Moving Through Cancer: Why Exercise is One of the Most Powerful Tools in Your Treatment Plan

Evidence-based guidance for Australians diagnosed with cancer — what to do before, during, and after treatment, and why an Exercise Physiologist is an essential part of your care team.

169,500 New cancer diagnoses in Australia per year

72% Five-year survival rate, up from 50% in the 1990s

50% Lower mortality risk in physically active survivors

<13% Of patients currently receiving exercise guidance in their care

A cancer diagnosis changes everything. In the days and weeks that follow, you are navigating appointments, test results, treatment plans, and a flood of emotions — all at once. Exercise is likely not the first thing on your mind. But there is a growing and compelling body of evidence that suggests it should be one of the first things you and your healthcare team discuss.

The Clinical Oncology Society of Australia (COSA), Exercise & Sports Science Australia (ESSA), and leading international organisations like the American College of Sports Medicine (ACSM) are united in their position: exercise is a safe, effective, and essential component of cancer care. It is not a ‘nice extra’ — it is medicine.

The COSA Position Statement

COSA’s landmark position statement, endorsed by more than 20 organisations, states that inactivity should be avoided, aim to achieve the recommended physical activity guidelines for adults, should be tailored to the individual and should be embedded as standard practice in cancer care (Cormie et al., 2018).

The Case for Exercise in Cancer Care: What Does the Research Say?

Research consistently demonstrates that cancer patients who regularly engage in moderate-intensity exercise are more likely to experience better outcomes across every stage of their cancer journey. Despite this, fewer than 13% of people in Australia reportedly receive exercise guidance as part of their cancer care (Dallavia et al., 2025) — a significant gap Exercise Physiologists aim to address.

Less Fatigue: Fewer severe treatment side effects

Preserved Strength: Reduced muscle wasting and deconditioning

Bone Protection: Maintained bone mineral density

Mental Wellbeing: Reduced anxiety and depression

Lower Recurrence: Reduced risk of cancer coming back

Better Function: Improved independence and quality of life

Before Treatment Even Begins: The Power of Prehabilitation

One of the most underutilised windows of opportunity in cancer care is the period between diagnosis and the start of treatment. This phase — known as ‘prehabilitation’ — involves using exercise and other supportive interventions to build up your physical reserves before your body faces the demands of surgery, chemotherapy, or radiation.

Think of it this way: the fitter and stronger you are going into treatment, the better equipped your body is to tolerate it and recover from it. Research from the University of Melbourne’s Peter MacCallum Cancer Centre describes exercise prehabilitation as being increasingly central to how well patients are prepared for major cancer treatment — particularly surgery (Denehy & Granger, 2022). Emerging research on prehabilitation prior to non-surgical treatments like chemotherapy and radiotherapy is also growing rapidly, with studies suggesting improvements in physical capacity, quality of life, and potentially treatment tolerability (Pinto et al., 2025).

Prehabilitation programs typically focus on aerobic conditioning (building cardiovascular fitness) and resistance training (maintaining and building muscle mass and strength) where appropriate. The goal is to arrive at your first treatment appointment as physically prepared as possible.

Exercise During Treatment: Staying Active When It Feels Hardest

Many people assume that rest is the best approach during cancer treatment. In most cases, the evidence says otherwise. While there are times when complete rest is medically necessary, extended physical inactivity during treatment is now recognised as harmful due to accelerating muscle loss, worsening fatigue, increasing the risk of depression, and overall reducing treatment tolerance. Exercise is one of the most backed treatment strategies to avoid dipping below the disability threshold.

The ESSA and COSA guidelines consistently recommend that people with cancer avoid inactivity, even during active treatment, and aim to progress toward established exercise targets as their condition allows (Hayes et al., 2019; Cormie et al., 2018). Exercise during treatment has been demonstrated across a large body of evidence to:

• Reduce the severity of cancer-related fatigue (the most commonly reported side effect of treatment)
• Preserve cardiorespiratory fitness and muscle mass
• Improve psychological wellbeing, reduce depression and anxiety
• Improve immune function
• Support maintenance of a healthy body weight and composition

Understanding Cancer-Related Fatigue — And Why Exercise Helps

Cancer-related fatigue (CRF) is not ordinary tiredness. It is a persistent, distressing sense of physical, emotional, and cognitive exhaustion that is not relieved by rest and significantly impairs day-to-day functioning. It is the most commonly reported side effect of cancer and its treatment, affecting the majority of patients.

CRF is caused by multiple interacting mechanisms: systemic inflammation; decreased muscle mass and impaired nerve-to-muscle signalling; alterations in brain chemistry affecting perceived effort; hormonal disruption; and anaemia from chemotherapy (Brownstein et al., 2023). Exercise directly addresses each of these.

When muscles contract during exercise, they release signalling proteins called myokines that actively reduce systemic inflammation — one of the core drivers of fatigue. Exercise also improves neuromuscular function, supports healthy hormonal regulation, and enhances the brain’s management of perceived exertion.

A major network meta-analysis of 56 randomised controlled trials found that combined aerobic and resistance exercise had the highest probability of efficacy for reducing cancer-related fatigue — outperforming all other exercise modalities, both during and after treatment.

