Exercise after a cancer diagnosis

What are the benefits of exercise?

Exercise is important for everyone’s overall health and wellbeing, but it has a range of general benefits for people with cancer. It may:

• improve how you respond to treatment (for some cancers)
• reduce the risk and severity of side effects of cancer treatments
• reduce complications from surgery and time spent in hospital
• help with recovery from treatment by increasing energy levels, reducing treatment-related  muscle loss, strengthening bones, and improving mobility and balance
• improve sleep and fatigue, and relieve stress, anxiety and depression
• help maintain a healthy weight
• reduce the risk of developing or improve health issues, such as high blood pressure, heart disease, stroke, osteoporosis and type 2 diabetes
• reduce the risk of some cancers coming back, including breast, prostate, bowel and  endometrial (uterine) cancers
• boost mood and self-esteem
• offer new ways to meet people and socialise.

How much exercise should I do?

The Clinical Oncology Society of Australia (COSA) recommends that exercise should be prescribed to all cancer patients as a standard part of their cancer care to help manage the effects of cancer and its treatment. Exercise & Sports Science Australia (ESSA) also encourages people with cancer to exercise.

Aim to be as physically active as your abilities allow. Exercise for people living with cancer  should be tailored to the type and stage of cancer and any side effects. Talk to an exercise professional (an accredited exercise physiologist or physiotherapist) or a clinical nurse consultant about how much and what type of exercise is best for you. COSA recommends that people with cancer who are relatively healthy and have been assessed as low risk, aim for and maintain per week:

• at least 2½ hours of moderate intensity aerobic or cardio exercise or 1¼ hours of vigorous aerobic or cardio exercise
• 2–3 strength or resistance sessions to build muscle strength.

It can take time to build up to this level of exercise. After treatment, aim to gradually increase exercise to ‘Australia’s Physical Activity and Sedentary Behaviour Guidelines for Adults’, which recommend you:

• move more and sit less
• aim to be active on most, preferably all, days of the week
• get a total of 2½ to 5 hours of moderate intensity or 1¼ to 2½ hours of vigorous intensity physical activity (or an equivalent combination of both moderate and vigorous activities) throughout a week
• do 2–3 strength or resistance training sessions a week, involving large muscle groups
• break up long periods of sitting as often as you can.

How can exercise ease common side effects?

Cancer treatment causes various physical effects that are different for different people. Exercise has been shown to help ease some of these.

Side effect – fatigue
Why exercise can help – Losing fitness can make fatigue worse, but low intensity exercise can help you stay fit (unless you have severe anaemia). Try to keep active and build your muscles and adjust how hard and often you exercise. Some people find that short, frequent aerobic and cardio sessions are easier; others prefer strength and resistance training, where you can take a rest between sets.

Download our fact sheet ‘Understanding Fatigue and Cancer’

Side effect – anaemia
Why exercise can help – Low red blood cell and/or haemoglobin count is a common side effect of cancer treatment. Symptoms include unexplained tiredness and fatigue. Combined with good nutrition, exercise has been shown to improve anaemia. For mild or moderate anaemia, try low intensity exercise, with a gradual increase in intensity and/or duration. If anaemia is severe, ask an exercise professional about what exercise to avoid until it improves.

Side effect – loss of muscle strength/muscle tightness
Why exercise can help – If muscles aren’t being used, they can get smaller and weaker. Lost muscle strength is a side effect of some hormone therapy and steroid treatment. Some treatments also leave muscles tight. Strength and resistance training improves muscle condition.

Side effect – lymphoedema
Why exercise can help – Starting exercise early in treatment may reduce the risk of  lymphoedema (swelling in a part of the body). A lymphoedema practitioner or exercise professional can develop a tailored exercise plan. After lymph node surgery, follow post-operative instructions for exercise and gradually return to activity.

Download our fact sheet ‘Understanding Lymphoedema’

Side effect – mood changes
Why exercise can help – Feeling anxious or depressed during and after treatment is common. Exercise helps the brain to produce chemicals (e.g. endorphins, endocannabinoids) that  improve your mood.

