If you or someone you care about has been told they have cancer, the question of what to do with movement and exercise comes up quickly. The short answer from Australian and international oncology bodies is that movement, in the right amount, is part of care. The longer answer depends on the cancer, the treatment, and the person.
01 · The role
What Accredited Exercise Physiologists do in cancer care
Exercise Physiology is the study of how the body responds and adapts to physical activity. In Australia, an Accredited Exercise Physiologist is a university-trained, Exercise and Sports Science Australia-accredited allied health professional who prescribes exercise as treatment for chronic and complex conditions, including cancer.
In an oncology setting, an Accredited Exercise Physiologist works alongside the medical team. They take a referral, review the cancer type and treatment plan, assess current fitness and any treatment side effects, and write a program the person can actually do that week. The program changes as treatment changes.
The work is collaborative. An Accredited Exercise Physiologist does not replace oncology care. They sit alongside it, taking on the movement, strength, and conditioning side of the plan so the medical team can focus on the cancer-directed treatments.
02 · Why it matters
Why exercise matters across the cancer continuum
Cancer and cancer treatments can lead to physical deconditioning, loss of muscle, fatigue, and reduced cardiovascular fitness. Some of that comes from the cancer itself, some from the treatment, and some from long stretches of being unwell and less active.
Each loss compounds the next. Less muscle makes everyday tasks harder, which leads to less activity, which leads to more muscle loss. The Clinical Oncology Society of Australia (COSA) position statement on exercise in cancer care, published in the Medical Journal of Australia, frames this as a clinical problem worth treating in its own right, alongside the cancer itself.
The COSA position is that exercise should be embedded as part of standard practice in cancer care, with people referred to an Accredited Exercise Physiologist or a physiotherapist with experience in cancer care for individualised prescription. Sitting still during treatment, when avoidable, is no longer the conservative option.
03 · Side effects
Managing side effects: fatigue, deconditioning, and treatment toxicity
Exercise during treatment can help with treatment-related symptoms and side effects. A small Danish study of 54 people undergoing chemotherapy ran a six-week program combining physical activity, relaxation, body-awareness work, and massage. Most of the measured side effects eased over the six weeks, with a significant reduction in pain. It was an early, exploratory study, but it pointed in a direction later and larger research has supported.
For people on androgen deprivation therapy for prostate cancer, structured exercise has a particular role. Hormone treatment commonly causes loss of muscle and bone, increased fat mass, and reduced cardiovascular fitness. An Australian review found that supervised resistance and aerobic exercise produced positive effects on muscle strength, physical function, body composition, fatigue, and quality of life for men on this treatment, without reducing how well the treatment worked.
Cancer cachexia, the loss of muscle and weight that can accompany advanced disease, is harder to treat. A 2022 review still found that targeted exercise has a role even here, alongside nutrition and medical care, with evidence that people with cachexia can safely do resistance exercise and gain muscle.
Sitting still during treatment, when avoidable, is no longer the conservative option.
04 · The COSA position
What the COSA position statement recommends in Australia
The Clinical Oncology Society of Australia’s 2018 position statement, endorsed by a wide range of Australian cancer organisations including Cancer Council Australia, is the canonical Australian reference. It makes three core recommendations for people with cancer:
1. Avoid inactivity. Even small amounts of movement matter. Long periods of sitting and bed rest, where avoidable, work against recovery.
2. Build towards 150 minutes of moderate aerobic activity per week, plus two or three resistance sessions per week. The exact target is individualised. For many people, building up to it across weeks or months is the goal, not week one.
3. Refer to an Accredited Exercise Physiologist or a physiotherapist with experience in cancer care for individualised prescription. This matters most during active treatment, after surgery, or when there are complicating factors like bone metastases, lymphoedema, or significant fatigue.
A 2016 systematic review and meta-analysis in the British Journal of Sports Medicine, covering 16 randomised controlled trials, found that exercise during and after cancer treatment significantly improved quality of life compared with usual care, with related gains in fatigue and physical functioning.
The international companion to COSA is the 2019 international consensus roundtable, which set specific exercise-dose recommendations for anxiety, depressive symptoms, fatigue, physical function, and quality of life. Australian Accredited Exercise Physiologists draw on both.
05 · Survivorship
Survivorship and recurrence risk: what the evidence says
An Australian-led systematic review of 100 studies found that, compared with people who did little or no exercise, people who were physically active after a cancer diagnosis were observed to have a lower relative risk of cancer recurrence and death, and fewer or less severe treatment-related side effects, across several common cancers.
These are observational findings, not guarantees. The survival evidence comes from studies that follow large groups over time, not from randomised trials, so exercise is best understood as one part of comprehensive cancer care, alongside surveillance, ongoing medical follow-up, and the other supports a person needs. Researchers are still working out the biological mechanisms behind the link. But the direction of the evidence is consistent.
Most of this survivorship research has been done in people with breast, bowel, and prostate cancer, which are among the most common cancers in Australia. The same general principles apply across other cancer types, even where the specific research base is smaller. The program is tailored to the person, not the diagnosis alone.
06 · First appointment
What a first appointment with an Accredited Exercise Physiologist looks like
A first appointment usually runs 45 to 60 minutes. The Accredited Exercise Physiologist reads the referral and any recent scans or letters, asks about the cancer type and treatment stage, and asks what the person’s life and movement look like now.
The next step is a baseline assessment. Depending on what is safe and useful that day, this might include simple measures of strength, balance, walking endurance, and range of movement, plus a conversation about fatigue, sleep, and what feels too hard at the moment.
From that assessment, the Accredited Exercise Physiologist writes a starting program. The starting program is usually conservative. The early goal is consistency and tolerance, not heroics. Programs change as treatment changes. What works in cycle one of chemotherapy will not be the same program in cycle four, or six months after treatment ends.
Funding pathways in Australia include a GP Chronic Condition Management Plan through Medicare (a GP referral can provide rebated visits), NDIS funding for eligible participants, Department of Veterans’ Affairs cover for veterans, private health extras, and self-funded private appointments. The right pathway depends on the person’s circumstances.
Further reading
- Exercise and Sports Science Australia position statement on exercise medicine in cancer management. The ESSA clinical-prescription reference.
- Cancer Council Australia: Exercise and cancer. A patient-facing companion resource.
- Exercise and Sports Science Australia: Find an Accredited Exercise Physiologist.
