Cancer Prehabilitation: The 5 Step Process
cancer prehabilitation
Marian Barnick

Marian Barnick

Registered Kinesiologist and Human Movement Specialist


Is Cancer Prehabilitation Right for You?

I had a great opportunity to attend the Canadian Prehabilitation Symposium last month.  It was a fantastic opportunity to listen to presentations, speak with other Kinesiologists who work with cancer patients, and really get inspired. 


There were many esteemed presenters from University of Toronto and McGill University supporting the work being done at Princess Margaret Cancer Centre and Montreal General Hospital.  A special ‘shout out’ to Dr. Daniel Santa Mina and Dr. Franco Carli for making this such a great event.


Research continues to show the many benefits of exercise for cancer patients.  It’s incredibly motivating and a real inspiration to continue with my work in this field.  It was amazing to listen, learn, and discuss prehab protocols for cancer patients.


I mentioned in my last post about the idea of starting exercise even before treatment so I think it’s a good idea to talk about what that looks like.


shoulder examination

What’s Cancer Prehabilitation?

Sounds like a funny word yet vaguely familiar…Prehab/Rehab…that’s where the word AND the idea came from.


We all know the word rehab (short for rehabilitation).  Well prehab is short for prehabilitation.  The difference between prehab and rehab is when it’s completed.  Prehab happens BEFORE treatment.  So in the case of cancer patients, this generally means before surgery or chemo.



Prehab can encompass different areas besides exercise – including psychology and nutrition.  But as my passion is exercise I’m keeping my info here just on that area.


breast cancer exercise

Cancer and Exercise

The idea of prehab isn’t new.  Utilizing exercise prescription to get the body ready for an upcoming surgery or treatment has been used in many different areas of health.  And it’s shown amazing results in helping patients recover faster and have less negative affects from treatment.


So why wouldn’t this work for cancer patients?


Prehab for cancer patients has been around for a while but applying the research to general cancer patient care is just starting to gain momentum.  Dr. Julie Silver, a Physiatrist from Harvard University has been a critical researcher in this area.  For years she has been implementing prehab strategies and seeing positive results.  And Dr. Silver is not just a scientist – she’s a cancer survivor.


Prehab for Cancer Patients

If you look at the idea simply, the goal for prehab and rehab are pretty similar – both trying to improve get your health, fitness, and function.  But let’s look at this a little differently.


PREHAB is proactive and REHAB is reactive


By adding prehab to your fight for better health, you are jump starting your body’s ability to fight through the stresses that are going to occur.  Rehab is the struggle after the fight and prehab gets your body into ‘fighting’ mode. 


By completing prehab, cancer patients build up their physical reserve.  We know the benefits of exercise and these benefits apply to helping patients tackle treatment as well as recovery. 


And there’s proof – lots of it.   And studies are continuing to show the benefits of exercise including prehabilitation for cancer patients.

cancer prehabilitation

Are You a Candidate for Cancer Prehab-ilitation?

Lung cancer, colorectal, breast, gastrointestinal, abdominal…the list goes on.  Research is being completed on all of these types of cancer with one goal in mind.  How can prehab – that is exercise before treatment – help these patients cope with treatment, get better faster, and improve their quality of life.

A study of 120 colorectal cancer patients at McGill University shows that just 4 weeks of prehab helped some of these patients “get in shape” before surgery which leads to a speedier recovery.  By adding a Kinesiologist onto the team, McGill has been able to offer prehab to patients, providing additional support with beneficial results.

Cancer Prehab Benefits

There are other benefits to a Prehab Exercise Program besides just the physical benefits.  Exercising can reduce anxiety which runs high after diagnosis and knowing that you’re going to face treatment.

Exercise gives patients a focus, something they are in control of, prior to facing uncertain side effects of treatment.

Your Five Steps to Evaluate Cancer Prehab

  1. Talk to your Oncologist 

Is there any reason you are not able to exercise?  Let’s get this out of the way so you are in control of making the decision as to whether or not you want to add Prehab to your arsenal.  Every patient is unique and every diagnosis is different.  Your lab results, MRI, and other tests will give your Oncologist the information they need to provide you with the information on moving forward with prehab.

