Barriers for cancer patients to have access to exercise on different levels, including medical settings, personal safety, lack of social support, and neighborhood design. (Image by Nick Ng)
Part one of exercise and cancer highlights the evidence of what and how exercise can reduce the risk of cancer and the biological mechanisms behind exercise on cancer. Part two focuses on the psychological, social, and environmental factors that reduce the risk of some cancer and improve cancer survivors’ quality of life. It also explores accessibility issues to exercise and adopting an active lifestyle for cancer patients and survivors.
“I want to do stuff. I want to get myself as fit as I can and…not die just yet.”
“And you know what the feelings are when you’re able to do a particular exercise for a particular period of time, you know how you’re gonna feel. But I just know that my system at the moment just wouldn’t handle what I would do. Mentally, I think it wears on you and…then you keep saying to yourself, ‘Well, I wonder whether I’m ever gonna go back to what I had?’”
These statements are from two of 20 cancer survivors with cachexia from a 2022 Australian study who expressed their thoughts about what exercise means to them. These common themes include:
- Life is disrupted by cancer and cachexia.
- Exercise offers hope.
- Exercise barriers are multifaceted.
- Exercise access and support are important.
Exercise is more than just a way to decrease the risk of getting cancer. For many, it is a way to “reclaim” control of their body and self-worth.
For example, a 2025 Spanish study of five female breast cancer survivors who participated in a 12-week structured strength training program found three themes emerged:
- Physical activity is a “catalyst for empowerment and recovery.”
- Social bonds were formed during group activities.
- Changes in body perception and self-acceptance.
The researchers wrote that exercise helped the women “regain control over their bodies, mitigate side effects, and foster resilience. Group activities provided emotional support, reducing isolation and promoting psychological well-being. Instructors echoed these findings, describing visible improvements in participants’ confidence, emotional expression, and social engagement.”
“My body is not perfect, but it’s mine, and it’s strong,” said one of the participants. “Every time I push through a workout, I remind myself that it carried me through the hardest fight of my life.”
Another participant said, “At first, I couldn’t look at myself without feeling sad. The scars, the changes—they were reminders of what I went through. But as I continued with exercise, I started to see my body differently, not as damaged but as resilient.”
The exercise instructors reported that the women continued an active lifestyle after the study. “Some of them are still training with me, others joined swimming or hiking groups—the important thing is that they didn’t want to stop,” one of the instructors said.
The researchers added that physical activity helped “buffer against anxiety and contributed to a more positive outlook on life.” However, they said that the small sample size and the location may not likely be generalizable to other populations.
The breast cancer survivors were from Almería in southern Spain and may be influenced by strong family-oriented values, close community networks, and access to healthcare and sports facilities, according to the researchers.
“Future research should aim to include a larger and more diverse sample to enhance the transferability of the results and explore whether these findings hold true across different cultural and social settings,” they wrote.
Inequality and accessibility issues
While numerous studies have shown the benefits of exercise for cancer patients, there are barriers for patients to have access to exercise on different levels, including medical settings, personal safety, and neighborhood design.
Cancer treatment settings
A 2021 Australian review identified 243 barriers to exercise in cancer treatment settings based on 50 studies. Led by Dr. Mary A. Kennedy from Edith Cowan University in Perth, Western Australia, the researchers categorized the barriers into six levels in a health care system, which are:
- Organizational context
- Individual professional
- Innovation
- The patient
- Economic and political context
- Social context
Organizational context
- Capacity: Many health care providers reported the lack of time during patient visits to counsel, prescribe, and arrange exercise referrals because of heavy workloads and concerns about clinic workflow.
- Staff and resources: Clinics often lack trained exercise staff, funding to hire them or buy equipment, and referral networks. Without resources, the researchers report that clinic staff often hesitate to raise the topic. “It’s not worth bringing it up. You don’t plant the seed unless you can water it,” said one nurse in a 2020 study.
- Structures and organization of care processes: Few clinics have clear referral pathways, integrated exercise specialists, or systems to track patient activity. Therefore, the care is described as fragmented and reactive with limited follow-up on exercise.
Kennedy et al. reported that in one 2017 study from Western Australia that explored a state-run, non-profit exercise program designed for people with cancer, none of the participants were referred to the program by their treating oncology team.
Individual professional
- Knowledge: The researchers reported that health care professionals often report poor understanding of exercise and cancer, including guidelines, safe prescription during treatment, and behavior-change strategies, leading to vague or no advice.
“When patients ask me what they can do I say well just do whatever you want…” said one oncologist in a 2020 study. - Attitude: Some clinicians think patients are uninterested or unsuitable, such as because of their age or being in treatment. They worry about exercise safety or program quality, or view exercise as a low-priority “extra” outside their role.
“I mean for some people, the idea to put 80-year-old people on treadmills is close to torture…” said one general practitioner in a 2016 study.
Some healthcare professionals also thought that cancer patients may “overexert” themselves during exercise or exercise can make patients “even more weak,” according to a 2018 German study.
Innovation
- Advantages in practice: Kennedy et al. reported that some clinicians have doubts about the evidence or benefits of exercise for certain patient groups and therefore see little reason to promote it, particularly for those who are “already fit” or “elderly” or having chemotherapy.
