Cancer Rehabilitation: Why Exercise, Physiotherapy and Nutrition Work Together
Updated: Oct 14
Written by Rosy Allan, BSc (Hons), ANutr
Registered Associate Nutritionist | Level 3 Personal Trainer | Level 4 Cancer Exercise Rehabilitation Specialist
Recovering from cancer treatment isn't always straightforward.
You might have completed chemotherapy, surgery or radiotherapy but still be experiencing fatigue, muscle weakness, pain or restricted movement.
Perhaps you'd like to return to the gym but aren't sure which exercises are appropriate. Or maybe you're struggling with your appetite, have lost strength and don't know where to begin.
These challenges don't always fit neatly into one area of healthcare. That's why I believe a joined-up approach to cancer rehabilitation can be so valuable.
Exercise rehabilitation, physiotherapy and nutritional support can each address different aspects of recovery. When the right professionals communicate and work together, that support can become more coordinated and individualised.
Why cancer rehabilitation sometimes needs more than one professional
Cancer treatment can affect several aspects of physical health at the same time.
For example, someone recovering from breast cancer treatment might experience:
Reduced shoulder mobility following surgery
Muscle weakness after chemotherapy
Cancer-related fatigue
Peripheral neuropathy affecting balance or grip strength
Changes in body composition
Difficulty returning to their previous exercise routine
These symptoms may overlap, but they don't necessarily require the same intervention.
A physiotherapist may be best placed to assess persistent shoulder restriction or a specific movement problem.
A qualified cancer exercise rehabilitation specialist can help someone rebuild strength and fitness through an appropriately adapted programme.
A dietitian may be needed when treatment has resulted in significant weight loss, malnutrition or complex nutritional difficulties.
The importance of individualised exercise is supported by international guidelines, which recognise benefits for physical function, fatigue and quality of life while emphasising the need to consider treatment-related complications (Campbell et al., 2019).
Good rehabilitation isn't about expecting one professional to solve every problem. It's about recognising which kind of support is needed and when.
The role of specialist cancer exercise rehabilitation
Exercise is an important component of cancer care and recovery.
The American Society of Clinical Oncology recommends appropriately prescribed aerobic and resistance exercise during many forms of active cancer treatment, with evidence of benefits for strength, physical fitness and fatigue (Ligibel et al., 2022).
Exercise can also support physical functioning and quality of life following treatment (Campbell et al., 2019).
However, knowing that exercise is beneficial doesn't automatically tell someone what they should do in the gym.
For example, someone experiencing peripheral neuropathy may have sufficient lower-body strength to perform a squat but struggle to hold dumbbells securely.
Someone recovering from surgery may need an exercise adapted because of restricted movement.
Another person might be physically capable of resistance training but need shorter sessions because of fatigue.
As a Level 4 Cancer Exercise Rehabilitation Specialist, my role is to consider these individual difficulties when designing and adapting exercise programmes.
What might this look like in practice?
Depending on the person's capabilities and clinical circumstances, adaptations could include:
Replacing free-weight exercises with supported resistance machines when balance is affected
Using appropriately selected lifting straps or weighted cuffs when grip strength is limiting
Reducing exercise volume during periods of increased fatigue
Adjusting the range of movement for an exercise when discomfort or mobility restrictions are present
Gradually introducing resistance as confidence and strength improve
These are practical adaptations I've used in my work, as well as approaches I've explored during my own recovery from cancer treatment.
They aren't suitable for everyone. In particular, significant numbness, bone fragility, lymphoedema, surgical restrictions or balance difficulties may require additional
precautions or clinical assessment.
The aim is to find an appropriate way to keep someone active, rather than automatically removing an exercise because it has become difficult.
Where physiotherapy fits into cancer rehabilitation
Physiotherapists bring a different area of expertise to rehabilitation.
They can assess and help manage problems involving movement, pain, physical function and mobility.
For example, someone who has undergone breast surgery might develop significant shoulder stiffness or restricted movement.
Rather than simply prescribing more upper-body exercises, it may be appropriate for a physiotherapist to assess what is causing the restriction.
