Art of onco-physiotherapy – embedding exercise into cancer care 

“Movement is Medicine” is the mantra of Physiotherapy. Physiotherapy is the field where a trained professional is dedicated to evaluating, assisting, and strengthening physical function and movement. It is grounded in the science of structured physical activity to enhance health and quality of life. “Onco-Physiotherapy” is a dedicated branch of physiotherapy, where the field has focussed programs to assist cancer patients during all the stages of cancer care.

Cancer (diagnosis and treatment) can have a global impact on the patient and the family. The treatment comprises a combination of surgery, chemotherapy and radiation. This multi-modality treatment approach is the key to potential cure and better outcomes.

However, the disease and the treatment can be debilitating. The journey to recovery post-treatment is not always a smooth journey; it may be pervaded with pain, weakness, stiffness, fatigue, muscle wasting and reduced mobility. “We need more than just treatment to combat cancer; a dedicated field such as “Onco-Physiotherapy” works as a vital counter balance and perfect partner to negate some treatment side-effects and strengthen the body and mind of our patients,” said Professor V. Sridevi, senior surgical oncologist. At our hospital, we administer one-on-one physiotherapy sessions to our in-patients.

Physiotherapy at every stage of cancer care

Physiotherapy plays a vital role across the entire spectrum of cancer care, supporting patients through each phase of their journey.

Before treatment (prehabilitation) enhances physical resilience, preparing patients to better tolerate cancer treatment and assist recovery. During and after treatment (rehabilitation & survivorship), targeted exercises help manage symptoms, reduce side effects, increase stamina and energy levels, restoring physical function, and enabling a return to everyday life. In after care (palliative support), physiotherapy supports comfort, mobility, and dignity, even within palliative care settings.

Prehabilitation, an essential phase before surgery and cancer treatment, helps strengthen patients both physically and mentally. Physiotherapy is a key component, offering customised exercises to boost fitness, strength, and flexibility, thereby minimising complications. “Physiotherapy driven approach reduces the length of hospital stay and readmissions, and improves surgical outcomes; all of which emphasises a proactive, patient-centered approach,” mentioned . C. Punitha, anesthesiologist.

“Physiotherapy not just focusses on cardiac fitness and mobility exercises, but also on breathing exercises. This is crucial in reducing post-treatment respiratory related complications such as pneumonia,” added . S. Keerthika, physiotherapist.

Physiotherapy plays a crucial role in cancer care by helping patients manage side effects, improve functional independence, and enhance overall well-being.
| Photo Credit:
Special Arrangement

Strengthening survivorship

Post-treatment, when patients return for their follow-up care to meet their doctors, they also come back to see their physiotherapists to work on improving their fitness and attend to any physical challenge. “Cancer survivors are almost three times more likely to report fair or poor overall health, twice as likely to experience psychosocial disabilities and functional limitations compared to those without cancer or chronic illness. We have adopted globally established framework, such as The International Classification of Functioning, Disability, and Health. This helps our physiotherapists to assess and address the multifaceted impacts of cancer. Such objective tools for assessment ensure a holistic rehabilitation approach,” saidAnitha D., senior physiotherapist.

Mental health and exercise

For a majority of cancer patients, healing is not merely a physical process, it is also a deep wound at the psychological level. “Research has proven that exercise has a profound impact on mental well-being of cancer patients; from alleviation of depressive and anxiety symptoms to enhanced self-esteem and improved sleep,” said Surendran Veeriah, head of psycho-oncology Department. Physical activity triggers the release of endorphins, natural chemicals in the body that make you feel well and help reduce pain and boost mood/energy. Regular moderate exercise can increase motivation and provide a natural, non-pharmacological way to cope with stress during and after cancer treatment.

Managing cancer-related fatigue (CRF)

Cancer-Related Fatigue is frequently reported as the most debilitating and persistent symptom of cancer treatment. Guidelines recommend regular fatigue screening during all phases of treatment and survivorship. “Fatigue is not just a side effect it is often the most distressing symptom reported by cancer patients. It can persist for months or even years post-treatment, hence regular exercise is crucial for long-term,” says M.S. Satish, chief physiotherapist.

