mobility during prehabilitation. It also supports combined exercise approaches during and immediately after treatment for selected functional outcomes.
The value of prehabilitation is not about proving that a patient is “fit enough” to deserve treatment.
It is about helping the patient enter treatment with as much reserve, confidence, and practical preparation as possible.
Even a brief prehabilitation period may provide time to teach:
Safe transfers.
Walking strategies.
Breathing and airway-clearance techniques when indicated.
Postoperative mobility expectations.
Use of assistive devices.
A realistic home movement plan.
Warning signs that require communication with the medical team.
5. Physical therapy may address cancer-specific functional concerns
Some impairments require additional training or specialty care.
Breast cancer
Potential rehabilitation concerns include:
Shoulder range-of-motion loss.
Upper-extremity weakness.
Scar or soft-tissue restrictions.
Postural changes.
Pain.
Lymphedema or lymphedema risk.
Reduced tolerance for reaching, lifting, or work tasks.
Patients with swelling, heaviness, tissue changes, or other possible lymphedema symptoms may benefit from evaluation by a clinician with appropriate lymphedema training.
Genitourinary cancers
Patients treated for prostate, bladder, or other pelvic cancers may experience:
Urinary leakage.
Urgency.
Pelvic pain.
Reduced pelvic-floor coordination.
Sexual health concerns.
Difficulty returning to exercise.
A pelvic health physical therapist may provide individualized pelvic-floor muscle training, behavioral education, movement retraining, and functional progression when appropriate.
Head and neck cancer
Potential needs may involve:
Neck and shoulder mobility.
Postural endurance.
Soft-tissue changes.
Balance.
General conditioning.
Swallowing, speech, or significant nutrition concerns require coordination with speech-language pathology, dietetics, and the medical team.
Lung cancer
Patients may experience:
Reduced walking capacity.
Dyspnea.
Deconditioning.
Postoperative pain.
Reduced thoracic mobility.
Fear of exertion.
Treatment may include individualized aerobic exercise, strengthening, breathing interventions, mobility training, pacing, and prehabilitation when appropriate.
Bone involvement or bone metastases
Exercise may still be possible, but loading must reflect lesion location, structural integrity, pain, fracture risk, neurologic findings, and medical recommendations.
Physical therapists should obtain sufficient medical information and coordinate with oncology, orthopedics, physiatry, or other appropriate specialists before prescribing loads that may stress an involved region.
New, progressive, severe, or unexplained bone pain in this population should not be written off as routine exercise soreness and requires follow-up when it occurs.
👩⚕️ For Providers 👨⚕️
Start with the person—not the protocol
Two patients with the same diagnosis may have completely different rehabilitation needs.
Before prescribing exercise, consider:
Where is the patient in the cancer-care continuum?
What treatments have they received?
What treatment are they receiving now?
When was the most recent treatment?
What symptoms change across the treatment cycle?
What medications are being taken?
Are recent laboratory values relevant to today’s intervention?
Is there known or suspected bone involvement?
Is there a central line, ostomy, drain, incision, or healing restriction?
Is neuropathy affecting balance or foot sensation?
What does the patient want to be able to do?
What type of movement does the patient enjoy—or strongly dislike?
What worries the patient about exercise?
Patient preference is not an optional extra. Enjoyment, confidence, access, culture, responsibilities, cost, transportation, and previous experiences all influence adherence.
The “best” exercise on paper is not effective if the patient cannot or will not continue it.
The relationship is part of the intervention
Cancer can create a loss of control. A rigid exercise prescription may unintentionally reinforce that experience.
Consider using collaborative language:
“What feels most important for us to work on today?”
“Would you like to try a shorter session and reassess?”
“How did your body respond after the last visit?”
“What does a good-energy day look like for you?”
“What signs tell you that you need to pause?”
“Would it help if we contacted your oncology team together?”
Notice nonverbal communication as well.
A patient may say, “I’m fine,” while moving more slowly, guarding an area, avoiding eye contact, or appearing unusually breathless. These observations are not proof of a medical complication, but they are reasons to ask another question.
Trust grows when the patient sees that reporting symptoms does not automatically mean losing all movement—and that the therapist will not push past something concerning.
Use a flexible exercise framework
A practical cancer-rehabilitation program may draw from several categories.
Aerobic activity
Examples include walking, cycling, stepping, dancing, aquatic activity (when medically appropriate), or other rhythmic movement.
Monitor:
Symptoms.
Rating of perceived exertion (RPE).
Heart rate and blood pressure before, during, and after exercise.
Oxygen saturation when indicated.