This step is very important.  As a Cancer Exercise Professional, I always consult with my patients’ Oncologists before a Pre-Exercise Assessment.  This keeps everyone working together for the patient’s benefit and focused on the same goals.

  1. Chart your treatment timeline

Know when you are scheduled for surgery, pre-op appointments, or other treatment that has been recommended by your Oncologist.

Use Outlook, Google Calendar, or your Planner to chart your weekly schedule including your personal and work requirements.  The goal here is to be in control and have a good overview of the upcoming weeks and months.

Don’t get overwhelmed with where you have to go and what you have to do.  Chart it out and be aware of your busy times.  You may need to re-schedule some previously booked appointments but that’s ok!  The idea is to make it fit for you and reduce your stress.

  1. Take stock of your physical abilities

OK, I know we sometimes don’t like to go here, but it’s necessary.  Let’s take a look and see if we need to up our game in the physical fitness area.

The American Counsel of Sports Medicine (ACSM) defines physical fitness as:

“the ability to carry out daily tasks with vigor and alertness, without undue fatigue, with ample energy to enjoy leisure-time pursuits and meet unforeseen emergencies.”

If you meet this outline of physical fitness – congrats!  You have an awesome baseline and a great reserve.   If not, what are the areas where we might be lacking?

  1. cardio fitness – for endurance
  2. body composition – the amount of fat compared to lean body mass
  3. muscle strength – for tasks requiring force (lifting, pushing, etc.
  4. muscle endurance – keeping up strength throughout the day without fatigue
  5. flexibility – how well our joints are moving

Depending on your fitness level and the type of treatment you’re going to undergo, there are specific areas that will be key for you to work on.

  1. Make the positive and negative list

I love the pen and paper approach and I find I really struggle with decisions until I actually sit myself down and make ‘the list’.

Take an objective look at things.  Do you have time to add 2 to 3 sessions of exercise into your week?  Do you want to exercise?  Will prehab help you with the flood of emotions you’re going through at this time?  Do you have any external support system that can give you the time you need to complete a prehab program?

These are some of the questions you can ask yourself and see how the benefits of prehab weigh against the other areas in your life you need to consider.

If it turns out you just can’t make prehab work for you on a structured basis don’t give up.  If your answers to #3 show that you need a little extra in the exercise area, then try to do a little extra each day – what your can.  Every little bit helps both physically and emotionally.  So take a couple extra stairs, do a few wall push ups, add some shoulder stretches – whatever you can fit in.

  1. Support your goals with a Professional

Now is not the time to try and figure out how to exercise if you’ve been less than stellar at keeping in shape.  And if you’re a ‘regular’ at exercise you still need to get yourself an objective assessment of where you’re at.  You need to know where you have shortfalls in your program and exactly what you need to prehab based on your diagnosis and type of treatment.  

Your Prehab Program can be based on different goals and require different strategies than a regular fitness program.

You can prehab on your own or with a Cancer Movement Specialist.  But you’re NOT training to run a marathon before your treatment if you’ve never walked a block.  The goal of prehab is to build up YOUR body’s functional reserve so YOUR prehab program has to be designed for you and your upcoming fight.

Shoulder Pain After Breast Cancer

shoulder flexibility test

If you’ve been diagnosed with breast cancer, one of the unfortunate side effects of treatment is shoulder pain and loss of mobility.  Treatments including biopsy, surgery, and chemotherapy disrupt the muscle tissue, lymphatic system, and form scar tissue that makes it difficult to move your shoulder.


As  part of your cancer prehabilitation program, take The Shoulder Flexibility Test.  This will give you your baseline numbers so you know where you’re at before treatment.  This helps guide your rehabilitation program post surgery and treatment so you have a goal for your program.


Click the button below and take the FREE Shoulder Flexibility Test.

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