Safe exercising during cancer treatment

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Hello, my name is Nicola

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and I'm a clinical specialist physiotherapist

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here at Cambridge University Hospitals.

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When undergoing cancer treatment, it is safe

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to remain active and participate in exercise.

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Generally, there are very few contraindications,

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particular types of exercise, even with complex disease

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or when undergoing intensive treatment.

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There will, however, be times

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when you'll need to modify the type

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or the intensity of exercise that you are undertaking.

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This is called anaemia

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and affects the ability to carry oxygen to cells

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around the body, which can make you feel tired,

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breathless, and lightheaded.

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Whilst there is some evidence to suggest

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that exercise can improve anaemia, we would recommend low

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to moderate exercise only

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and a very slow increase in activity intensity

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as you feel comfortable.

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This condition is called neutropenia

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and can mean that you are more likely

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to pick up an infection.

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Exercise, however, has been shown

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to increase white blood cell and neutrophil levels

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and so should not be avoided altogether.

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If you feel well enough to exercise, try to continue as low

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to moderate intensity activity, but either exercise alone

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or with members of your own immediate household only.

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Try to exercise outdoors,

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avoiding public exercise spaces such as gyms

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and swimming pools.

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In REACT, we're able to adapt our rehab surroundings

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so that immunocompromised patients can exercise safely.

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This is called thrombocytopenia

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and reduces the ability for the blood to clot,

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making you prone to bleeding and bruising.

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If you have a low platelet count, we would encourage you

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to keep to an exercise programme,

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which focuses on light resistance training,

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gentle stretches, short walks,

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and low intensity spells on a static exercise bike only.

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Contact sports and vigorous intensity exercise

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should be avoided.

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This is a common side effect of chemotherapy

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where you can experience numbness, reduced sensation

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or pins and needles, tingling and burning

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in your hands and feet.

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This may affect your balance, leaving you feeling unsteady

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and more prone to falls.

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It can also mean that you occasionally drop items

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that you are carrying or struggle with tasks

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such as craft work, doing up buttons and zips,

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or tying up shoe laces.

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If peripheral neuropathy is becoming an issue for you,

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you may need to modify your physical activities

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to keep you safe and reduce the risk of falling,

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such as performing seated exercises rather than in standing,

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using walking poles or resistance bands

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and weights with different handles and attachments.

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The risk of bone fracture

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in both of these conditions is increased,

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but should not mean that you avoid exercise altogether.

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It's really important to keep your bones and muscles strong

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and avoid long periods of reduced or sedentary behaviour.

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You may need to modify your exercise regime

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to include a mixture of gentle cardiovascular

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and aerobic exercise with low impact activities

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and exercises which can improve your balance,

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such as in Tai Chi.

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It's best to avoid rapid twists

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and rotations of your trunk

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and high velocity contact sports.

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For a long time, exercise has been discouraged

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in patients at risk of developing lymphoedema.

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Whilst there are sometimes early exercise limitations

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encouraged post-surgery on individual patients,

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exercise on the whole is safe

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and encouraged in patients at risk of

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or living with lymphoedema

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as long as the introduction of the movement

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and the progression on the intensity

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is sensible and gradual.

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For those who have established limb swelling

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or lymphoedema in a limb

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or elsewhere on the body, you may have been advised

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to exercise only whilst wearing a compression garment

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to aid lymphatic drainage.

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Some patients experience skin reactions

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and tenderness in areas where they are having

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or have had radiotherapy.

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This effect is normally only temporary,

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but some patients may need to adjust

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what activities they participate in

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until the skin settles down.

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Fatigue is one of the most common side effects

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of cancer treatment

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and can leave you feeling exhausted,

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causing a lack of energy, poor memory, and brain fog.

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Exercise can help

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with managing the feelings of fatigue,

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but it's important to recognise which activities

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boost energy levels

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and which ones deplete your energy reserves.

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Pacing, energy conservation, effective rest

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and relaxation alongside graded regular exercise can help

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keep your muscles strong

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and release chemicals into the blood and the brain,

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which can help boost your mood and your energy level.

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Some patients who have a central line in place

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may be given specific guidance on exercise.

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Please visit the vascular access page on the CUH website

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to find out more information on your central line

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or talk to a member of your treating team.

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Some surgical procedures such as breast reconstruction,

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stoma formation, muscle or soft tissue flap transfer

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or orthopaedic stabilisation

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may also require some exercise modification,

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and your surgeons may recommend

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a specific exercise recovery programme.

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The primary aims during treatment

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are to maintain a healthy body weight

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and enjoy a diet that contains enough fuel

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and nutrients to help you recover well and heal.

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If your food and calorie intake, however,

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is significantly reduced during your cancer treatment,

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it may not be advisable

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to participate in moderate intensity exercise

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because it will further deplete

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your limited energy reserves.

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Try instead to reduce your sedentary behaviour

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and remain physically active,

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but make sure that you are getting

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the best possible nutrition

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and dietary information and input.

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There are, however, some contraindications

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to exercise which apply to everyone

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regardless of their cancer treatment.

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Any new chest, jaw or arm pain, vomiting or diarrhoea,

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irregular or unusually high or low blood pressure,

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new onset of fainting or dizziness,

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severe bone or joint pain, any swelling or bleeding

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should all be flagged to your treating team

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and investigated as required.

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In general, please try not to think of exercise as

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black and white, do or don't do.

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There were always other forms of physical activity

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or exercise that can be undertaken if you're experiencing

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any of the symptoms

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or if you're feeling generally unwell that day.

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Thank you for watching.

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If you need more information or guidance,

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speak to your treating team about a referral to REACT

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or visit the REACT page on the CUH website.