Prehabilitation

Prehab promotes healthy lifestyle behaviours for people living with cancer to reduce their risk factors to health; including exercise, nutrition, smoking cessation, psychological and wellbeing interventions. It starts before treatment begins, continues during treatment, and supports patients to manage their cancer journey with greater resilience.

Prehab aims to empower people to take control of their health and preparation for treatment, instilling physical and psychological resilience and providing opportunities to reflect on the importance of healthy lifestyle behaviours to improve long term health. 

Prehab is a patient-centred, evidence-based and multidisciplinary team developed pathway which is part of a continuum to rehabilitation. It aims to enable people affected by cancer to prepare for their treatment, reduce their surgical stress response and optimise their physiological function in order to support their recovery and improve their quality of life post treatment.

The evidence is clear, patients who take part in prehab are more likely to experience:

  • fewer postoperative complications
  • shorter hospital stays
  • improved physical function and quality of life
  • reduced anxiety and depression
  • better treatment tolerance and recovery.

As part of CMCA’s personalised care programme, three different prehab service models received cancer transformation funding in 2021/2022. 

All three models evaluated really well, below is feedback from two patients that attended the prehab services.

“The benefits have been invaluable to me, not just that the physical side of it, of your well-being, but also the mental and emotional aspects because when you're diagnosed with cancer it's quite a traumatic experience and when you attend these classes, you’re meeting people of a similar nature.”

“I've found the rehabilitation to be essential. It's not just the fact that it improves your levels of fitness. One of the major benefits I've had is meeting different people who are at different stages of the process.”

Of the three services, two still continue but the third service wasn’t able to secure future funding to continue.

In 2026/27, CMCA is funding a project to delivery prehab within Cheshire and Merseyside. The specific project aim is to deliver a community-based cancer prehab and rehabilitation programme, in partnership with the English Football League (EFL) and local football club charities, supporting newly diagnosed cancer patients to improve physical and mental wellbeing, enhance treatment readiness, and contribute to improved recovery outcomes. This is called the Versus Cancer Programme. The four football club charities are Everton in the Community, Chester, Crewe Alexandra and Tranmere Rovers. 

Throughout the development of the Versus Cancer project, based on learning from the Lancashire and South Cumbria project, the decision was made to expand the prehab programme to include rehabilitation. The programme being delivered consists of a prehab physical activity session for patients prior to treatment and/or surgery, a peer support social and wellbeing sessions followed by a rehabilitation physical activity session for patients following treatment. All patients come together for the peer support session.

The programmes started delivery in June 2026 and will run for 12 months, an initial review was due to take place after 6 months to look at the uptake and impact in order to consider expanding the programme into other areas of Cheshire and Merseyside.

Macmillan Cancer Support’s Prehabilitation for People with Cancer: These Clinical and Implementation Guidelines were launched in October 2025. They provide a comprehensive evidence-based framework to support embedding a consistent model into routine practice.

For further information about prehabilitation please see: Prehabilitation for cancer care | Macmillan Cancer Support

 

Physical activity

As mentioned previously, one in two people will have a cancer diagnosis during their lifetime. Differences in type of cancer and point of diagnosis will mean outcomes will be different. 

Cancer diagnosis and treatments are improving, meaning many people are living longer. But those that are, are not necessarily always living well.  Many people are living with disabling consequences of cancer treatment and multiple health conditions. Supporting people to be physically active from diagnosis through to end of life has been called a ‘wonder drug’.[1] It has a crucial role to play in both prehabilitation (before treatment) and rehabilitation afterwards. Not only does moving more help improve clinical outcomes, but it can also help people take control of their lives, reduce social isolation, and enable people to live independently.

Improving physical fitness prior to treatment can help to reduce the negative impact on physical fitness, usually experienced during and after cancer treatment. Macmillan’s Physical Activity and Cancer information booklet[2], highlights the benefits of physical activity both before treatment, during treatment and post-treatment when living with and beyond cancer. Continuing to undertake recommended levels of physical activity as part of a healthy lifestyle can reduce the possibility of developing late effects of treatment such as fatigue, weight gain and other health problems such as heart disease. There is also evidence that maintaining recommended levels of physical activity can also reduce the risk of certain cancers (including breast and bowel cancer) coming back, i.e. improving five year survival rates.

Recognised benefits of physical activity at each stage of patients’ cancer journeys2 are:

  • Pre-treatment: Increased cardio-respiratory fitness, fewer post-operative complications, and shorter hospital admissions
  • Treatment: Helps to preserve cardio-respiratory and muscular fitness, and to control cancer related fatigue
  • Post-treatment: Increased cardio-respiratory and muscular fitness, reduced fatigue, and improved body composition and wellbeing outcomes
  • Palliative (living with cancer): Exercise is feasible, and may help maintain physical function, control fatigue, and improve bone health
  • Survivorship (living beyond cancer): Associated with longer survival and a lower risk of recurrence or disease progression.

CMCA works with All Together Active (ATA), a system-wide strategy for physical activity, commissioned by the Integrated Care System Population Health Board and developed by Merseyside Sports Partnership and Active Cheshire. ATA is developing workstreams around improving physical activity pathways across Cheshire and Merseyside. Visit the ATA website for more information All Together Active - All Together Active.

The following are some resources that give more information about cancer and physical activity:

[1] Macmillan Physical Activity and Cancer: the underrated wonder drug – 2018 - Physical activity and cancer: the underrated wonder drug (macmillan.org.uk)

[2] Physical activity and cancer MAC12515_E5 (macmillan.org.uk) – updated January 2022