Dong et al., 2023 — Journal of Orthopaedic & Sports Physical Therapy

Protecting Your Muscles: Why Resistance Training Matters in Cancer

Cancer and its treatments are profoundly catabolic — meaning they break the body down. Cancer cachexia (a syndrome of severe muscle and body weight wasting) occurs in a significant proportion of patients and is associated with poorer treatment tolerance, reduced quality of life, and worse survival outcomes (Libramento et al., 2025).

Chemotherapy, radiation, and hormone therapies all contribute to muscle wasting through multiple pathways: elevated inflammatory signalling promotes the breakdown of muscle proteins; reduced physical activity accelerates deconditioning; and hormonal changes — particularly testosterone decline from androgen deprivation therapy in prostate cancer, and oestrogen loss in breast cancer treatment — further drive muscle wasting.

The myokine effect

Resistance exercise stimulates muscle protein synthesis and releases myokines — muscle-derived signalling proteins that help counteract the inflammatory environment created by cancer and its treatments. A 2023 systematic review confirmed supervised resistance training is effective for reducing cancer-related fatigue at sufficient intensity (Barker et al., 2023).

Maintaining muscle mass is not just about physical appearance. It directly impacts your energy levels, immune function, metabolic health, ability to tolerate treatment doses, and your functional independence both during and after cancer.

Protecting Your Bones: The Physiological Case for Weight-Bearing Exercise

Bone health is a critically underappreciated concern in cancer. Many treatments accelerate bone loss with many treatment pathways significantly reducing key hormones essential for maintaining bone mineral density. Chemotherapy, corticosteroids, and some targeted therapies can further compromise bone health.

From a physiological standpoint, bone is a dynamic, living tissue constantly undergoing remodelling. The key players are osteoblasts (cells that build new bone) and osteoclasts (cells that break it down). Mechanical loading — the physical stress placed on bones during weight-bearing and resistance exercise — is one of the most powerful stimuli for osteoblast activity and new bone formation. Without adequate loading, bone resorption outpaces formation, increasing fracture risk (Avancini et al., 2022).

Important: Bone metastases require specialist prescription

Exercise for bone health in people with cancer needs to be carefully prescribed by a qualified professional. People with known bone metastases require a modified program that prioritises safety. International expert consensus guidelines have been developed specifically for this population (Campbell et al., 2022).

What Type of Exercise Is Recommended? The Evidence-Based Guidelines

COSA, ESSA, and the ACSM all recommend a broadly similar framework, while unanimously emphasising that there is no single prescription that suits everyone. The following reflects current evidence-based guidance:

Aerobic Cardiovascular Exercise

• Target 150 min/week of moderate intensity. Walking, cycling, swimming, light jogging — anything that elevates heart rate in a sustained, rhythmic way.
• Why: Improves cardiovascular fitness, reduces fatigue, supports healthy body weight, enhances immune function, and improves mood via endorphin release and anti-inflammatory mechanisms

Resistance (Strength) Training

• Target: 2–3 sessions/week targeting all major muscle groups. 60–80% of 1RM. Weights, bands, or bodyweight. Essential for muscle and bone health.
• Why: Preserves and rebuilds muscle mass, protects bone mineral density, counteracts cachexia, reduces fatigue, improves functional capacity and independence

Flexibility and Balance Training

– Stretching and balance work for those with neuropathy, post-surgical stiffness, or lymphoedema. Yoga is evidence-supported for reducing cancer-related fatigue.

A multimodal approach combining aerobic and resistance training is most beneficial for most people with cancer (Hayes et al., 2019; Cormie et al., 2018). Exercise should begin at a level appropriate to your current fitness and health status, and progress gradually under professional supervision.

Why You Should See an Accredited Exercise Physiologist

This is where it becomes critical. A general gym program or online workout guide is not appropriate for someone undergoing chemotherapy, recovering from surgery, managing bone metastases, or dealing with lymphoedema.

COSA explicitly recommends referral to an Accredited Exercise Physiologist (AEP) or physiotherapist with experience in cancer care for the prescription and delivery of exercise (Cormie et al., 2018). ESSA reinforces that targeted exercise prescription accounting for cancer type, treatment, side effects, contraindications, and individual goals is essential to ensuring both safety and therapeutic benefit (Hayes et al., 2019). A 2023 systematic review found that supervised resistance training programs achieved substantially greater reductions in cancer-related fatigue compared to home-based, unsupervised programs — attributed to the ability to control training variables and provide the social support that promotes physiological adaptation (Barker et al., 2023).

What an AEP will do for you

Thorough health assessment for your specific cancer, treatment, and side effects · Identify contraindications and design appropriate modifications · Build a personalised, progressive exercise program · Monitor and adjust the program as treatment changes · Communicate with your oncology team as part of a multidisciplinary approach.

Exercise and Survivorship: Living Well Beyond Cancer

With Australia’s five-year cancer survival rate sitting at approximately 72% — up from just 50% three decades ago — more Australians than ever are living long lives after a cancer diagnosis (Cancer Australia, 2025). How well those lives are lived depends greatly on what happens during and after treatment.

For breast, colorectal, and prostate cancers — Australia’s most commonly diagnosed — regular physical activity after diagnosis is associated with a reduced risk of recurrence, cancer-specific mortality, and all-cause mortality (Cormie et al., 2018; Rock et al., 2022). Research from Monash University found that increased physical activity is associated with significantly better quality of life among those receiving cancer care in rural Australia (Leach, 2023).