One of the many reasons Justice Ruth Bader Ginsburg came to be known as the “Notorious RBG” was her inspiring exercise routine with a personal trainer. Ginsburg’s husband, Marty, was the one who persuaded his reluctant wife to go to a physical therapist after her initial treatment for colon cancer in 1999. 

Her famous exercise regimen might not have happened were it not for Marty. “I didn’t want to do it,” Ginsburg told NPR. “I was exhausted, and Marty said, ‘You do it.’ ” She then full-heartedly adopted a consistent exercise routine, even despite a diagnosis of pancreatic cancer years later. Ginsburg had metastatic cancer and yet famously out-exercised Stephen Colbert of The Late Show just two years ago in 2018, and continued exercising until the last weeks of her life.

For 24 years, I have worked with patients diagnosed with cancer, from early diagnosis to those at the end of life. Long before Ginsburg was planking post colon-cancer treatments, my patients would express surprise that physical therapy and exercise prescription could be a crucial part of their cancer journey. They were unsure how to exercise safely and felt lousy from surgery, chemotherapy and radiation. I taught them how to exercise during cancer treatments, through the ups and downs. Physical therapy helped them more confidently accept their “new self” and feel better. As an oncologic physical therapist, I believe that Ginsburg’s commitment to regular exercise helped her to live longer and continue to work by lessening her cancer and treatment-related fatigue and pain.

Not a week goes by without a patient asking me why an oncology physical therapist isn’t an automatic part of their cancer team from the beginning. They relay frustration about why it “took so long” for them to be referred to a specialist. Severe muscle loss seems to be a given. Cancer patients who work with a specialized physical therapist from the start of treatments fare better than those who try to regain strength after treatments leave them exhausted and unmotivated. 

Appropriate, early intervention can help prevent physical decline, reduce inflammation and improve patient outcomes. What’s more, exercise during and after cancer treatments reduces and manages side effects, such as chronic pain, lymphedema severity, fracture risk and decreased balance from neuropathy. Early treatment of these issues can also reduce the financial burden of patients, insurance payers and hospital systems. Cancer patients should request physical therapy before, during and after treatments.

Research shows that tailored exercise and physical fitness also can improve the length and quality of life for people diagnosed with cancer. The American Cancer Society recommends physical therapy to improve function, reduce risk of recurrence and improve cancer survival. Ginsburg was diagnosed with pancreatic cancer in 2009; the vast majority of patients do not survive five years. She lived for another 11. While no one can say for certain how she beat the odds, it is my opinion that exercise played a role. 

Richard Briggs, physical therapist, coined end-of-life exercise as, “rehab in reverse.” What he meant was that appropriate physical therapy helps reduce the risk of falls, fractures and hospitalizations, all too common with frail patients. Physical therapists teach patients about safety, equipment and swelling management when patients are still walking, different guidance when patients become more sedentary and updated recommendations when patients are bed-bound. Studies show that when pain and other symptoms of a terminal illness are managed, people can work and live longer, just like Ginsburg.

Justice Ginsburg was clearly determined to live, work and exercise as long as she could. Exercise was a critical part of her life and helped her live a full life. Cancer treatments should include more than just chemotherapy, radiation and surgery. Oncology physical therapy should be available to all cancer patients, from beginning to end.