What does an exercise physiologist actually do for someone going through cancer treatment?
You've been told exercise would help during your treatment. Possibly you've read our article “Why is exercise during cancer treatment helpful?” and you are keen to start.
Then comes the practical question: how do I actually do it? The professional who sits down with your diagnosis, your treatment plan, and your last set of bloods and builds something around them.
In the UK, that person is usually a Clinical Exercise Physiologist. This page explains what they are, what happens when you see one, and what they're doing behind the scenes that a generic exercise programme can't.
What a Clinical Exercise Physiologist is
A Clinical Exercise Physiologist — CEP — is a healthcare professional who uses exercise as a clinical treatment for people with complex or long-term conditions. This is not necessarily to get you fit in the sense of how most people would define that word but to help you manage what's happening to you.
The profession's own progress report describes CEPs as qualified to "screen and triage, complete functional assessments, prescribe and deliver safe and effective exercise." Cancer is one of nine condition areas in the scope of practice, alongside cardiovascular, respiratory, neurological, metabolic and musculoskeletal conditions.
UK CEPs work in NHS cardiac rehabilitation, pulmonary rehabilitation and cancer services, and across the private practice sector. The registration sits with the Academy for Healthcare Science, on a register accredited by the Professional Standards Authority. This register a voluntary register, not statutory regulation. "Clinical Exercise Physiologist" is not yet a legally protected title in the UK, which is exactly why we check each practitioner's registration. Every CEP on The Health Nav is AHCS-registered and personally reviewed by our team.
And plainly: a CEP is not a personal trainer. This is not a criticism of personal trainers, who do a different job well. But nobody with a cancer diagnosis should have to work out from a job title whether the person in front of them can read a treatment plan.
Where a CEP sits alongside your oncology team and your physiotherapist
Your oncology team runs your treatment; that doesn't change, and nothing a CEP does displaces any part of it.
Physiotherapy is the question people ask most, and the clearest answer comes from the physiotherapy profession itself. The Chartered Society of Physiotherapy runs a project on this called Collaborate, don't compete. Its position is that CEPs "specialise in the prescription and delivery of evidence-based exercise interventions" across conditions from prevention through to rehabilitation and long-term management, that "the scope of practice of a UK registered CEP is not the same as a physiotherapist," and that the demand for clinical exercise "cannot be met by expanding the physiotherapy workforce alone."
Different points on the pathway, different training, same patient. If you're seeing a physiotherapist for a specific post-surgical problem, a shoulder that won't move properly after breast surgery, for example, that work continues. A CEP is generally concerned with the whole of your physical capacity across the length of your treatment.
What happens in a first appointment
Your treatment history, in detail. What you've been diagnosed with, what your treatment has looked like so far and what's coming and when, your medications, your surgeries and their dates. Recent bloods if you have them and anything else you're managing, a dodgy knee, high blood pressure, asthma, all important and won’t have gone away because of your new diagnosis.
A screening conversation. This is the risk-stratification step, and it decides everything that follows. Some things mean a programme should be modified; some mean your CEP should check with your oncology team or your surgeon before starting. Established international guidance sets out exactly this kind of triage, and a good CEP will work through this deliberately and carefully.
Baseline measures. Usually simple, functional things, and it will entirely depend on the person in front of them — how far you can walk in a set time, how many times you can stand from a chair, grip strength, balance, how your body responds to gentle effort. They're not a test you pass or fail, but a moment in time; they exist so that in six weeks there's something to compare against, and so that if something is changing, it gets noticed early.
Arguably the most important part: a conversation about what you want to be able to do. This is not a target weight or a step count, but something that is tangible and important for you; this could be, getting up the stairs without stopping halfway, carrying your own shopping, staying in work through treatment, walking your daughter down the aisle in October. The answer shapes the whole programme, which is why a good CEP will ask this first and build the programme around you.
