In the past, people being treated for a chronic illness (an illness a person may live with for a long time, such as cancer or diabetes) were often told by their doctor to rest and reduce their physical activity. This may still be true if movement causes severe pain, rapid heart rate, or shortness of breath.

Newer research has shown that exercise is not only safe and possible during cancer treatment, but it can improve physical functioning and quality of life. Too much rest may result in loss of function, strength, and range of motion in the person with a chronic illness. As a result, many cancer care teams are now urging their patients to be as physically active as possible during cancer treatment. Regular exercise is an effective way to counteract the negative effects of inactivity in chronic illness.

Possible benefits of regular exercise during cancer treatment

• keep or improve your physical abilities
• better balance, lower risk of falls and broken bones
• keep muscles from wasting due to inactivity
• lower risk of heart disease
• less risk of osteoporosis (weak bones that are more likely to break)
• better blood flow to legs and lower risk of blood clots
• less dependence on others to do normal activities of daily living
• improved self-esteem
• lower risk of anxiety and depression
• less nausea
• better ability to keep social contacts
• fewer symptoms of fatigue
• better weight control
• improved quality of life

We still do not know a lot about the effects of exercise and physical activity on recovery from cancer and on the immune system. But regular moderate exercise has been found to have health benefits for the cancer patient. Moderate exercise is defined as activity that takes as much effort as a brisk walk.

Goals of an exercise program

While there are many reasons for being physically active during cancer treatment, each person's exercise program should be based on what is safe, effective, and enjoyable for that person. Your exercises should take into account any exercise program you already follow, what you can do now, and any physical problems or limits you have. You and your doctor should tailor an exercise program to meet your interests and needs.

The type of cancer you have; your cancer treatment; and your stamina, strength, and fitness level all affect your ability to exercise. What may be of low or moderate intensity for a healthy person may seem like a high intensity activity for some cancer survivors. While some people can safely begin their own exercise program, many will have better results with the help of an exercise specialist, physical therapist, or exercise physiologist. Be sure to get approval from your doctor first, and be sure that the person knows about your diagnosis and limitations. These specially trained professionals can help you find the type, frequency, duration, and intensity of exercise that is right for you.

Exercise safety and precautions for cancer survivors

Always check with your doctor before starting any exercise program. This is especially important if you are taking treatments that affect your lungs (such as bleomycin or radiation to the chest) or your heart (such as doxorubicin or epirubicin) or if you have risk of lung or heart disease.

• Do not exercise if you have anemia (low red blood cell count). Your cancer care team will be checking your blood counts during your treatment, so ask them about the best time to exercise.

• If you have low white blood cell counts or if you take medicines that may reduce your ability to fight infection, avoid public gyms and other public places until you are back at safe levels. Check with your cancer care team about these.

• Do not exercise if the level of minerals in your blood, such as sodium and potassium, are not normal. This can happen if you have had a lot of vomiting or diarrhea. Ask your doctor about your blood tests. If it is ok with your doctor, drink plenty of fluids.

• If you are very tired and don't feel up to exercising, you can try to do 10 minutes of stretching exercises every day. (Later we will discuss fatigue and exercise in more detail.)

• Avoid uneven surfaces or any weight-bearing exercises that could cause a fall and injury.

• Do not use heavy weights or do exercise that puts too much stress on the bones if you have osteoporosis, cancer that has spread to the bone, arthritis, nerve damage, poor vision, poor balance, or weakness. You may be more likely to injure yourself or break bones.

• If you have numbness in your feet or problems with balance, you are at higher risk for falls. You might do better with a stationary reclining bicycle, for example, than a treadmill.

• Watch for swollen ankles, unexplained weight gain, or shortness of breath while at rest or with a small amount of exertion. Let your doctor know if you have any of these problems.

• Watch for bleeding if you are taking blood thinners. Avoid any activity that raises your risk for falls or injury. If you notice swelling, pain, dizziness, or blurred vision, call your doctor right away.

• To avoid irritation, don't expose skin that has had radiation to the chlorine in swimming pools.

• Do not exercise if you have unrelieved pain, nausea/vomiting, or any other symptom that causes you concern. Call your doctor.

• Do not exercise above a moderate level of exertion without talking with your doctor. Remember, moderate exertion is about as much effort as a brisk walk.

• If you still have a catheter (tube that goes into your body), avoid water and other exposures that may cause infections. Also, avoid resistance training that uses muscles in the area of the catheter to avoid dislodging it. Talk with your cancer team about what is safe for you.

Effective exercise

To make your exercise most effective, it is important that you work your heart. Pay attention to your heart rate, your breathing, and how tired your muscles get. If you get short of breath or very tired, rest for a few seconds, and start back exercising as you are able. Start slowly at first, and over the next few weeks, increase the length of time you exercise. Be careful if you are taking blood pressure medicine that controls your heart rate. Your heart rate will not go up, but your blood pressure can get high. Ask your doctor, nurse, or pharmacist about this if you are not sure about your medicine.

The best level of exercise for someone with cancer has not been established. But the goal is to have your exercise program help you maintain endurance, muscular strength, flexibility, and level of functioning. The more you exercise, the more your ability to exercise can improve and your ability to function can improve. It is common for people who have exercised before they were diagnosed with cancer to need to reduce their intensity (make it easier and less taxing) and amount of exercise during treatment. Even if planned exercise stops, it is good to continue being active by keeping up your normal activities.

