Exercise After Cancer Treatment South Africa

If you have recently finished cancer treatment, you may have been told to rest. For many years that was the standard advice. The evidence has moved significantly since then, and the message from the major clinical guidelines is now the opposite: gentle, structured exercise is one of the most effective tools available to support recovery.

This post looks at what the research actually shows, which types of cancer have the strongest evidence, what a biokineticist specifically does in this context, and how to begin safely when energy is limited.

What the evidence shows

In 2022, the American Society of Clinical Oncology (ASCO) published its first-ever evidence-based guidelines on exercise during and after active cancer treatment, drawing on more than 100 clinical trials. The conclusion was clear: providers should recommend regular aerobic and resistance exercise to people undergoing treatment with curative intent.

The panel found consistent evidence across multiple cancer types that exercise during and after treatment:

Reduces cancer-related fatigue, which affects the majority of people undergoing chemotherapy and radiotherapy.
Preserves cardiovascular fitness, which can decline significantly during treatment.
Maintains and rebuilds muscle strength, counteracting the atrophy caused by inactivity and some cancer medications.
Improves mood and reduces symptoms of anxiety and depression.
Improves quality of life in measurable, sustained ways.

A large meta-analysis of 136 observational studies found that physical activity after a cancer diagnosis was associated with up to a 40 percent lower risk of cancer-specific and all-cause mortality, particularly in breast, colorectal and prostate cancers. That is a striking finding, and it reflects years of converging evidence from multiple research groups.

Which cancers have the strongest evidence?

Breast cancer has the most extensive research base. Exercise during and after breast cancer treatment consistently improves fatigue, anxiety, depressive symptoms and physical functioning. Resistance training, in particular, helps counter the bone density loss associated with some hormone therapies.

Colorectal and prostate cancers also have strong evidence. For prostate cancer, where androgen deprivation therapy is commonly used and causes muscle loss, bone thinning and fatigue, structured exercise is now considered a standard part of managing the side effects of treatment.

There is also growing evidence for lung cancer (particularly prehabilitation before surgery), haematological malignancies (lymphoma, leukaemia), and other solid tumour types. The ASCO guidelines note that evidence was found across chemotherapy, radiotherapy and surgical recovery.

What a biokineticist does that is different

Cancer survivors are not a homogeneous group. A 40-year-old finishing breast cancer treatment has very different needs from a 70-year-old three months post-prostatectomy. The value of working with a biokineticist, rather than following a generic exercise programme or joining a regular gym class, is that the programme is built around your specific situation.

A biokineticist will consider the type and stage of cancer, the treatment received (and any known side effects), current fitness and strength levels, any comorbidities, and your goals. Contraindications are important here. Bone metastases, peripheral neuropathy, extreme fatigue, anaemia and recent surgery all require specific modifications. A good exercise prescription accounts for these from the start.

Biokinetics is recognised as a professional healthcare discipline in South Africa and is covered by most medical aids. For cancer rehabilitation, this means you can use your medical aid savings or chronic benefits to fund sessions with a registered biokineticist.

What about fatigue?

Fatigue is the most commonly reported side effect of cancer treatment, and it is the main reason many cancer survivors avoid exercise. The counterintuitive finding from the research is that exercise reduces fatigue rather than worsening it. The mechanism involves improvements in cardiovascular efficiency, muscle function, sleep quality and mood, all of which contribute to the subjective experience of fatigue.

The key is starting low and progressing slowly. A programme for someone who is exhausted after treatment looks very different from one for a healthy adult. The goal in the early stages is simply to restore movement, establish a routine, and build tolerance gradually.

How to start

If you have recently finished cancer treatment and want to begin exercise rehabilitation, the sensible starting point is an individual assessment with a biokineticist. This gives you a clear picture of your current strength and fitness, flags any concerns that need discussion with your oncologist, and results in a programme that is designed for where you are right now, not a generic template.

You do not need to be feeling well to make that appointment. Many people we see are still in the middle of treatment or have been in recovery for only a few weeks. The earlier exercise rehabilitation begins, within appropriate safety parameters, the better the outcomes tend to be.

Need a hand?

We see patients during and after cancer treatment, working alongside their oncology team. To discuss whether biokinetics rehabilitation is appropriate for your situation, contact us or have a look at our chronic disease management services.