(Photo by Julia Larson)
For decades, the standard advice for patients with cancer was rest: Conserve energy, avoid exertion, and let treatments work. More recently, science has rewritten that script. Emerging evidence from the National Cancer Institute (NCI) and the American College of Sports Medicine (ACSM) underscores that exercise isn’t just safe—it’s a powerful adjunct therapy in treating cancer.
A 2022 review in Cancers reported that moderate-intensity aerobic training and resistance exercises during and after treatment can reduce fatigue by up to 30%, help with anxiety and depression, and boost health-related quality of life.
A 2025 review in the British Journal of Sports Medicine, found good evidence that exercise reduces cancer-related pain, improves sleep, and enhances cognitive function, particularly in survivors of breast and lung cancers. Preclinical studies suggest it even amplifies the effects of chemotherapy by improving drug delivery to tumors through better vascularization.
These benefits extend to survival. The American College of Sports Medicine’s Roundtable report on physical activity and cancer prevention show physically active breast cancer survivors face 20-40% lower recurrence risk, while colorectal and prostate patients see similar reductions in mortality.
A 2022 survey of 375 healthcare professionals in cancer care revealed strong endorsement of exercise with nearly all likely to advise physical activity. Most of these professionals discussed its role in symptom management, yet just over half routinely refer patients to structured exercise programs or specialists.
The ACSM’s 2019 Roundtable recommended that all cancer survivors should aim for 150 minutes of moderate aerobic activity and two sessions of strength training per week. Despite that recommendation, fewer than half of survivors meet these guidelines. Barriers such as pain, fatigue, cost, and misinformation persist.
As with all training, exercise for patients with cancer or survivors of cancer should be personalized. The program needs to consider the type of cancer, stage, and side effects to be most effective.
Despite the robust evidence, insurance coverage for exercise during treatment remains patchwork in the U.S. and Canada. Many patients who want to take part in a supervised exercise program find themselves doing so while paying out of pocket.
In the U.S., Medicare (Part B) covers outpatient physical therapy for cancer-related impairments like lymphedema or neuropathy, but only if deemed medically necessary. Cardiac rehab, which includes exercise, is reimbursable for some cancers (e.g., post-chemo heart issues), yet oncology-specific programs are still often denied because they are not considered medically necessary.
A 2022 guideline from the American Society of Clinical Oncology states that exercise during curative treatment improves outcomes. A savvy physical or occupational therapist can get this type of exercise covered by using a more general diagnosis, such as debility, generalized muscle weakness, or other malaise.
Generally, Medicare part B will pay for these diagnosis codes provided the services provided are medically necessary and skilled, meaning they are complex and sophisticated enough that the patient cannot perform them on their own. This coverage may not vary from state to state. Medicaid programs may cover these diagnoses, too, but state regulations can limit the number of visits or how many units can be billed during a single session.
Private insurers like Blue Cross, Blue Shield, and United Healthcare may also cover these diagnoses, but coverage varies widely by plan. Another major variable for those battling cancer with private insurance is the cost to the patient.
Outpatient physical therapy visits can range from $5 to $100 or more depending on deductible amounts, in-network vs. out-of-network coverage, or out-of-pocket maximum values. Nearly half of all insured patients with cancer reported debt exceeding $5,000, per the American Cancer Society Cancer Action Network.
Canada’s universal system is better, but it is not without its own challenges. Provincial plans cover physician-directed rehab, but exercise oncology isn’t standardized. Ontario’s Cancer Care Ontario funds community-based programs like the Alberta Cancer Exercise (ACE) initiative, which integrates aerobic and resistance training into survivorship care at no cost.
British Columbia’s Provincial Health Services Authority reimburses supervised sessions for fatigue or mobility issues, yet coverage in Quebec is limited to services accessed through a hospital system. The Quebec Cancer Foundation bridges the gap between hospital-based and non-hospital based physiotherapy with programs of its own. The Foundation provides free kinesiology services—personalized exercise, group sessions, post-op follow-ups—to help patients with cancers manage fatigue and mobility issues.
In Canada’s eastern provinces, public health insurance covers in-person, supervised exercise sessions in hospitals or approved clinics, but it does not provide the support needed to continue exercising at home. Patients must pay out-of-pocket or use private supplemental insurance to get home-based exercise equipment, apps, virtual coaching, or printed workout plans—even if these are prescribed by their oncologist.
Out-of-pocket costs for a 12-week program can cost upwards of $1,000, a major deterrent to those who weren’t avid exercisers prior to their diagnosis, those on a fixed budget (as most seniors are), and low income survivors.
Some options for integrating cost-effective exercise into their cancer treatment plan include:
- Nonprofit registries like ACSM’s Moving Through Cancer, which lists free or sliding-scale community classes at YMCAs or cancer centers.
- Patient assistance funds from the Leukemia & Lymphoma Society or Canadian Cancer Society cover copays for vulnerable groups. While generally helpful in this population in terms of exercise, this only helps if the exercise program is covered by insurance in the first place.
- Free clinical trials test exercise interventions while providing access if you qualify.
Legislative momentum is building. In the U.S., the advent of coverage of telehealth by the Centers for Medicare and Medicaid Services can be helpful to patients who don’t live near specialists. Using synchronous visits, the patients and specialists can work together to find real-time solutions to exercise barriers and explore modifications based on what the patient has available at home. Cancer coverage of telehealth by commercial insurers, like all services, varies widely by provider and policy.
Related: Medicare may cover massage therapy under specific circumstances
Penny Goldberg, DPT, ATC
Penny Goldberg, DPT, ATC earned her doctorate in Physical Therapy from the University of Saint Augustine and completed a credentialed sports residency at the University of Florida. She is a Board Certified Clinical Specialist in Sports Physical Therapy.
Penny holds a B.S. in Kinesiology and a M.A. in Physical Education from San Diego State University. She has served as an Athletic Trainer at USD, CSUN, and Butler University.
She has presented on Kinesiophobia and differential diagnosis in complicated cases. Penny has published on returning to sports after ACL reconstruction and fear of movement and re-injury.
Outside of the clinic, Penny enjoys traveling, good cooking with great wine, concerts, working out and playing with her dogs.