Things to think about when planning an exercise program

• Discuss any exercise with your doctor before starting.

• Start slowly with an exercise program. Even if you can only do an activity for a few minutes a day it will help you. How often and how long you do a simple activity like walking can be slowly increased. Your muscles will tell you when you need to slow down and rest.

• Try short periods of exercise with frequent rest breaks. For example, walk briskly for a few minutes, slow down, and walk briskly again, until you have done 30 minutes of brisk activity. You can divide the activity into three 10-minute sessions, if you need to. You will still get the benefit of the exercise.

• Try to include physical activity that uses large muscle groups. Strength, flexibility, and aerobic fitness are all important parts of an exercise program that works.

• Try to include some exercises that will help you keep lean muscles mass and bone strength, such as exercising with resistance or light weights.

• You might want to include exercises that will increase your flexibility and maintain the range of motion in your joints.

• Always start with warm-up exercises for about 2 to 3 minutes. Examples of warm-up exercises are shoulder shrugs, lifting arms overhead, toe tapping, marching, and knee lifts. End your session with stretching or flexibility exercises. Hold the stretch for about 15 to 30 seconds and relax. Remember to breathe when you stretch. Examples of stretching are reaching overhead, deep breathing, and bending over to touch your toes so that you relax all the muscle groups.

• Exercise moderately.

Too tired to exercise -- Fatigue in cancer

Most cancer patients notice a loss of energy. During chemotherapy and radiation, about 70% of patients have fatigue. For many, fatigue is severe and limits their activity. Inactivity leads to muscle wasting and loss of function.

An aerobic training program can help break this cycle. In research studies, regular exercise has been linked to reduced fatigue. It is also linked to being able to do normal daily activities without major limitations. An aerobic exercise program can be prescribed as treatment for fatigue in cancer patients. Talk with your doctor about this.

Tips to reduce fatigue:

• Set up a daily routine that allows activity when you are feeling your best.
• Exercise regularly at light to moderate intensity.
• Get fresh air.
• Unless you are told otherwise, eat a balanced diet that includes protein (meat, milk, eggs, and legumes such as peas or beans) and drink about 8 to 10 glasses of water a day.
• Keep your symptoms such as pain, nausea, or depression controlled.
• To save energy, keep things you use often within easy reach.
• Enjoy your hobbies and other activities that give you pleasure.
• Use relaxation and visualization techniques to reduce stress.
• Balance activity with rest that does not interfere with nighttime sleep.
• Ask for help when you need it.

Keep it fun

The key is to keep your exercise program simple and fun. Exercise and relaxation techniques are great ways to relieve stress. Reducing your stress is a vital element in maintaining health.

Tips to enhance your interest in your exercise program

• Set short-term and long-term goals.
• Focus on having fun.
• Do something different to keep it fresh. Try yoga, dancing, or tai chi.
• Ask for support from others, or get friends, family, and co-workers involved in your exercise program.
• Use charts to record your exercise progress.
• Recognize and reward your achievements.

Beginning an exercise program can be a big task, even for a healthy person. It may be even harder for you if you have a chronic illness, more so if you were not used to exercising before your diagnosis. Start slowly and build up as you are able. If you were exercising regularly before you were diagnosed with cancer, you may need to reduce your intensity and length of exercise sessions.

Let exercise provide you with its benefits.

• helping prevent muscle wasting
• reducing the side effects of treatment
• improving your fitness
• improving your quality of life

Ways to add physical activity to your daily routine

Remember, only do what you feel up to doing.

• Take a walk around your neighborhood after dinner.
• Ride your bike.
• Mow the grass or rake the leaves instead of using the blower.
• Scrub your bathroom.
• Wash and wax the car.
• Play active games with the kids, like freeze tag, jump rope, and the games you loved to play when you were a kid.
• Walk a dog (one that can be controlled enough that you don't trip or get pulled off balance.)
• Weed your garden by hand.
• Take a friend dancing, or dance in your own living room.
• Use an exercise bike or treadmill or do arm curls, squats, lunges, and sit ups while watching TV.
• Walk to lunch.
• Park your car in the farthest parking space at work and walk to the building.
• Use the stairs instead of the elevator or escalator.
• Get off the bus several stops early and walk the rest of the way to work.
• Make appointments for yourself in your daily planner for 10-minute walking breaks.
• Form a walking club of co-workers to help you stay motivated to walk during the workday.
• Wear a pedometer every day and increase your daily steps.

Cancer survivors may need to exercise less intensely and increase their workout at a slower rate than people who are not getting cancer treatment. Remember, the goal is to keep up as much activity as possible. Keep it safe, keep it effective, and keep it fun.

Additional resources

More information from your American Cancer Society

We have selected some related information that may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-ACS-2345.

• American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention (also available in Spanish)

• Guidelines for the Early Detection of Cancer (also available in Spanish)

• Nutrition and Physical Activity During and After Cancer Treatment: Answers to Common Questions

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-ACS-2345 or visit www.cancer.org.

References

Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2008 Apr 16;(2).

Doyle C, Kushi LH, Byers T, et al. Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices. CA Cancer J Clin 2006; 56:323-353

Last Medical Review: 06/04/2008
Last Revised: 06/04/2008