Recovery.
Gait quality.
Treatment-related changes.
Patient confidence.
Note: Heart rate alone may be misleading in patients taking medications that alter cardiovascular response or in those with autonomic, hematologic, or cardiac complications.
Resistance training
Use major functional movement patterns when appropriate and modify for:
Surgical precautions.
Bone health.
Pain.
Neuropathy.
Lymphedema risk or symptoms.
Healing tissues.
Lines or medical devices.
Balance.
Fatigue.
Gradual progression and symptom monitoring are more useful than blanket restrictions.
Balance and neuromotor training
This may be especially important for patients with:
Peripheral neuropathy.
Vestibular symptoms.
Lower-extremity weakness.
History of falls.
Cognitive changes.
Fear of falling.
Mobility and flexibility
Interventions may target postoperative restrictions, scar-related movement limitations, radiation-associated tissue changes, posture, joint mobility, and performance of functional tasks.
Recovery and pacing
Teach patients how to adjust activity without abandoning it.
Options may include:
Shorter sessions.
Distributed activity throughout the day.
Alternating harder and easier days.
Performing priority tasks during higher-energy periods.
Using seated exercise.
Reducing environmental demands.
Planning recovery after treatment days.
Using an assistive device to increase safe participation.
Pacing is not failure. It is dosage management.
Screen, measure, and reassess
An oncology rehabilitation examination may include:
Functional history and patient goals.
Vital signs.
Fatigue.
Pain.
Strength.
Range of motion.
Balance.
Gait.
Transfers.
Sensation.
Cardiopulmonary response.
Fall risk.
Soft-tissue mobility.
Edema or limb-volume concerns.
Pelvic health concerns when relevant.
Participation restrictions.
Psychosocial factors affecting movement.
Review of systems and medication history.
Outcome measures should be selected according to the patient’s condition, burden, goals, and ability to complete the test.
Do not let the measurement process exhaust the patient before treatment begins.
When to contact the physician, oncology team, or another medical provider
The appropriate response depends on severity, onset, medical history, and the patient’s established care plan. Urgent or emergency evaluation may be required for severe symptoms.
Pause or modify physical therapy and contact the appropriate medical provider when a patient demonstrates concerns such as:
New or rapidly worsening shortness of breath.
Chest pain, pressure, or unexplained cardiopulmonary symptoms.
Fainting, near-fainting, or new severe dizziness.
New confusion or significant change in mental status.
Fever, chills, or signs of systemic infection.
Uncontrolled bleeding or unusual bruising.
New calf swelling, warmth, pain, or symptoms concerning for thrombosis.
Sudden neurologic changes.
New bowel or bladder dysfunction with spinal or neurologic symptoms.
Severe, progressive, or unexplained bone pain.
Sudden inability to bear weight.
New marked weakness or rapid functional decline.
Persistent vomiting or inability to maintain hydration.
New or rapidly progressing swelling.
Wound changes, drainage, dehiscence, or signs of infection.
A major unexplained increase in fatigue.
Symptoms suggesting that the current exercise dose is no longer medically appropriate.
Call emergency services for symptoms suggesting a life-threatening event, including suspected pulmonary embolism, stroke, acute coronary syndrome, spinal cord compression, severe allergic reaction, or other medical emergency.
Physical therapists should follow facility procedures, the patient’s oncology plan, state law, and professional judgment.
When to involve a pharmacist
Pharmacists are valuable members of the cancer-care team.
Refer medication-specific questions to the prescribing clinician or pharmacist, particularly when the patient asks:
“Should I skip or change my dose?”
“Is this symptom caused by my medication?”
“Can I take this supplement?”
“Can I take an over-the-counter pain medication?”
“Could my medications be causing dizziness or balance problems?”
“When should I take my medication relative to exercise?”
“Could these drugs interact?”
“Is this medication affecting my heart rate, blood pressure, blood sugar, or bleeding risk?”
The physical therapist should document the medication history, screen for movement-related effects, and communicate observations.
The physical therapist should not independently prescribe, discontinue, or modify cancer medication.
When to refer to another rehabilitation or supportive-care professional
Consider referral or co-management with:
Occupational therapy: activities of daily living, upper-extremity function, cognition, energy conservation, work, and home modification.
Speech-language pathology: swallowing, communication, voice, or cognitive-communication concerns.
Registered dietitian nutritionist: weight loss, poor intake, malnutrition risk, nutrition during treatment, or complex dietary concerns.
Psychologist, counselor, or social worker: distress, anxiety, depression, adjustment, caregiver needs, financial concerns, or barriers to participation.