How your programme is built around your treatment
This is the difference between clinical exercise physiology and a plan you could download. Cancer treatment isn't a flat line, and neither is how you feel during it. Chemotherapy runs in cycles, often people have a predictable pattern within each one — days that are hard, days that lift. Radiotherapy tends to bring fatigue that accumulates across the course rather than hitting on day one. Surgery has a recovery timeline with real restrictions attached to it. Hormone therapy affects bone and muscle over months.
We plan harder work for the part of your cycle where you can absorb it. The week after an infusion asks less of you. If your surgery is six weeks away, the plan runs to that date and picks up on the other side of it. Guided by how you feel, your cycle length, your surgical date, or that your bloods came back low on Thursday. A clinician can, and the international consensus guidance is explicit that when someone is on active treatment, working closely with the oncology team is part of the job, because treatment plans change.
What a session actually looks like
Sessions typically run 30 to 60 minutes, one-to-one, and sometimes in small groups. Some CEPs work from a clinic room, some come to you, some work online, and many do a mix: a supervised session or two to establish technique and confidence, then work you can do at home with check-ins. Research consistently shows supervised programmes producing greater improvements in mood, physical function and quality of life than programmes people do entirely alone.
Equipment needed depends on you, what you have available and your current ability; bodyweight movements, resistance bands, dumbbells, a chair, a bike, or a corridor to walk can all be part of the equipment list.
Intensity is calibrated to you on that day, not to an average patient in a study. Macmillan's guidance is a good description of the target: at the end of an activity you should feel energised, not exhausted. Some days that's a full session, some days it's ten minutes of movement and a conversation about why this week has been hard.
How it changes as you go
The work isn't the same at every stage, which is why this is a relationship rather than a programme.
Before treatment — prehabilitation. The weeks between diagnosis and surgery or the start of treatment are a genuine window, and the aim is to go into treatment with more in reserve. → What is prehab, and how can it help me before my surgery?
During treatment. Holding on to strength and function, and managing fatigue — the outcome with the strongest evidence behind it.
→Why is exercise during cancer treatment helpful
After treatment. Rebuilding what treatment took, and dealing with the side effects that outlast it. This is often when people feel most adrift: the appointments stop, and everyone assumes you're fine. Psychologically, this can be a difficult time period, and a feeling like your safety net has gone.
What your CEP is watching for
While you're working, your CEP will be monitoring you, and the list of things that change what you should be doing is long. Your bloods. Cancer treatment can affect red cell counts, white cells and platelets. Those numbers change how hard you should be working and, at times, whether a session should go ahead.
Peripheral neuropathy. Numbness and altered sensation in hands and feet are common with certain chemotherapies, and it affects balance and grip. It changes what's safe to stand on, hold, or step over. International guidance flags neuropathy as a reason to modify a programme and to have a medical assessment first.
Bone health. Some treatments reduce bone density; some cancers spread to bone. Where there are bone lesions and bone mets, guidance is specific: avoid loading the affected skeletal site, and don't run maximal strength testing on muscles acting on it.
Post-surgical restrictions. Lifting limits, wound healing, range of movement, and — after abdominal or chest surgery — a staged return that respects what was actually done in theatre.
Lymphoedema and lymph node surgery. Advice here has changed; the current evidence supports progressive resistance training, started under supervision, on a "start low, progress slow" basis, rather than the avoidance that used to be recommended.
And how you're actually tolerating it. Guidance says the clinician should watch for early signs that training isn't being tolerated and adjust the dose; "even if this means dropping below recommended training volumes." The guideline itself expects the plan to bend around the person.
How they work with the rest of your team
In practice, that means being clear about what falls outside their scope and referring on when it does. It means asking you to check with your oncology team or surgeon where guidance says clearance is needed, and it means keeping your team informed — a short summary of what was assessed, what's been prescribed and how you're responding, so that what you're doing isn't invisible to the people running your treatment.
That's the standard we think patients should expect and the standard we advocate for. If it matters to you, ask about it directly at a first appointment. It's a fair question and a good CEP will have a clear answer.
International guidance also asks oncology clinicians to assess activity, advise on it and refer — while acknowledging they aren't expected to write the exercise prescription themselves. That division of labour is the point: your oncologist decides your treatment and a CEP builds your exercise programme around it.
