Your cancer rehabilitation team: who does what in the UK

A cancer rehabilitation team is the group of people who help you stay as strong, well and independent as possible before, during and after treatment. In the UK it is usually coordinated by your clinical nurse specialist and can include physiotherapists, clinical exercise physiologists, Level 4 cancer rehabilitation instructors, dietitians, occupational therapists and psychological support. Not every hospital has every role.

Who is in a cancer rehabilitation team?

Your oncology doctors and your GP are involved, and usually a clinical nurse specialist. Depending on your needs and your hospital, the team can also include a physiotherapist, a dietitian, an occupational therapist, psychological support, a clinical exercise physiologist or a Level 4 cancer rehabilitation instructor. Not every hospital has every role.

UK prehabilitation guidance from 2019 says the team "could include any of the following: allied health professionals, cancer exercise physiologists, cancer exercise specialists, clinical nurses specialists, doctors, fitness instructors, information and support staff, pharmacists, psychologists, rehabilitation/therapy support workers and social workers" [1].

For what rehabilitation covers at each stage, see our cancer rehabilitation guide.

Clinical exercise physiologist: their part in the team

A clinical exercise physiologist tests how your body copes with exercise and writes a programme that fits your cancer, your treatment and your goals. Macmillan describes a CEP as "a healthcare professional who is an expert in screening, assessing and advising what physical activity is best for you and your situation" [2].

NHS Health Careers says CEPs are "responsible for prescribing and delivering evidence-based exercise to help patients prevent, treat and manage their long-term conditions", and lists oncology among the areas they work in [3]. Most train through a one-year master's degree in clinical exercise physiology after a relevant first degree; there is also an equivalence route to the register for people with suitable experience [3], but it closes on 31 December 2026. After that, only graduates of AHCS-accredited MSc programmes can register [22].

CEPs can join a voluntary register run by the Academy for Healthcare Science (AHCS), which opened to CEPs in January 2022 [4]. The register is accredited by the Professional Standards Authority [5]. Registration shows a CEP is "appropriately trained, meet[s] standards of proficiency, [has] indemnity insurance" and keeps learning [6]. This is not the statutory regulation that covers physiotherapists and dietitians. The title clinical exercise physiologist is not protected by law [10], so check the AHCS register.

CEPs complement physiotherapists rather than replace them. The Chartered Society of Physiotherapy notes that "The scope of practice of a UK registered CEP is not the same as a band 5 physiotherapist" [4]. Many people see both. For what a first appointment looks like, read what an exercise physiologist actually does for someone going through cancer treatment.

What is a Level 4 cancer rehabilitation instructor?

A Level 4 cancer rehabilitation instructor is a qualified fitness professional with an exercise referral qualification who has taken a specialist course in exercising safely with people who have cancer. Macmillan calls this role a cancer exercise specialist: "a fitness instructor who is qualified to help people with cancer to exercise safely" [2].

One provider, the WRIGHT Foundation, runs a five-day "Level 4 Cancer Rehabilitation" course, endorsed for CPD by CIMSPA (the Chartered Institute for the Management of Sport and Physical Activity), and asks for a relevant fitness qualification and an exercise referral qualification first [7]. Another, CanRehab, offers a "CanRehab Specialist Instructor qualification" assessed by written exam, client viva and case study [8].

Macmillan says cancer exercise specialists "might work in a gym or local leisure centre" [2], and many community cancer exercise classes are run by them. See cancer exercise programmes.

The 2025 UK prehabilitation guidelines list specialist exercise instructors at the universal and targeted levels (explained below), and note that instructors with a relevant degree or Level 4 qualifications could work at a higher level of practice. Targeted support is still assessed and prescribed by a registered healthcare professional [20]. Clinical exercise physiologists are listed at all three levels [20].

What do the other members of your cancer care team do?

Your clinical nurse specialist coordinates your care, a physiotherapist helps with movement, a dietitian with eating, an occupational therapist with pacing and tiredness, and psychological support with coping. Most are reached through your hospital team or GP.

Clinical nurse specialist

Macmillan says a CNS who specialises in your type of cancer "is usually your main contact at the hospital. They are called your key worker." They explain your treatment, "usually co-ordinate your care" and can "refer you to other services that can help" [9]. There may not always be a CNS for your cancer type, so ask your doctor.

Physiotherapist

Macmillan describes a physiotherapist as "someone who gives advice about exercise and mobility" [2]. Physiotherapist is a title protected by law: anyone using it must be registered with the Health and Care Professions Council (HCPC) [10].

Dietitian

A dietitian helps with eating well and eating problems around treatment. Macmillan describes dietitians as "experts in assessing people's food needs" who "can advise you about foods to eat or avoid, to help with any eating problems" [21]. The British Dietetic Association says dietitians "are the only nutrition profession with statutory (legal) regulation" [11]. Its Oncology Specialist Group began in 1988, "formed by a group of dietitians working with patients diagnosed with cancer" [12]. More in nutrition during cancer treatment.

