Physical Activity and the Cancer Patient

In the past, people being treated for a chronic illness (an illness a person may live with for a long time, like cancer or diabetes) were often told by their doctor to rest and reduce their physical activity. This is good advice if movement causes pain, rapid heart rate, or shortness of breath. But newer research has shown that exercise is not only safe and possible during cancer treatment, but it can improve how well you physically function and your quality of life.

Too much rest may lead to loss of function, muscle weakness, and reduced range of motion in the person with a chronic illness. So today, many cancer care teams are urging their patients to be as physically active as possible during cancer treatment.

Ways regular exercise may help you 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 the risk of heart disease
• Lessen the risk of osteoporosis (weak bones that are more likely to break)
• Improve blood flow to legs and lower risk of blood clots
• Make you less dependent on others to do normal activities of daily living
• Improve your self-esteem
• Lower the risk of anxiety and depression
• Lessen nausea
• Improve your ability to keep social contacts
• Fewer symptoms of tiredness (fatigue)
• Help you control your weight
• Improve your quality of life

We still do not know a lot about how exercise and physical activity affect your recovery from cancer, or their effects on the immune system. But regular moderate exercise has been found to have health benefits for the person with cancer. (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 exercise plan 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.

Certain things affect your ability to exercise, for instance:

• The type and stage of cancer you have
• Your cancer treatment
• Your stamina, strength, and fitness level

What may be a low- or moderate-intensity activity for a healthy person may seem like a high- intensity activity for some cancer survivors. Some people can safely begin their own exercise program, but many will have better results with the help of an exercise specialist, physical therapist, or exercise physiologist. Be sure to get your doctor's OK first, and be sure that the person working with you 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 your treatments can affect your lungs (such as the drug bleomycin or radiation to the chest), your heart (such as the drugs doxorubicin or epirubicin), or if you are at risk for lung or heart disease.

• Your cancer care team will check your blood counts during your treatment. Ask them about your counts and if it's OK for you to exercise.
• Do not exercise if you have anemia (low red blood cell count).
• If you have low white blood cell counts or if you take medicines that make you less able to fight infection, stay away from public gyms and other public places until your counts are at safe levels.
• 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.
• If it's OK with your doctor, drink plenty of fluids.
• If you feel very tired (have fatigue) 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 you to fall and injure yourself.
• Do not use heavy weights or do exercise that puts too much stress on your 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 a bone.
• 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, especially 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 effort 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 exercising again as you are able. Go slow 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.

We do not know the best level of exercise for someone with cancer. But the goal is to have your exercise program help you maintain endurance, muscular strength, flexibility, and keep you able to do the things you want and need to do. The more you exercise, the better you will be able to exercise and function.

It is common for people who were exercisers before they were diagnosed with cancer to need to reduce the intensity (make it easier and less taxing) and amount of exercise they do while they are being treated. Even if planned exercise stops, it is good to keep being active by doing your normal activities as much as you can.

Things to think about when planning an exercise program

• Discuss any exercise with your doctor before you start.
• Start slowly. 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 increased slowly. 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 such as your thighs, abdomen (belly), chest, and back. 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 muscle mass and bone strength, like exercising with resistance or light weights.
• You might want to include exercises that will increase your flexibility and keep 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 a 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. This is not the time to push yourself. Listen to your body and rest when you need to.

When you are too tired to exercise -- fatigue and cancer

Most people with cancer notice that they have a lot less energy. During chemotherapy and radiation, about 70% of patients have fatigue. Fatigue is when your body and brain feel tired. This tiredness does not get better with rest. 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 controlled, like pain, nausea, or depression.
• 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 exercise easy and 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 an important part of getting well and staying well.

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 to exercise with you.
• Use charts to record your exercise progress.
• Recognize and reward your achievements.

Starting 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, especially if 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 the intensity and length of exercise sessions.

Let exercise provide you with its benefits.

• Helping prevent muscle wasting
• Reducing treatment side effects
• Improving your fitness
• Improving your quality of life

Add physical activity to your daily routine

Here are some ways to add physical activity to the things you day every day. Remember, only do what you feel up to doing.

• 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 so that you don't trip or get pulled off balance).
• Weed your garden.
• 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 fun, and make it work for you.

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, 1-800-227-2345.

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

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

Nutrition for the Person With Cancer During Treatment

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

Nutrition for Children with Cancer

Books

The following books are also available from the American Cancer Society. Call us to ask about cost or to place an order:

What to Eat During Cancer Treatment

The Great American Eat-Right Cookbook

The American Cancer Society's Healthy Eating Cookbook

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 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;(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.