Guidelines for Exercising During Cancer Treatment

The recommendations for exercising during cancer treatment are not much different from those geared toward the general public, experts say. The American College of Sports Medicine (ACSM) recommends healthy adults should get a minimum 150 minutes of moderate-intensity aerobic exercise per week at least two days of which should include some resistance training.

1) Get started now.

The sooner you start moving, the better, says Spencer. “A lot of people think, I don’t need to work on this now, and so they wait until treatment is done. At that point, they may be tired and deconditioned, and side effects possibly could have been mitigated if they had started moving sooner.

It’s just about meeting [yourself] where you’re at.

“For the most part everyone can be moving more: It’s just about meeting [yourself] where you’re at. If you haven’t been active your entire life and now you’re going through treatment, you might be doing five minutes a day and building up from there,” she says.

 

2) Make a plan with your care team.

“Besides getting the initial clearance to work out, it’s important to find out if there are any issues you should be particularly concerned about,” says Champ. “Ask, ‘Based on the surgery I had, is there a decreased range of motion? Are there concerns because of chemo? Are there concerns because of [my] immune system?’ All those things come into play.”

Experts recommend working with an exercise professional who can communicate and collaborate with your care team. This helps ensure safety while also increasing the effectiveness of workouts. “Much like medical treatment, this should all be done in person, under expert personnel. But also it has to be dose-escalated,” says Champ. “If I give you a low dose of radiation, it’s not going to cause any side effects, but also it’s not going to work.”

Some of the most prominent cancer organizations, such as the Mayo Clinic and Memorial Sloan Kettering, promote exercise as an integral part of treatment plans. There are also trainers, physical therapists, and other movement professionals who have experience with cancer and may be a resource for clients.

“While there are certifications out there in the field, there isn’t a generally accepted approach saying [this] is ‘the right way,’” says Schneider. “The best option would be for the fitness professional to stay in contact with the oncology team to make sure they are clear on treatment and potential side effects, and the team is aware of exercise and recovery the patient is going through.”

 

3) Take it one day at a time.

Cancer treatment has a cyclical nature, explains Spencer. “The first one to five days after chemo, a patient may be feeling badly, but the closer they get to the next cycle, the more energy they’ll have. It’s important to reassure them it’s normal not to feel their best after treatment. Doing something at a lesser intensity is OK, as long as they’re still moving.” (Try this gentle, somatic workout designed to support you well-being.)

That said, not every day has to be an easy day. When a patient is feeling good, Spencer advises, the approach to exercise should look much the same as it does for someone without a cancer diagnosis: Progressively increase the load, intensity, and/or volume of their workouts to match their energy and fitness level.

Champ uses a red-, yellow-, and green-light system so that patients can let him and other trainers know how they’re feeling. Red indicates a light and easy day; yellow means they can push a little harder; and green shows they’re ready for a regular workout.

 

4) To maximize your benefits, maximize your efforts.

“Too often, people say, ‘This person has cancer; we’re not going to push them hard.’ But data shows that the more muscle mass and the less fat you have, the better the outcome [of overall treatment],” says Champ.

When patients come to Champ’s facility, they get a quick lesson in the principle of progressive overload: This means that to see results, you need to continue to put your body under additional stress.

“Whether you’re on nasty chemo or you’re not on chemo at all, we’re going to overload you. It’s just figuring out personally where you are and what that level of overload is,” says Champ. This approach helps ensure that patients aren’t just going through the motions — that the work they’re putting in is actually effective.

“If we think we’re going to put on muscle with exercise, it has to be exercise that’s going to cause you to put muscle mass on.”

Similarly, Almli urges cancer patients to challenge themselves with their cardio workouts. “A lot of people think, Well, I’m just going to walk. But you need to walk fast enough to get your heart rate up. If it took you 25 minutes to walk a mile on the treadmill, that’s probably not an effective cardio exercise. We’re human beings, we’re supposed to walk,” she says. “I love the idea of some sort of wearable technology so you can see what your heart rate is doing.”

 

5) Be aware of red flags that indicate you’re doing too much.

“I tell people it’s OK to be tired; it’s not OK to be hurting. If you want to stop because you’re tired, challenge yourself to do a little bit more,” says Almli.

“If you want to stop because you’re tired, challenge yourself to do a little bit more.”

To see if a client has pushed too far — or not enough — Schneider watches for changes in mental clarity or brain fogginess, windedness, strength gain or loss, pain, range of motion, and emotional states.

“The biggest tell will be if they can recover quickly,” he says. “The metric I use is: Work as hard as you can while being able to do it again tomorrow. Not necessarily the same routine but being able to maintain a similar intensity level.”

 

6) Find an accountability partner.

“It’s really hard to exercise on your own, especially if you don’t feel well,” says Almli. “But if you get a buddy and start slow, you have someone to hold you accountable.” You can make regular plans with a friend to meet for walks, join a group fitness class that you’re expected to attend, or work with a personal trainer.

She recommends scheduling exercise like you would an appointment. “When you’re going through cancer treatment, your calendar is so full of things you don’t want to do — labs, scans, doctor appointments, chemotherapy, radiation, etc. Add some exercise with a friend, so when you look at your calendar, it gives you something to look forward to.”