Occupational therapist

Cancer rehab occupational therapy focuses on everyday life. Macmillan says your GP or cancer doctor may refer you to an OT, who "can advise you on how to pace yourself and manage tiredness" [2]. Occupational therapist is an HCPC-protected title [10]. See cancer-related fatigue.

Psychological support

Your CNS can give "practical and emotional support" and refer you on [9]. Psychologists are part of the prehabilitation workforce named in UK guidance [1], and "clinical psychologist" is an HCPC-protected title [10].

Your GP

If long-term side effects stop you being active, Cancer Research UK says your healthcare team or GP "can refer you to a physiotherapist or another healthcare professional who specialises in working with people with cancer" [13].

The team at a glance

Role	Register or title protection	What they do	Where you usually meet them	How to reach them
Clinical nurse specialist	Registered nurse	Key worker; coordinates care and refers you on [9]	Hospital cancer team	Usually allocated at diagnosis
Physiotherapist	HCPC; title protected by law [10]	Exercise and mobility [2]; pain management [16]	Hospital, community, private	CNS, MDT or GP referral; some private
Clinical exercise physiologist	Voluntary AHCS register, accredited by the PSA [4][5]	Exercise testing and a prescribed programme [2][3]	Some NHS services, private practice, remote	Hospital team, exercise referral, or direct
Level 4 cancer rehabilitation instructor	Title not protected [14]; course endorsement varies (e.g. CIMSPA-endorsed for CPD [7])	Delivers supervised exercise at universal and targeted levels; targeted programmes are assessed and prescribed by a registered professional [20]	Gyms, leisure centres, community classes	Exercise referral schemes or direct
Dietitian	HCPC; title protected by law [10][11]	Eating well and eating problems [21]	Hospital or community	CNS, MDT or GP referral
Occupational therapist	HCPC; title protected by law [10]	Pacing, tiredness, daily tasks [2]	Hospital or community	GP or cancer doctor referral [2]
Psychological support	"Clinical psychologist" is HCPC-protected [10]	Emotional support, coping	Hospital, charities, GP services	Ask your CNS or GP [9]

How do the members of a cancer rehabilitation team work together?

They work in layers: everyone gets expert advice, some people get targeted support, and people with complex needs get specialist care from registered professionals. UK prehabilitation guidelines describe these levels as universal, targeted and specialist. They cover support before treatment and call rehabilitation "related but distinct", but the layers are a useful way to picture the team [20].

Universal prehabilitation is "the provision of expert advice on exercise, nutrition and psychological support, along with behaviour change advice, to all individuals before cancer treatment"; "Generic lifestyle advice alone does not constitute universal prehabilitation". Targeted prehabilitation "is assessed and prescribed by a registered healthcare professional with relevant competencies and may be delivered by un-registered or non-healthcare professionals". Specialist prehabilitation "is assessed, prescribed and delivered by registered healthcare professionals" [20]. The guidelines add "a workforce matrix aligned to the ACCEND framework" to help services decide who delivers each level [15].

An example in the earlier 2019 guidance describes a patient's exercise prescription "designed by a physio/ clinical exercise physiologist or supervised by a cancer exercise specialist", alongside a review with a dietitian [1]. At The Royal Marsden, patients are first triaged and assessed by physiotherapists, who also cover pain and screening for warning signs [16]. The service's cancer exercise specialist holds an MSc in clinical exercise science as well as Level 3–4 cancer rehabilitation qualifications, and was registering with the Registration Council for Clinical Physiologists (RCCP); after that assessment he manages his own caseload, and some patients see only him while others see both [16].

For support before treatment starts, see our prehabilitation guide.

Is "cancer exercise specialist" a protected title?

No. "Cancer exercise specialist", "exercise oncology specialist" and "cancer rehabilitation specialist" are not protected titles in the UK. The CSP says exercise professionals "do not have statutory regulation like physiotherapists and titles are not protected" [14].

That does not mean the person is unqualified; ask what sits behind the title. For the full set of levels, see types of exercise professional in the UK.

How can you check someone's credentials?

Ask which register or course sits behind their title, then check it yourself.

• Clinical exercise physiologist: use the Academy for Healthcare Science register, which you can look up by name, ID, location or specialism [17].
• Physiotherapist, dietitian or occupational therapist: check the HCPC register by surname or registration number [18].
• Level 4 cancer rehabilitation instructor: ask to see their course certificate first. You can also try the CIMSPA member directory, which CIMSPA calls "the definitive list of qualified and recognised sport and physical activity professionals" [19]. Not everyone qualified is a CIMSPA member, so absence from the directory is not proof they are unqualified.

If someone cannot tell you, or you cannot confirm what they say, talk to your CNS before you start.

Getting matched through The Health Nav

NHS rehabilitation is not available everywhere. At the moment, The Health Nav matches people with verified clinical exercise physiologists only, in person in parts of south-west London and remotely across the UK. A CEP works alongside your NHS team, not instead of it.

Dietitians, specialist nurses, physiotherapists, occupational therapists and Level 4 instructors are important members of the wider team, reached through your hospital team or GP. Questions first? Email support@thehealthnav.co.uk.

Request a match with a verified clinical exercise physiologist through The Health Nav.

