Drawing on the success of the Prehab4Cancer (P4C) Programme in Greater Manchester, there is rapidly growing evidence showing just how transformative exercise can be for people preparing for treatment. Movement is more than beneficial; it can be a catalyst for change, speeding up recovery, reducing complications, and empowering people to live well beyond their treatment.

In a recent episode of the Four Ways Forward podcast series, we captured this concept as we discussed our clinical expertise combined with human experiences, challenging the outdated belief that ‘rest is best’ and replacing it with a simple, modern truth: movement is medicine.

When we talk to patients about ‘physical activity’, the concept often feels more familiar and less intimidating than the word ‘exercise’. But prehabilitation isn’t just a nice thing to do, it’s scientifically proven to help people prepare for treatment. We often use the analogy: ‘you wouldn’t run a marathon without doing any training’, and likewise, cancer treatment can be physically demanding and preparing the body improves resilience and outcomes, just like marathon training. Everyday movement such as walking or taking the stairs is valuable; but structured, personalised exercise plays a more targeted role in building strength and function. In many ways, exercise is prescribed like medication, tailored to each person’s capabilities and designed to maximise benefits for their upcoming treatment.

The P4C programme originated from an earlier enhanced recovery after surgery (ERAS) model, with Professor John Moore, Clinical Lead for Prehab4Cancer instrumental in its development after observing that for many newly diagnosed patients the idea of exercise felt daunting, and they lacked confidence in what they could safely do. There was a gap in the support that patients could access in that regard, and this insight shaped the creation of P4C, a structured and supportive programme, embedded within the NHS, designed to make prehab feel achievable for everyone. With P4C, we decided to take a multimodal approach, blending nutrition, wellbeing, and exercise; and through collaboration with GM Active, we worked together to deliver the programme within community leisure centres across Greater Manchester.

1 of the most powerful features of P4C is the community it creates. For many patients, this is the first time they’ve met others facing a similar journey, and peer groups naturally form. The prehab phase typically starts around 4 weeks before surgery, and it combines cardiovascular training with functional strength exercises, all personalised to individual needs. Whether someone has joint pain, mobility challenges, or limited fitness experience, the programme meets them at their level. For some, support continues during chemotherapy or radiotherapy to help maintain strength and prevent deconditioning.

Muscle health plays a crucial role in surgical recovery. Sarcopenia, the medical term for muscle wastage, is linked to higher complication rates, longer hospital stays, and slower recovery compared with those who have stronger muscle function. In prehab, our focus isn’t only on the cancer itself, but on preparing the body for the physical demands of major surgery, which is often the most significant challenge to a person’s body.

Stepping into a gym can feel intimidating, but with guidance from the P4C team, the environment quickly becomes normalised. A key part of P4C is building confidence, breaking down barriers, and helping people realise that exercise is both achievable and empowering.

After surgery, rehabilitation becomes more personalised to a recovering body, slowly building up strength to support people as they return to meaningful daily activities and build long-term healthy habits.

Macmillan have produced national prehab guidance (updated in 2025) on the concept of prehabilitation and evidence behind this guidance is compelling. Patients who complete prehab experience reduced length in hospital stays, fewer A&E admissions, and reduced complications. These benefits support not only patients but the wider healthcare system through reduced pressures and cost savings, but most significantly, patients who complete prehab show improved survival rates at both 1-year and 5-years post treatment. Similar programmes across the UK are also seeing the same powerful clinical and economic benefits.

Simply put, prehabilitation works – and its impact on patients and families can be life-changing.

As 1 patient family member commented recently, “Physical activity was one of the best things that happened to our loved one during the time that she had her cancer”.