Objective: This study investigated the impact of rehabilitation modalities on the maintenance of walking ability in terminally ill cancer patients admitted to a palliative care unit (PCU). Methods: We retrospectively analyzed patients who died in our PCU between April 2020 and March 2024. Eligible patients were those who remained ambulatory during admission and received physical or occupational therapy. Based on the content of rehabilitation, patients were categorized into an Exercise group (Ex group), who engaged in dynamic tasks such as walking and stair climbing, and a Bedside group (BS group), who primarily underwent bed-based training with little or no dynamic activity. The primary outcome was the duration until loss of toileting ambulation, defined as the ability to walk independently to the in-room toilet. Group differences were evaluated using Kaplan–Meier analysis, log-rank tests, and Cox proportional hazards models. Results: Patients in the Ex group demonstrated a significantly longer duration of preserved ambulation compared with those in the BS group (median 30.0 days vs 20.5 days, log-rank p=0.002). Multivariate Cox regression further indicated that the Ex group had a substantially reduced risk of ambulation loss (hazard ratio 0.50, 95% confidence interval 0.33–0.77, p=0.001). Conclusion: Active rehabilitation that incorporates dynamic movement practice was associated with prolonged preservation of walking ability in terminally ill cancer patients. These findings underscore the potential role of structured rehabilitation in sustaining mobility, autonomy, and quality of life during the final stage of illness.