Talk to your oncology team first

• Tell your CNS or cancer doctor before starting any new exercise programme, and keep them informed if you work with someone outside the hospital.
• Macmillan advises talking to "your cancer doctor, specialist nurse or GP if you are new to exercising or if you have any concerns before you start exercising" [2].
• Get advice first if cancer affects your bones or your immunity is low [13], or if you have a new or unexplained symptom.

This article is general information and does not replace advice from your own healthcare team.

References

1. Macmillan Cancer Support, Royal College of Anaesthetists, NIHR Cancer and Nutrition Collaboration. Principles and guidance for prehabilitation within the management and support of people with cancer. 2019. https://cdn.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/1532-10061/prehabilitation-for-people-with-cancer-tcm9-353994 (accessed 12 Oct 2026).
2. Macmillan Cancer Support. Physical activity and cancer. https://www.macmillan.org.uk/cancer-information-and-support/treatment/preparing-for-treatment/physical-activity-and-cancer (accessed 12 Oct 2026).
3. NHS Health Careers. Clinical exercise physiologist. https://www.healthcareers.nhs.uk/explore-roles/healthcare-science/roles-healthcare-science/physiological-sciences/clinical-exercise-physiologist (accessed 12 Oct 2026).
4. Chartered Society of Physiotherapy. Supporting the development of a Clinical Exercise Physiologist: FAQs. https://www.csp.org.uk/node/1303511 (accessed 12 Oct 2026).
5. Academy for Healthcare Science. PSA accredited register. https://www.ahcs.ac.uk/registration/psa-accredited-register/ (accessed 12 Oct 2026).
6. Chartered Association of Sport and Exercise Sciences. BASES and CEP-UK announce Clinical Exercise Physiologists now eligible for professional registration. 14 December 2021. https://www.cases.org.uk/article-bases_and_cep_uk_announce_clinical_exercise_physiologists_now_eligible.html (accessed 12 Oct 2026).
7. WRIGHT Foundation. Level 4 Cancer Rehabilitation. https://www.wrightfoundation.com/course/level-4-cancer-rehabilitation-09-12-25/ (accessed 12 Oct 2026).
8. CanRehab Education. https://canrehabeducation.co.uk/ (accessed 12 Oct 2026).
9. Macmillan Cancer Support. Macmillan nurses. https://www.macmillan.org.uk/cancer-information-and-support/get-help/macmillan-nurses (accessed 12 Oct 2026).
10. Health and Care Professions Council. The professions we regulate. https://www.hcpc-uk.org/about-us/who-we-regulate/the-professions/ (accessed 12 Oct 2026).
11. British Dietetic Association. Dietitian or nutritionist? https://www.bda.uk.com/about-dietetics/what-is-dietitian/dietitian-or-nutritionist.html (accessed 12 Oct 2026).
12. British Dietetic Association. Oncology Specialist Group. https://www.bda.uk.com/specialist-groups-and-branches/oncology-specialist-group.html (accessed 12 Oct 2026).
13. Cancer Research UK. Exercise guidelines for people with cancer. https://www.cancerresearchuk.org/about-cancer/coping/physically/exercise-guidelines (accessed 12 Oct 2026).
14. Chartered Society of Physiotherapy. Frequently asked questions about exercise professionals. https://www.csp.org.uk/campaigns-influencing/campaigns/collaborate-dont-compete/faq-about-exercise-professionals (accessed 12 Oct 2026).
15. Macmillan Cancer Support. Prehabilitation: transforming cancer care before treatment begins. https://www.macmillan.org.uk/healthcare-professionals/news-and-resources/blogs/prehabilitation-transforming-cancer-care-before-treatment-begins (accessed 12 Oct 2026).
16. Chartered Society of Physiotherapy. Case study: The Royal Marsden cancer rehab service. https://www.csp.org.uk/node/1335164 (accessed 12 Oct 2026).
17. Academy for Healthcare Science. Search the Academy for Healthcare Science Register. https://app.ahcs.ac.uk/search (accessed 12 Oct 2026).
18. Health and Care Professions Council. Check the Register. https://www.hcpc-uk.org/check-the-register/ (accessed 12 Oct 2026).
19. CIMSPA. The CIMSPA Member Directory can help you advance your career. https://cimspa.co.uk/the-cimspa-member-directory-can-help-you-advance-your-career/ (accessed 12 Oct 2026).
20. Macmillan Cancer Support. Prehabilitation for people with cancer: clinical and implementation guidelines. October 2025. https://www.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/22869-10061/prehabilitation-for-people-with-cancer-clinical-and-implementation-guidelines (accessed 12 Oct 2026).
21. Macmillan Cancer Support. Eating problems and cancer. https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/eating-problems (accessed 12 Oct 2026).
22. Academy for Healthcare Science. CEP-UK and AHCS to close portfolio registration pathway for Clinical Exercise Physiologists in December 2026. 10 December 2025. https://ahcs.ac.uk/2025/12/10/cep-uk-and-ahcs-to-close-portfolio-registration-pathway-for-clinical-exercise-physiologists-in-december-2026/ (accessed 12 Oct 2026).