Depending on the findings, physiotherapy could involve specific rehabilitation exercises, movement advice or other clinically appropriate interventions.
Once those difficulties have been assessed, a cancer exercise rehabilitation programme can be adapted to accommodate the person's changing capabilities.
Working alongside other specialists
At ROSY, I collaborate with Lisa at Clifton Physio, a physiotherapist who has also completed specialist CanRehab training.
Our professional relationship allows us to draw on our complementary expertise when supporting people living with and beyond cancer.
For example, Lisa may assess and help manage specific movement restrictions, pain or physical limitations, while I focus on rebuilding strength, improving physical fitness and adapting exercise programmes around the individual's needs.
Where appropriate, we can refer clients to one another and communicate about their rehabilitation, with their consent.
I believe this collaborative approach is particularly valuable because cancer recovery rarely fits neatly into one professional discipline.
By working together, we can help clients access the right expertise at the right stage of their recovery, rather than expecting one practitioner to address every concern.
Why nutrition matters alongside physical rehabilitation
Cancer and its treatments can affect nutritional status in different ways.
Some people experience poor appetite, unintended weight loss or difficulty eating enough.
Others may have gained weight during treatment but also lost muscular strength or become less physically active.
These situations require different approaches.
The European Society for Clinical Nutrition and Metabolism recommends screening people with cancer for nutritional risk and providing appropriate interventions when problems are identified (Muscaritoli et al., 2021).
Adequate nutrition is important for maintaining body tissues and supporting physical activity.
However, there is an important distinction between general nutrition coaching and clinical nutritional management.
As a Registered Associate Nutritionist, I provide evidence-based nutrition education and support within my professional scope.
Where someone has significant malnutrition, cancer cachexia, swallowing difficulties or complex treatment-related nutritional needs, an appropriately qualified oncology dietitian should be involved.
Practical ways nutrition can support exercise
For someone who is eating adequately and beginning to rebuild strength, useful considerations might include:
Including a source of protein at regular meals. Eggs, fish, dairy products, tofu, beans and meat can all contribute to protein intake.
Eating enough overall. Someone experiencing unintended weight loss or struggling to meet their nutritional requirements may not benefit from introducing a weight-loss diet.
Making meals easier to prepare. Frozen vegetables, microwave rice, ready-prepared proteins and batch-cooked meals can be especially helpful when fatigue is a problem.
Planning around exercise. If someone regularly feels hungry or lacks energy during training, it may be useful to review meal timing and overall food intake.
These are general strategies rather than a substitute for individual oncology dietetic assessment.
An example of how joined-up rehabilitation could work
Imagine someone who has completed breast cancer treatment and wants to return to strength training.
They have several concerns:
Their shoulder movement is restricted following surgery.
They feel weaker than before treatment.
They become tired more quickly.
They have digestive issues.
They're unsure how much exercise is appropriate.
A joined-up approach might look like this.
First, a physiotherapist assesses the shoulder restriction
They identify any movement limitations that need targeted rehabilitation and advise on relevant precautions.
Next, a cancer exercise rehabilitation specialist develops an appropriate strength programme
Rather than immediately returning to the person's previous routine, the programme uses exercises they can perform with control and confidence.
Upper-body movements might initially be adapted, while suitable lower-body strength exercises are introduced according to their capabilities.
Nutrition is considered alongside physical recovery
If the person is eating well, general nutrition guidance may be sufficient.
If they're losing weight unintentionally or experiencing significant dietary difficulties, an oncology dietitian may be needed.
Progress is reviewed over time
As shoulder movement and physical confidence improve, exercises can be modified and resistance gradually progressed.
This is a hypothetical example, not a fixed rehabilitation pathway. The appropriate professionals and interventions will depend on the individual's needs.
The important point is that each professional contributes their own expertise.
How to ask for more joined-up support
One difficulty people sometimes experience after cancer treatment is not knowing whom to approach about ongoing symptoms.
You may have several concerns but feel unsure whether they belong with your GP, oncology team, physiotherapist or exercise specialist.
A useful starting point is to write down the problems affecting your everyday life.
For example:
I can't comfortably reach overhead following surgery.