Side effect – heart problems
Why exercise can help – Radiation therapy to the chest and some types of chemotherapy and targeted therapy drugs may damage the heart muscle, making it less effective at pumping  your blood. Some hormone therapy drugs, low physical activity and poor nutrition may also increase the risk of heart problems. Aerobic and cardio exercise can help reduce the risk of long-term heart problems.

Side effect – loss of bone strength
Why exercise can help – Cancer and its treatment, particularly hormone and radiation therapy, can have long-term effects on bone strength. Early menopause and reduced levels of physical activity may also cause bones to weaken and break more easily (osteoporosis). Resistance training and exercises where you support your own body weight can help keep your bones strong.

Side effect – joint pain
Why exercise can help – Some hormone therapy and cancer treatments can cause joint pain. Exercise can improve muscle size and strength, flexibility and range of motion, and increase your ability to move, which can help protect your joints and reduce pain.

Side effect – weight gain
Why exercise can help – Weight gain is a common side effect of many treatments, including some types of hormone therapy, and steroids given to manage the side effects of  chemotherapy or immunotherapy. People with cancer may also gain weight due to inactivity. Exercise can help you manage weight gain and assist in weight loss, when necessary.

Side effect – quality of life
Why exercise can help – Studies show that physical activity can help improve wellbeing,  sexuality, brain fog, sleep issues, anxiety, fatigue, pain and how you feel about yourself in general.

What side effects need extra care?

Some side effects of cancer or treatment need extra care, which means you may have to adjust how hard and long you exercise. Speak to your doctor, physiotherapist or exercise physiologist before you exercise. Check with your health professional first, but most people are able to exercise with a port or PICC line, a chemotherapy pump or a stoma. Ask a nurse, exercise physiologist or physiotherapist to show you how to avoid bumping or disrupting it when moving.

Weak bones – If you have cancer in the bones (bone metastases or bone mets) or myeloma, you may be at risk of a break or fracture. Radiation therapy and hormone therapy may leave bones more fragile. Choose gentle activity such as walking and swimming, and avoid contact sports, running or jumping. Resistance exercise may help by strengthening the muscles around the bones. If you have osteoporosis, consult your doctor and ask for advice from a physiotherapist or accredited exercise physiologist.

Low white cell count (neutropenia) – Some cancers and treatments can weaken your immune system and cause your white blood cell count to drop. This can increase your risk of developing an infection. When your immune system is not working well (called being  immunocompromised), it is important to clean any shared exercise equipment before use and avoid public spaces such as gyms, swimming pools and training venues until your white blood cell count returns to a safe level.

Low platelet count (thrombocytopenia) – Platelets stop bleeding in the body by forming clots. When the platelet count drops, you are at increased risk of bruising or bleeding. It is best to avoid contact sports, cycling and high-impact activities (such as jumping or boxing), as these could cause bruising or bleeding if you get knocked or fall over.

Skin irritation – Areas of skin affected by radiation therapy can be extremely sensitive and often uncomfortable. Choose activities and clothing to minimise fabric rubbing on affected areas. Chlorine can irritate the skin, so avoid the pool if you have a rash or your skin is red.

Surgical wound – You will need to wait for the wound to heal before starting any exercise, so follow your surgeon’s or doctor’s advice about when it is safe to begin. If you have post-surgery stiffness and pain, you may need an assessment from an oncology physiotherapist or other exercise professional. They can suggest specific exercises to reduce stiffness and pain in the affected area. Pain, weakness, stiffness and reduced movement are common after surgery, but they usually improve with time.

Poor balance and coordination – Surgery or cancer treatment may affect balance and  coordination. This can make you unsteady and lead to a fall. Choose exercises to improve balance and muscle strength, or exercise sitting down. If your balance or coordination has been affected, avoid exercise such as riding a bike outside or using a treadmill, and avoid lifting free weights without a training partner.

Peripheral neuropathy – Some chemotherapy drugs damage nerves, causing pins and needles and numbness in the hands and feet (peripheral neuropathy). This means you could injure yourself without noticing. If you can’t feel your feet, you’re more likely to lose balance or fall, so walk on even surfaces. Ask an exercise professional how to lift weights safely. Some people may find exercise machines safer to use than free weights.

Heart damage – Some chemotherapy drugs and other treatments can cause damage to the heart (cardiotoxicity). In this case you will need specialised exercise advice before taking on exercise.