Physiatrist: complex rehabilitation needs, spasticity, pain, neurologic complications, or coordinated cancer rehabilitation.
Certified lymphedema therapist: suspected or established lymphedema requiring specialized evaluation and management.
Pelvic health physical therapist: continence, pelvic pain, sexual-function-related movement concerns, and pelvic-floor rehabilitation.
Palliative care: symptom management, quality of life, communication, and support at any stage of serious illness.
Orthopedics or orthopedic oncology: structural bone concerns, impending fracture risk, or significant musculoskeletal complications.
Cardiology or cardio-oncology: suspected treatment-related cardiovascular limitations or new concerning symptoms.
Pulmonology: complex respiratory impairment beyond the rehabilitation plan.
Referral is not a failure of your physical therapy practice.
It is evidence that the therapist sees the whole person.
Scope-of-practice reminder
Physical therapists examine movement and function, establish a physical therapy diagnosis, identify rehabilitation needs, prescribe and progress movement-based interventions, monitor response, educate patients, and coordinate care.
However, professional scope does not eliminate jurisdictional or personal limits.
APTA describes physical therapist scope as having three components:
Professional scope.
Jurisdictional scope.
Personal scope.
Physical therapists must comply with the applicable state practice act, facility policies, payer requirements, referral laws, and their own education and demonstrated competence.
Oncology specialization or certification may support advanced knowledge, but certification does not expand what state law permits.
When the patient’s needs exceed the therapist’s competence or legal scope, the therapist should refer, collaborate, or seek consultation.
A final clinical reflection
A movement plan can be evidence-based and still fail if the patient does not feel heard.
Before ending the visit, consider asking:
“What is one thing you want your oncology team to understand about how your body is functioning right now?”
The answer may reveal more than another repetition, test, or checklist.
Cancer rehabilitation works best when movement is connected to meaning—and when communication connects every member of the care team.
Key Clinical Reminders
Screen for cancer-related fatigue regularly and investigate meaningful changes.
Do not assume that all fatigue is explained by cancer.
Match exercise dosage to the patient’s treatment phase, symptoms, risks, goals, and preferences.
Screen for cancer- and treatment-specific impairments.
Ask about medications and treatment timing.
Consider bone health and metastatic involvement before loading.
Use symptoms and functional response—not diagnosis alone—to guide modification.
Communicate new or worsening concerns promptly.
Refer medication decisions to the prescriber or pharmacist.
Practice within professional, state, facility, and personal scope.
📂 Supplemental Information / Citations
Ness KK, Gilchrist L. Innovations in rehabilitation for people who have cancer or who have survived cancer. Phys Ther.2020;100(3):361-362. doi:10.1093/ptj/pzaa001
Alappattu MJ, Coronado RA, Lee D, Bour B, George SZ. Clinical characteristics of patients with cancer referred for outpatient physical therapy. Phys Ther. 2015;95(4):526-538. doi:10.2522/ptj.20140106
Herranz-Gómez A, Suso-Martí L, Varangot-Reille C, et al. The benefit of exercise in patients with cancer who are receiving chemotherapy: a systematic review and network meta-analysis. Phys Ther. 2024;104(2). doi:10.1093/ptj/pzad132
Fisher MI, Cohn JC, Harrington SE, Lee JQ, Malone D. Screening and assessment of cancer-related fatigue: a clinical practice guideline for health care providers. Phys Ther. 2022;102(9). doi:10.1093/ptj/pzac120
Vargo M, Gerber LH, Gilchrist LS, Fisher MI. Recommendations for interventions to improve function in patients with lung cancer: a clinical practice guideline. Cancer Med. 2025;14(13). doi:10.1002/cam4.70626
American Physical Therapy Association. Scope of practice. Accessed July 11, 2026. https://www.apta.org/your-practice/scope-of-practice
Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375-2390. doi:10.1249/MSS.0000000000002116
This content drafted, researched, edited, and generated by:
McKinley Pollock, PT, DPT
McKinley Pollock, PT, DPT, OCS, CSCS is a physical therapist with a background in orthopedics and sports rehabilitation. Dr. Pollock earned his doctorate of physical therapy from Campbell University in 2021, is a board-certified orthopedic clinical specialist (OCS), and certified strength and conditioning specialist (CSCS). Dr. Pollock enjoys combining lessons learned from his DPT training and research, translating these into clinical practice. His passions include promoting relationships between patients & clinicians to promote clinical effectiveness, satisfaction, and efficiency, the implementation of primary preventative medicine into clinical practice, and leadership and education development.
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