Stronger Together: How Specialized Physiotherapy & Cancer Exercise Redefine Recovery -  By Dr. Mhawej, Marie-Antoinette, DPT, CES, CLT-LANA, Cancer Physiotherapist and Cancer Exercise Specialist

Survivorship Isn’t the End — It’s the Beginning of Recovery

Cancer recovery doesn’t end when the treatment stops. Survivors frequently face persistent functional impairments long after their treatment ends (1). That’s when the real journey begins. 

“She survived cancer, but couldn’t lift her arm above her shoulder. Walking to the mailbox left her breathless. Nobody told her that she should have to relearn how to move. She did, but not alone. It took a team that understood both her clinical challenges and her untapped potential to thrive.”

Unfortunately, too many survivors are discharged with little more than a pamphlet and well wishes. The issue isn’t a lack of resources, but a lack of coordinated services in the cancer care system.  A truly effective recovery requires an integrated approach, where both specialized rehabilitation and cancer-specific exercise are delivered in a coordinated, evidence-based framework (2,3).

As a dual-certified cancer physiotherapist and CETI OncoVie™ Cancer Exercise Specialist (CES), I’ve seen firsthand how bridging these roles transforms outcomes. It is not just about function, it’s about returning confidence and vitality to every survivor’s life (4,5).

Two Experts. One Path to Recovery.

• Cancer Physiotherapy: Laying the Foundation 

Oncology-trained physiotherapists are uniquely equipped to address physical impairments caused by cancer and its treatment, such as fibrosis, lymphedema, fatigue, pain, and surgical limitations. Through specialized manual therapy, functional training, and targeted rehabilitation techniques, we restore the foundation for safe, pain-free movement (6,7). 

• CETI OncoVie™ Cancer Exercise Specialist (CES): Rebuilding Strength & Confidence 

Once a survivor is medically cleared and foundational impairments are addressed, a cancer exercise specialist (CES) steps in. With their expert knowledge, they deliver a structured, evidence-based movement tailored to each individual’s health status, goals, and risks. They help patients rebuild strength, endurance, and independence (8,9).

One without the other? Incomplete.

Together? Transformational.

The Power of Integration: A Coordinated Continuum of Care 

This model isn’t linear, it’s integrated. They complement each other in the right order, for the right reasons.

• Start Early: Physiotherapists in oncology clinics for early screening throughout the continuum of cancer care (10).
• Build a Bridge: Transition patients from rehabilitation to CES-guided progressive exercise (11).
• Coordinate as a Team: Collaborate on team-based workflows for personalized care across phases (12,13).

When individualized rehabilitation and structured exercise work together in a coordinated model, recovery becomes not only safer but also more sustainable.

Why This Model Works 

• 🚫 Reduces long-term complications (14,15).
• 📈 Boosts energy and physical function (15,16).
• 🎯 Delivers individualized, progressive care (16).
• 🧠 Improves mental health and well-being (17,18).
• 📅 Supports sustainable, long-term care (19).

What Patients Gain 

• 💡 Faster return to independence (15,16).
• 🚫 Reduced chronic side effects (14).
• 💪 Confidence in a stronger body (16).
• 📅 Structured guidance (15).
• 📈 Improved Long-term outcomes

A Call for a New Standard of Care

We are in the middle of a cancer survivorship boom. More people are living with and beyond cancer than ever before (14). And yet, too many survivors are discharged with nothing more than a pamphlet and a hopeful farewell.

It’s time to redefine recovery. Survivors deserve a team that speaks both languages: the clinical and the functional. A system that addresses impairments and empowers potential. A care model that doesn’t end at survival, but begins at recovery.

Stronger together. Because no survivor should have to walk this path alone or connect the dots themselves.

Marie-Antoniette is a Doctor of Physical Therapy with extensive clinical, teaching, and research expertise, specializing in women's health including pelvic floor rehabilitation, Breast cancer rehabilitation, Prenatal and Postnatal Fitness & Therapeutic Yoga across Canada and Lebanon. A Licensed member of the "Ordre Professionnel de la Physiothérapie du Quebec", and the Order of Physiotherapists in Lebanon. I have delivered high-quality patient care, taught at the University of Montreal, and participated in research. I have committed to evidence-based practices, conferences, and continuing education courses. 

She has her Doctorate in physical therapy (DPT) from the University of Montana, USA (2023), Rehabilitation Administration Certificate from the University of Montana, USA (2023), Qualification program in Physiotherapy (QPP) from the University of Montreal, Canada (2016), Master of Physiotherapy (MSc PT) from the Lebanese German University, Lebanon (2011), Bachelor of Physiotherapy from the Lebanese German University, Lebanon (2008), and Padma yoga and Physiotherapy (2021).

