<p>Head and neck cancer (HNC) is a diagnosis with substantial lifelong implications. Most patients diagnosed with HNC undergo treatments—typically surgery, radiotherapy, and/or chemotherapy—that negatively affect function and quality of life. As cancer survival rates improve, there is a growing focus on mitigating the related morbidity and addressing rehabilitation needs, including exercise. Exercise is a safe and effective intervention across the cancer continuum, with demonstrated benefits for physical and psychosocial outcomes in cancer populations. However, patients with HNC often present disease- and treatment-specific conditions—such as feeding-tube use, laryngectomy or tracheostomy, musculoskeletal impairments, xerostomia, and donor-site morbidity following free-flap reconstruction—that may require additional clinical precautions. This narrative review synthesizes evidence and clinical insights on these key domains specific to locally advanced HNC, identified through a structured literature search and informed by multidisciplinary expertise. Evidence reinforces the presence of recurring clinical challenges in HNC, underscoring the need for individualized and carefully adapted exercise programs. By outlining disease-specific considerations and functional sequelae, this review provides guidance for safe and evidence-informed exercise prescription, emphasizing that head and neck cancers are complex diagnoses requiring expertise not only in oncological treatment but also in supportive care.</p>