During cancer treatment
Exercise during cancer treatment: what the guidelines say and how to start safely
By Natura Integrative Care Clinic · Updated · 4 min read
The short answer
Major guidelines say exercise during cancer treatment is generally safe for most people, and they encourage staying as active as you can with your care team’s agreement. Check with your oncology team first, especially with low blood counts or a fever.
It’s natural to assume that cancer treatment means resting as much as possible. Evidence suggests otherwise: ideally people should be as physically active as their situation allows.
That doesn’t mean pushing through a hard workout the day after chemotherapy. It means finding an amount of movement that suits where you are today, and adjusting as treatment goes on. Some days that is a short walk around the block. Other days it could be a full strength session.
Is it safe to exercise during cancer treatment?
For most people, yes. A 2019 international roundtable convened by the American College of Sports Medicine reviewed the research and concluded that exercise is generally safe and well tolerated during and after cancer treatment. The Canadian Cancer Society notes that gentler forms of exercise, such as brief, slow walks, stretching and swimming, are usually fine to start with. There are certain restrictions to keep in mind, so a discussion with your oncologist and an exercise physiologist would be helpful.
Peter Hofmann, a researcher from Austria, describes some of the benefits of exercise in one of his articles:
Findings from 71 prospective cohort studies also showed a dose-response effect of PA [physical activity] on cancer mortality. Individuals with the highest physical activity had a HR of 0.83 (95% CI 0.79 to 0.87) and 0.78 (95% CI 0.74 to 0.84) for cancer mortality in the general population and among cancer survivors, respectively. There was an inverse non-linear dose response between the effects of physical activity and cancer mortality. A minimum of 2.5 h/week of moderate-intensity activity significantly reduced cancer mortality by 13% in the general population. Fifteen MET-h/week [equivalent to roughly 300 minutes of moderate-intensity exercise or 150 minutes of vigorous-intensity exercise weekly] of physical activity reduced cancer mortality risk by 27%. An even greater protective effect occurred in cancer survivors undertaking physical activity post-diagnosis versus pre-diagnosis, and the same amount of physical activity per week decreased the risk by 35% and 21%, respectively.
In plain English, he is saying that the evidence demonstrates that the more physically active someone with cancer is, the less likely they are to die. The HR (hazard ratio) of 0.78 means that there was a 22% reduction in cancer mortality in cancer survivors who exercised compared to cancer survivors who did not exercise.
What about cancer-related fatigue?
Cancer-related fatigue can feel very different from ordinary tiredness, and it is tempting to try to rest it off. Sometimes, exercise actually improves energy instead of using it up. On a low-energy day, a shorter, easier session still fits the guidelines’ message to avoid inactivity. Tell your team if fatigue is new, severe or getting worse.
When should you not exercise during treatment?
Some days your body needs you to hold off or change plans. Check with your cancer team in these situations:
- Fever or signs of infection: rest, and call your team.
- Low white blood cell count: stay away from public gyms, pools and crowds until your team says your infection risk is back to normal.
- Low platelets: you may bruise or bleed more easily, so avoid contact sports and activities that could lead to a fall, and ask which activities are safe.
- Anemia (low red blood cells): your blood carries less oxygen, so you may tire or get breathless more quickly.
- A catheter, port or feeding tube: avoid pools, lakes and ocean water, and strength exercises that use the muscles around it. Sometimes twisting or certain movements can move the port or tube, so ask your team what is safe.
- Dizziness or unsteadiness: hold off until it settles.
Exercise after cancer treatment
When treatment ends, many people are unsure how hard to push. The same guidelines continue to apply.
Your surgeon or oncology team may give you specific limits, for example on lifting after surgery or on returning to contact sports. Build up gradually, check with your team before you move above a moderate level of effort, and tell them about any new symptoms.
Questions to ask your oncology team before you start
- Is there anything about my treatment, blood counts or surgery that limits what I should do right now?
- Are pools, gyms and group classes safe for me at this point in treatment?
- Should I avoid lifting or strength work near a port, catheter or surgical site?
- Which symptoms mean I should stop and call you?
- Are there exercise programs available through my treatment centre?
Write the answers down and bring them to any exercise professional you see, so your program starts from the same information your team has.
Seeing a clinical exercise physiologist at Natura
At Natura in Steinbach, Lindsay Porter, B.Kin, CSEP-CEP is a clinical exercise physiologist. The Canadian Society for Exercise Physiology describes the CSEP-CEP scope as assessment, exercise prescription and supervision for people who are healthy or living with medical conditions, functional limitations or disabilities. Lindsay sees people during and after cancer treatment, as well as after surgery and injury, and nobody needs to be fit before they begin.
- Initial assessment: 60 minutes, $125. Expect questions about your history, treatment, symptoms and goals, and simple tests of posture, strength, balance and mobility.
- Follow-up: 30 minutes, $70.
- Individual exercise program: a four-week online training program, $200 (call the clinic to book).
- What to bring: comfortable clothes, supportive shoes, a list of your medications, any scan reports, medical letters or referral paperwork, the answers from your oncology team, and water.
If you’re looking for a cancer exercise program in Manitoba, you can also ask your cancer team what is available through your treatment centre. Natura doesn’t bill insurers directly, and coverage for exercise physiology varies by plan, so check yours before booking. At Natura, Dr. Erin Esau, ND provides adjunctive care during cancer treatment. For how exercise professions differ in scope, see kinesiologists and physiotherapists.
Common questions
Should I rest or exercise when I have cancer-related fatigue?
Usually a mix of both, weighted toward gentle movement. The Canadian Cancer Society suggests regular daily activity, such as a walk, timed for when your energy is highest. Rest when you need to, and on a low-energy day try a shorter, easier session rather than skipping movement entirely. Tell your team if fatigue is new or getting worse.
Can I exercise during chemotherapy?
Most people can, with adjustments. If your energy rises and falls through each treatment cycle, plan lighter activity on the harder days and more on the better ones. Avoid public gyms and pools if your white blood cell count is low, and don’t exercise with a fever. Your oncology team can tell you if anything about your treatment needs extra care.
Is it safe to lift weights during cancer treatment?
Generally, yes.
Do I need a referral to see a clinical exercise physiologist?
You can book an assessment with Lindsay at Natura directly through online booking. If your oncologist or family doctor has given you a referral, medical letters or scan reports, bring them, since they shape a safe program. Some extended health plans have their own rules for reimbursement, so check yours before your first visit.
Sources
- Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable (Campbell et al., 2019) — Med Sci Sports Exerc
- Hofmann P. Cancer and Exercise: Warburg Hypothesis, Tumour Metabolism and High-Intensity Anaerobic Exercise. Sports, 2018;6(1):10
- Being active — Canadian Cancer Society
- Physical activity and the person with cancer — American Cancer Society
- Safety and exercise — OncoLink (Penn Medicine)
- CSEP-CEP Scope of Practice — Canadian Society for Exercise Physiology
- Urgent Cancer Care / Helplines — CancerCare Manitoba
This article is general information, not medical advice for your situation. If you're unwell or worried, talk to your doctor or call Health Links – Info Santé, Manitoba’s free 24-hour nurse line, at 1-888-315-9257. In an emergency, call 911.