REFERENCES:

1. Nekhlyudov, L., Mollica, M. A., Jacobsen, P. B., Mayer, D. K., Shulman, L. N., & Syrjala, K. L. (2022). Developing a quality of cancer survivorship care framework: Implications for clinical practice, research, and policy. Journal of the National Cancer Institute, 114(2), 184–193. https://doi.org/10.1093/jnci/djab206
2. Smith, L., Croker, H., Fisher, A., Williams, K., Wardle, J., & Beeken, R. J. (2023). Cancer and exercise: A new era of tailored rehabilitation throughout the cancer continuum. CA: A Cancer Journal for Clinicians, 73(1), 33–52. https://doi.org/10.3322/caac.21762
3. Brown, J. C., Winters-Stone, K., Lee, J., & Schmitz, K. H. (2023). Cancer exercise programming: Evidence, guidelines, and implementation. Seminars in Oncology Nursing, 39(1), 151364. https://doi.org/10.1016/j.soncn.2022.151364
4. Lee, M. K., Park, H., & Oh, J. (2023). Effects of coordinated cancer rehabilitation integrating physiotherapy and exercise specialists: A pilot program analysis. Rehabilitation Oncology, 41(2), 56–64. https://doi.org/10.1097/01.REO.0000902833.34833.9d
5. Mitchell, S. A., Beck, S. L., Hood, L. E., Moore, K., & Tanner, E. (2024). Integrated survivorship care: Bridging rehabilitation and exercise for long-term recovery. Journal of Cancer Survivorship, 18(1), 1–12. https://doi.org/10.1007/s11764-023-01442-w

• Gilchrist, L., Levenhagen, K., Davies, C. C., & Colleagues. (2024). Effectiveness of complete decongestive therapy for upper extremity breast cancer–related lymphedema: A review of systematic reviews. Medical Oncology, 41(11), Article 297. https://doi.org/10.1007/s12032-024-02421-6

• Valdivia-Martínez, M., Fernández-Gualda, M. Á., Gallegos-García, E., Postigo-Martin, P., Fernández-González, M., & Ortiz-Comino, L. (2024). Physiotherapy interventions in lung cancer patients: A systematic review. Cancers, 16(5), 924. https://doi.org/10.3390/cancers16050924

• Buffart, L. M., Kalter, J., Sweegers, M. G., Courneya, K. S., Newton, R. U., Aaronson, N. K., & Brug, J. (2016). Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 randomized controlled trials. British Journal of Sports Medicine, 50(14), 812–824. https://doi.org/10.1136/bjsports-2015-095311

• Mutrie, N., Campbell, A. M., Faulkner, J., & Kee, F. (2018). Effects and moderators of exercise intervention on muscle strength and aerobic fitness in cancer patients: An IPD meta-analysis. British Journal of Sports Medicine, 52(15), 991–999. https://doi.org/10.1136/bjsports-2017-097725

• Scott, J. M., Nilsen, T. S., Courneya, K. S., & Thomas, R. J. (2024). Supervised, structured, and individualized exercise in metastatic cancer patients: A 9-month intervention study. Nature Medicine. https://doi.org/10.1038/s41591-024-03143-y

1. Courneya, K. S., McNeely, M. L., Booth, C. M., & Friedenreich, C. M. (2024). Exercise across the postdiagnosis cancer continuum: The EPiCC framework. Frontiers in Oncology, 14, 1432899. https://doi.org/10.3389/fonc.2024.1432899

• Santanmina, D., et al. (2021). Multiphasic prehabilitation across the cancer continuum: A narrative review and conceptual framework. Frontiers in Oncology, 10, 598425. https://doi.org/10.3389/fonc.2020.598425

• Swarnakar, R., & Yadav, S. L. (2025). Integration of rehabilitation and palliative care in cancer management: A futuristic model. World Journal of Clinical Cases, 13(12), 102326. https://doi.org/10.12998/wjcc.v13.i12.102326

• Schneider, K., et al. (2023). Embedding rehabilitation into the cancer care continuum: The Rehab-Toolkit model. Supportive Care in Cancer, 31(4), 2123–2132. https://doi.org/10.1007/s00520-022-07123-4

• Li, X., Su, J. J., Winnige, P., Chamradova, K., Dosbaba, F., Batalikova, K., Lin, R., Antoniou, V., & Batalik, L. (2025). Feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer: A systematic review. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-025-01234-5

• Su, J. J., Winnige, P., Chamradova, K., Dosbaba, F., Batalikova, K., Lin, R., Antoniou, V., & Batalik, L. (2025, March 22). Feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer: A systematic review. Journal of Cancer Survivorship.

• Rodrigues, B., Encantado, J., Franco, S., & Silva, M. N. (2023). Psychosocial correlates of physical activity in cancer survivors: Systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity.

• Patel, R., Morrison, E. J., & Breitbart, W. (2024). Meaning-centered interventions in cancer care: A review of outcomes. Frontiers in Psychology, 15, 2247. https://doi.org/10.3389/fpsyg.2024.02247

1. CBT meta-analysis reducing fatigue in cancer patients (2023). PubMed Central

• Li, Y., Ekwueme, D. U., Rim, S. H., Guy, G. P., & Richardson, L. C. (2022). Prevalence and care of cancer survivors — United States, 2015–2019. MMWR Morbidity and Mortality Weekly Report, 71(36), 1–6. https://doi.org/10.15585/mmwr.mm7136a1