How you get to see one
There's no search box here, and that's deliberate. Nobody halfway through chemotherapy should be assessing strangers' credentials.
- You get in touch. Name, email and phone number
- We call you. A short conversation about your situation, what your treatment involves and your stage, location and session type (in-person or virtual).
- We match you. We find a Clinical Exercise Physiologist who works with cancer and is near enough to be practical — AHCS-registered, verified by our team.
- We introduce you. You take it from there with your CEP, who confirms how they work and what it costs before anything is booked.
Some NHS trusts run good cancer exercise and prehabilitation services, and if yours does, ask your team about it directly. Provision across the UK is uneven, and many trusts can't offer it at all. We have built The Health Nav to allow more people to access clinical exercise across the UK.
Common questions
Do I need a referral from my GP or oncologist? No. You can come to us directly. That said, we'd always encourage you to tell your oncology team you're starting — and there are situations where guidance says you should be medically assessed or cleared before you begin. Your CEP will identify those at your first appointment.
What does it cost? The Health Nav is free to use. Clinical Exercise Physiologists set their own fees, and your practitioner will confirm the cost with you before anything is booked.
Will my insurance cover it?
Usually not, and we'd rather tell you that straight than let you find out later. UK insurers widely recognise physiotherapy; Clinical Exercise Physiology is a newer registered profession and cover isn't standard. If you hold a policy, check directly with your insurer — some will consider it case by case — and ask your CEP what they've seen.
Do I need to be fit already?
No, not at all. The programmes in the research were run with people going through chemotherapy and radiotherapy, not with athletes. Starting from a low baseline is the normal case, not the exception.
Can I start while I'm still on treatment?
Yes: that's the most common time to start. ASCO's 2022 guideline recommends aerobic and resistance exercise during treatment given with curative intent, specifically to reduce the side effects of therapy. Your programme gets built around your treatment schedule rather than waiting for it to finish.
What if I have a bad week and can't do anything?
Bad weeks are normal and to be expected. Programmes are adjusted around how you are, and a session that becomes a conversation and ten minutes of gentle movement is still a session.
Ready to talk to someone? Tell us about your diagnosis, where you are in treatment, and where you're based. We'll match you with a Clinical Exercise Physiologist who specialises in cancer — AHCS-registered and personally verified by our team. Free to use, and you won't be left searching a directory yourself.
→Reach out to our team to find your Clinical Exercise Physiologist
This article is general information and is not a substitute for advice from your oncology team. Always speak to them before starting or changing physical activity during cancer treatment.
Sources
- Jones H, Crozier A, George K, et al. Establishment of clinical exercise physiology as a regulated healthcare profession in the UK: a progress report. BMJ Open Sport Exerc Med. 2024;10(2):e002033. https://pmc.ncbi.nlm.nih.gov/articles/PMC11191777/
- Clinical Exercise Physiology UK (CEP-UK). AHCS Registration. https://www.clinicalexercisephysiology.org.uk/ahcs-registration
- The Chartered Society of Physiotherapy. Collaborate, don't compete — supporting the development of a Clinical Exercise Physiologist. https://www.csp.org.uk/professional-clinical/improvement-innovation/collaborate-dont-compete/supporting-development
- Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019;51(11):2375–2390. https://journals.lww.com/acsm-msse/fulltext/2019/11000/exercise_guidelines_for_cancer_survivors_.23.aspx
- Ligibel JA, Bohlke K, May AM, et al. Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. J Clin Oncol. 2022;40(22):2491–2507. https://pubmed.ncbi.nlm.nih.gov/35576506/
- Schmitz KH, Campbell AM, Stuiver MM, et al. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA Cancer J Clin. 2019;69(6):468–484. https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21579
- Macmillan Cancer Support. Being active during cancer treatment. https://www.macmillan.org.uk/cancer-information-and-support/treatment/preparing-for-treatment/physical-activity-and-cancer/during-treatment