Site-specific physiotherapy exercises

Site-specific physiotherapy exercises in cancer care involve individualised rehabilitation programs tailored to the specific area affected by cancer and its treatment
| Photo Credit:
Special Arrangement

A challenging consequence following breast cancer surgery is lymphedema, characterised by swelling in the arm, which can restrict mobility and cause discomfort. “Physiotherapy is an essential component after breast cancer surgery. It aids in restoring shoulder mobility and upper limb function and assists in preventing and managing lymphedema.”says V. Sridevi, senior surgical oncologist.

Physiotherapy is integral to the comprehensive management of musculoskeletal tumours. Early and individualised cancer rehabilitation is dedicated to restoring mobility, strength and for preventing common complications such as joint stiffness, pain and muscle atrophy. Thus, potentially reducing the need for pharmacological interventions. “In the context of limb-salvage surgeries, physiotherapists are pivotal in strength training, preventing falls and improving stability of patients,” says K. Chandra Kumar Krishnan, orthopaedic oncologist.

Women recovering from gynaecologic cancer often experience pelvic floor dysfunction, which can lead to issues such as pain and incontinence. Pelvic physiotherapy plays a vital role in their recovery, helping patients regain control over essential bodily functions and rebuild confidence during and after cancer treatment. “Physiotherapists support patients through the post-operative period, making recovery smoother and ensuring they are physically ready for timely adjuvant therapy and improves quality of life” says N. Jayashree, gynecologic surgical oncologist.

Treatment of oral cavity and throat cancers can impair mouth opening, speech, swallowing, breathing and shoulder movement. Physiotherapy is not just supportive care, it’s integral to recovery and survivorship. “By embedding physiotherapy into every phase of cancer care, we empower patients to reclaim function, independence, and quality of life. Early physiotherapy intervention is not optional it is essential,” says V. Venktesh, senior surgical oncologist.

In the treatment of blood cancers, such as lymphoma and myeloma, early integration of physiotherapy is critical. This proactive approach helps patients regain strength, significantly reduces hospital stays, and mitigates the risk of long-term disabilities.“Physiotherapy extends beyond mere exercise; it centers on restoring dignity, mobility, and independence for individuals who have undergone some of the most intensive medical therapies,” explains Parathan Karunakaran, hematology oncologist.

Radiation therapy plans are tailored to each patient’s needs and the specific characteristics of their cancer. Patients undergoing radiation therapy will need physiotherapy to cope with the side effects like fatigue and neuromuscular syndromes. “Our task is to help every patient regain maximum function and the confidence to return to daily life with dignity and strength. Physiotherapy plays a crucial role in this journey from day one till full recovery is achieved, enhancing mobility, and empowering patients to reclaim their independence” says . Alexander John, senior radiation oncologist.

Advances in cancer care have resulted in improved survival rates and an increase in survivors. A significant percentage of these survivors are young and in the working age group. Thus, it is imperative to focus on optimising their new normal via physiotherapy so we preserve their quality of life and their ability to resume work.

The benefits of regular physical exercise are overarching on global health (such as: improved cardiovascular parameters, respiratory function and mental health, reduction in obesity, diabetes and cancer, improved sleep and psychosocial well-being). Logically, “movement” should be the health mantra, not just for cancer patients, but for the general public as well.

Sadly, we live in an era where there is a reduction in overall physical activity especially with the advent of smart devices. Embedding exercise and gyms into our daily routines, workspaces should perhaps be the universal prescription for lasting health and well-being!

(Dr. Srinivasan Vijay is chief Physiotherapist, scientist & head at Department of Physiotherapy,Cancer institute (WIA), Adyar, Chennai. Email: physiotherapy@cancerinstitutewia.org; Dr. M.S.Sathish is chief physiotherapist & Scientist D, Cancer institute (WIA), Adyar.)