My legs feel weaker when climbing stairs.
My hands are numb, making it difficult to grip weights.
I'm losing weight without trying.
I'm exhausted after relatively small amounts of activity.
You can then discuss these concerns with your GP, clinical nurse specialist or oncology team and ask whether a referral to physiotherapy, rehabilitation services or an oncology dietitian would be appropriate.
If you're already working with an exercise professional, let them know about relevant clinical advice and any changes in symptoms.
Where appropriate, you can also give permission for professionals to communicate directly.
This helps ensure that exercise programmes reflect the medical and rehabilitation advice you've received.
You shouldn't have to become an expert in every aspect of cancer rehabilitation to find the right support.
My approach at ROSY
Having experienced cancer treatment myself, I understand how frustrating it can be to want to rebuild your strength but feel limited by symptoms you didn't have before.
I also know the value of receiving professional help for difficulties that can't simply be solved by exercising harder.
My approach at ROSY is to combine evidence-based exercise rehabilitation with practical adaptations and individualised support.
I recognise the importance of working within my professional scope and maintaining high standards of practice. I have established referral pathways to specialist oncology dietitians when clients require clinical nutritional support, and I undertake professional supervision to ensure my practice remains safe, evidence-based and appropriately supported. I also collaborate with other healthcare professionals where needed to provide a coordinated approach to cancer rehabilitation.
My ongoing professional relationship with Lisa at Clifton Physio reflects this approach. It allows me to collaborate with someone whose physiotherapy expertise complements my own specialist exercise rehabilitation work.
For some people, this might mean adapting their exercise programme around advice from a physiotherapist. For others, it may involve recommending further clinical assessment before progressing training.
I offer specialist cancer exercise rehabilitation online throughout the UK, alongside premium one-to-one sessions in Bristol.
The aim is to help people rebuild physical confidence and function in a way that respects their individual experiences and treatment histories.
Final thoughts
Cancer rehabilitation is rarely about addressing just one problem.
Muscle weakness, fatigue, restricted movement and nutritional difficulties can all influence someone's ability to return to exercise and everyday activities.
Research supports appropriately prescribed physical activity during and after cancer treatment, while clinical nutrition guidance highlights the importance of identifying and addressing nutritional difficulties (Campbell et al., 2019; Ligibel et al., 2022; Muscaritoli et al., 2021).
But research also needs to be applied to the individual.
Sometimes the most helpful thing isn't another exercise or nutrition recommendation. It's recognising when someone needs a different professional's expertise.
That's why I value a joined-up approach to cancer rehabilitation.
When exercise specialists, physiotherapists and clinical professionals work within their respective areas of expertise, people can receive more coordinated support for the challenges they're experiencing.
At ROSY, I aim to provide practical, knowledgeable cancer exercise rehabilitation that complements appropriate clinical care.
Disclaimer: This article is intended for general educational purposes and does not replace personalised medical, physiotherapy or oncology dietetic advice.
Cancer rehabilitation should be individualised according to diagnosis, treatment history, symptoms and current health. Anyone experiencing new or worsening pain, significant balance problems, unexplained weakness, unintended weight loss or other concerning symptoms should seek appropriate clinical assessment.
Exercise rehabilitation and general nutrition coaching do not replace necessary medical treatment or specialist clinical rehabilitation.
References
Campbell, K.L. et al. (2019) 'Exercise guidelines for cancer survivors: Consensus statement from International Multidisciplinary Roundtable', Medicine & Science in Sports & Exercise, 51(11), pp. 2375–2390. Available at: https://doi.org/10.1249/MSS.0000000000002116
Ligibel, J.A. et al. (2022) 'Exercise, diet, and weight management during cancer treatment: ASCO guideline', Journal of Clinical Oncology, 40(22), pp. 2491–2507. Available at: https://doi.org/10.1200/JCO.22.00687
Muscaritoli, M. et al. (2021) 'ESPEN practical guideline: Clinical Nutrition in cancer', Clinical Nutrition, 40(5), pp. 2898–2913. Available at: https://doi.org/10.1016/j.clnu.2021.02.005
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