The short version
- Research on prehab specifically in breast cancer is newer and smaller than for some other cancers, but it is promising: studies mostly show better physical function, quality of life and wellbeing.1
- The strongest evidence is that being active during and after treatment helps with fatigue, anxiety, low mood and physical function. Prehab starts the same habits earlier.2
- Prehab before breast surgery has been shown to be safe and practical. Whether it reduces surgical complications in breast cancer is still being studied.
Why this page exists
You’ll see strong claims about prehabilitation online. We think you should know what the research actually shows, including where the evidence is still developing. That way you can make your own decision, and set realistic expectations.
What research shows
Prehab in breast cancer
- A 2023 systematic review looked at 14 studies of prehabilitation in people with breast cancer, including exercise, upper-limb exercise, stopping smoking and multimodal programmes. Prehab mostly improved physical function, quality of life and psychological wellbeing. People preferred programmes that covered several areas (multimodal) rather than one, and wanted support for longer.1
- A study in Toronto offered home-based exercise to women waiting for breast cancer surgery. Most of those who took part did more than 70% of their prescribed exercise, there were no exercise-related safety problems, and both patients and nurses wanted prehab to be offered to everyone having surgery.3
- A UK study found that prehabilitation could be delivered as part of the NHS breast cancer pathway.4
- A Swedish trial advised women to be more active before and after breast cancer surgery. It did not find a difference in recovery measures between groups. This is a reminder that advice alone may not be enough: structured, supported programmes may matter more.5
Exercise during and after treatment
There is much more research on exercise during and after breast cancer treatment. An international expert review concluded that exercise improves fatigue, anxiety, depression, physical function and quality of life, and does not make lymphoedema worse.2 Trials in women having chemotherapy for breast cancer found that exercise protected fitness and strength, and reduced fatigue.6, 7
After surgery, the UK PROSPER trial showed that a structured exercise programme led to better arm function and less pain a year later, without extra complications.8
Digital prehab
UK studies of remotely delivered, multimodal prehab for people with cancer found high uptake (76% of those referred took part) and improvements in self-rated health and fatigue.9 A cost analysis estimated about £460 per patient for digital prehab, compared with average hospital stay costs about ten times higher.10 These studies were run by the team behind one of the programmes listed on this site, and had no comparison group.
What we can say with confidence
| Claim | How strong is the evidence? |
|---|---|
| Being active during and after breast cancer treatment improves fatigue, mood and physical function | Strong: many randomised trials and reviews |
| Exercise does not make lymphoedema worse, and supervised weight training is safe | Strong: randomised trials |
| Structured exercise after breast surgery improves arm function | Strong: large UK randomised trial |
| Prehab before breast cancer treatment is safe and practical | Good: several studies |
| Prehab improves wellbeing and physical function before treatment | Promising: mostly small studies |
| Prehab reduces complications after breast surgery | Not yet proven: more research needed |
What this means for you
- Being active, eating well and looking after your mental health before treatment is safe for most people and likely to help you feel better, physically and emotionally.
- You are building habits that the evidence shows are very helpful during and after treatment.
- Prehab is something you can do, at a time when a lot feels out of your control.
UK guidance from Macmillan, the Royal College of Anaesthetists and the NIHR recommends prehabilitation for people with cancer,11 and England’s National Cancer Plan commits to making it available to all cancer patients.12
Prefer a guided plan?
Evidence suggests people prefer prehab that covers several areas, with support over time.1 A personalised digital programme can do that from home. See how digital prehab works.
Related pages
- What is prehabilitation?
- Prehabilitation research: a plain-English summary
- Editorial policy and how we check sources
Everyone’s treatment is different, so talk to your cancer team about what is right for you.
References
- Toohey K, Hunter M, McKinnon K, Casey T, Turner MR, Taylor S, Paterson C. A systematic review of multimodal prehabilitation in breast cancer. Breast Cancer Research and Treatment. 2023;197(1):1–37. doi.org/10.1007/s10549-022-06759-1
- Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Medicine & Science in Sports & Exercise. 2019;51(11):2375–2390. doi.org/10.1249/MSS.0000000000002116
- Brahmbhatt P, Sabiston CM, Lopez C, et al. Feasibility of prehabilitation prior to breast cancer surgery: a mixed-methods study. Frontiers in Oncology. 2020;10:571091. doi.org/10.3389/fonc.2020.571091
- Wu F, Rampal T, et al. The feasibility of prehabilitation as part of the breast cancer treatment pathway. PM&R. 2021. doi.org/10.1002/pmrj.12543
- Heiman J, Onerup A, Wessman C, Haglind E, Olofsson Bagge R. Recovery after breast cancer surgery following recommended pre and postoperative physical activity: (PhysSURG-B) randomized clinical trial. British Journal of Surgery. 2021;108(1):32–39. doi.org/10.1093/bjs/znaa007
- Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of Clinical Oncology. 2007;25(28):4396–4404. doi.org/10.1200/JCO.2006.08.2024
- van Waart H, Stuiver MM, van Harten WH, et al. Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. Journal of Clinical Oncology. 2015;33(17):1918–1927. doi.org/10.1200/JCO.2014.59.1081
- Bruce J, Mazuquin B, Canaway A, et al. Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation. BMJ. 2021;375:e066542. doi.org/10.1136/bmj-2021-066542
- Wu F, Rotimi O, Laza-Cagigas R, Rampal T. The feasibility and effects of a telehealth-delivered home-based prehabilitation program for cancer patients during the pandemic. Current Oncology. 2021;28(3):2248–2259. doi.org/10.3390/curroncol28030207
- Gkaintatzi E, Nikolaou CK, Rampal T, Laza-Cagigas R, Zand N, McCrone P. Cost analysis of a digital multimodal cancer prehabilitation. Current Oncology. 2022;29(12):9305–9313. doi.org/10.3390/curroncol29120729
- Macmillan Cancer Support, Royal College of Anaesthetists and NIHR Cancer and Nutrition Collaboration. Principles and guidance for prehabilitation within the management and support of people with cancer. 2019, updated November 2020. www.macmillan.org.uk/healthcare-professionals/news-and-resources/guides/principles-and-guidance-for-prehabilitation
- Department of Health and Social Care. National Cancer Plan for England. February 2026. Summary of prehabilitation commitments as reported by the Royal College of Anaesthetists and Centre for Perioperative Care. rcoa.ac.uk/news/rcoa-cpoc-respond-release-governments-national-cancer-plan