- Accessibility: Cost, transportation, program location, and limited scheduling hinder patient participation and reduce provider referrals.
“It’s alright bringing up this about exercising, but how they’re going to get there, what’s the cost of it…I live on my own, you know, all these sorts of barriers that are put up,” said a breast cancer nurse in a 2019 study.
Patient
- Knowledge: Patients often do not know that exercise is recommended, how to exercise safely, or what programs exist. Advice from providers is commonly vague, contradictory, or absent.For example, Kennedy et al. cited two patients in a 2012 study who said “…they say to keep active in doing what you’re doing, and so that’s what I do” and “[the oncologist] didn’t really talk to me [about exercise]. He said it’s best and I took it upon myself.”
Economic and political context
- Policies and financial arrangements: Kennedy et al. reported a lack of policies that include exercise as part of cancer care as well as little reimbursement for exercise services, making referrals and program funding difficult. They cited a 2019 study where a majority of inactive patients were not considered “complex” enough to meet the medical requirements for a referral to physical or occupational therapists.
Social context
- Collaboration and leadership: Poor communication between oncology teams, primary care, allied health, and exercise providers limits referrals, according to Kennedy et. al.—as well as a lack of leadership support and funding. “I do think it probably is part of our role to be doing that but I don’t think it’s solely our role…we don’t always get to clinics to see patients for a follow-up, so consultants have to…take some of that responsibility as well…” said one colorectal cancer nurse from the same 2019 study.
Kennedy et al. wrote that all these barriers are “interrelated” and “solving one on its own will not be enough to create meaningful progress.”
“For exercise to be a meaningful part of routine care, programs need to be accessible to patients, yet the second most frequently reported barrier in our review described challenges related to cost, location and availability of exercise,” they reported.
Neighborhoods and personal safety
Neighborhood characteristics and safety can encourage or discourage people with cancer to exercise or be more physically active. These factors include public safety, walkability, socioeconomics, and accessibility to public transportation.
For example, a 2021 study found that neighborhoods that ranked low on the neighborhood socioeconomic status (nSES) were consistently linked to poorer cancer survival, lower quality of life, and reduced access to care in low-SES areas. Other metrics that many studies used include residential segregation and racial/ethnic composition, access to medical facilities and pharmacies, food environment (e.g. supermarkets vs. fast-food density), exercise opportunities, walkability, social cohesion, perceived neighborhood stress. The review was based on 291 studies from 2000 to 2021, and the cancers studied were primarily breast and colorectal.
Led by Dr. Kirsten Beyer from the Medical College of Wisconsin, the researchers reported that higher nSES predicts higher cancer survival and more follow-up care than areas with lower nSES. However, some studies find that racially-segregated areas have mixed effects.
For example, they cited a 2016 study of more than 35,400 Hispanic men in California found that those who were foreign-born have better survival rates after they were diagnosed with prostate cancer than U.S.-born Hispanic counterparts. The researchers hypothesized that a combination of factors that influence the higher survival rates, such as foreign-born Hispanics were less likely to adopt unhealthy American eating habits and having social and economic support while living in Hispanic communities.
However, a 2025 study of more than 34,000 men found that those who live in areas with higher levels of redlining—a measure of mortgage lending discrimination—were linked to worse prostate cancer survival. Men in highly redlined neighborhoods faced a 21% higher risk of dying from prostate cancer and a 25% higher risk of dying from any cause compared with men in low-redlined areas. While these associations held true for both Black and white men, this study reported that the association between racial lending bias and elevated mortality was “only observed among white men.”
Other findings include:
- Living on streets with high-quality sidewalks was significantly associated with better emotional well-being and social functioning among a sample of African-American breast cancer patients.
- Studies linked neighborhood amenities, walkability, and food environments to body size, diet adherence, and alcohol use. The researchers find that some breast cancer survivors who live near alcohol outlets were tied to higher alcohol consumption while better neighborhood amenities (nature trails, green belts, walkability) predicted higher physical activity levels.
- Higher neighborhood stress was associated with lower quality of health among Black and Hispanic breast cancer survivors in Los Angeles, California, according to a 2017 study. Such stress factors include housing situation, neighborhood environment, transportation, availability of public services, crime and violence, and relation with police.
Beyer et al. added that many of the neighborhood factors studied—such as intersection density, street connectivity, mixed land use, tree shade, and access to recreational facilities—align with LEED-ND (Leadership in Energy and Environmental Design for Neighborhood Development) criteria for healthy neighborhoods. This highlights the role of urban design in supporting cancer survivorship through opportunities for physical activity, social interaction, and resource access.
“Given that many of these measures are widely used in urban planning, design, and urban ecology, interdisciplinary collaboration will accelerate knowledge about the impact of these variables on survivorship,” Beyer et al. wrote.
Nick Ng is the editor of Massage & Fitness Magazine and the managing editor for My Neighborhood News Network.
An alumni from San Diego State University with a bachelor’s degree in graphic communications, Nick had completed his massage therapy training at International Professional School of Bodywork in San Diego in 2014. In 2021, he earned an associate’s degree in journalism at Palomar College.
When he gets a chance, he enjoys weightlifting at the gym, salsa dancing, and exploring new areas in the Puget Sound area in Washington state.
