Why exercise?

Exercise has many general benefits for your physical and mental wellbeing. It can:

• strengthen muscles and bones and improve circulation
• help you maintain or achieve a healthy weight
• improve your energy levels
• improve your mobility and balance
• improve appearance and self-esteem
• help you cope with stress, anxiety and depression
• provide new opportunities to meet people and socialise
• reduce the risk of, or help manage, high blood pressure, heart
• disease, stroke, diabetes, osteoporosis and some cancers.

Australia’s Physical Activity and Sedentary Behaviour Guidelines for Adults urge everyone to move more and sit less. Physical activity is any activity that gets your body moving and speeds up your breathing and heartbeat. It includes not only structured exercise sessions, but also everyday activities such as housework.

Adults should usually aim to be active for at least 30 minutes on most, preferably all, days of the week. The guidelines recommend a weekly total of 2.5 to 5 hours of moderate-intensity exercise, along with strength-training (resistance) activities twice a week. It is also important to break up long periods of sitting as often as you can.

"I was not as active before cancer as I am now. I walk three or four times a week. It gives me extra energy and helps clear my mind. If I don’t do any walking, I really notice the difference in my energy levels and my mood." - Rima

Safety tips for exercising with cancer

• If you are going out to exercise, let someone know when you will be back or take a phone with you in case you become fatigued or unwell.
• Start any new exercise program slowly, and increase your activity gradually.
• You may get sore muscles when you start a new form of exercise, but the soreness should go away in a few days. If it doesn’t, tell your doctor.
• Some symptoms are warning signs. If you experience any of the following symptoms while exercising, stop the activity immediately and call 000 for urgent medical assistance: pain or pressure in your chest or pain down your arms; severe shortness of breath; dizziness or fainting; irregular or unusually rapid heartbeat; nausea and/or vomiting; extreme weakness or extreme fatigue.

Should people with cancer exercise?

Recent research suggests that exercise benefits most people both during and after cancer treatment. It can help manage some of the common side effects of treatment (see below), speed up your return to your usual activities, and improve your quality of life. The evidence also shows there is little risk of exercise causing harm if care is taken and professional exercise advice is followed closely. For some cancers, exercise may even improve treatment outcomes.

People with cancer should be as physically active as their abilities and condition allow. Some days may be harder than others, but even a few minutes of light exercise is better than no exercise at all. You may want to work out two different exercise plans – one for your good days, and another for those days when you are experiencing strong side effects.

Talk to your doctor before starting an exercise program, particularly if you have bone cancer or if you have any persistent treatment-related side effects, such as lymphoedema (swelling caused by a build-up of lymph fluid), shortness of breath, nerve damage, skin irritation, fatigue or pain. Your doctor can advise whether you need a modified exercise program.

See below for some general information about the impact of exercise on common side effects of cancer treatment. If you have severe anaemia, high fever or severe weight loss, your doctor may recommend you delay starting an exercise program until your condition improves.

To help your doctors and exercise professionals fine-tune your exercise program, you could try keeping a diary to record your physical activity, other activities (such as work or socialising), and side effects. Over time, this will help them recommend the best exercise program for you. See ways you can track your physical activity.

If you are already very active at the time of the cancer diagnosis, talk to your doctor and an exercise professional (see below) about how you can retain your fitness during and after treatment.

Question checklist

You may find this checklist helpful when thinking about the questions you want to ask your doctors and exercise professionals about exercise during or after cancer treatment. If they give you answers that you don’t understand, ask for clarification.

Questions for your doctors

• Can I exercise while I’m having this treatment?
• Are there any types of exercise I should avoid?
• I have a port/PICC line and/or chemo pump. What precautions should I take?
• I haven’t exercised much before. Do I need to have any general health checks first?
• Can you recommend an exercise professional who has experience helping people with cancer?

Questions for your exercise professionals

• What are your qualifications? Are you accredited? By which organisation?
• Have you completed any training focused on exercise for people with cancer?
• Can you talk to my medical team about my exercise program?
• What will you consider when preparing an exercise program for someone with my medical history?
• How will I know that I am doing the exercises correctly?
• What should I do if I feel pain when exercising?
• Can I start slowly?
• What if I feel too unwell to exercise?
• How long might it be before I start to see some benefits from this exercise program?
• How many appointments are we likely to need?

Treatment side effects and exercise

Cancer treatment causes a range of physical effects that are different for different people. Exercise has been shown to help people cope with many of the common side effects, including fatigue, feeling sick (nausea), loss of appetite, anaemia, depression and anxiety, weight changes and loss of muscle tone. Some side effects need extra care if you are starting an exercise program.

Lymphoedema

Starting an exercise program early in treatment may lower the risk of developing lymphoedema. For those with lymphoedema, regular exercise can reduce the severity of the condition and its symptoms.

Fatigue

Many people experience fatigue (feeling tired even when rested) during and after cancer treatment. Carefully monitoring your condition and making adjustments to the exercise intensity and duration can help manage fatigue. It is important to keep doing some low-intensity exercise during times of excessive fatigue (unless you have severe anaemia, see below). You may find that shorter, more frequent sessions are more manageable. By stopping all activity you risk losing fitness and strength, which can make the fatigue worse.

Compromised immunity

Some cancers and treatments stop the immune system from working properly for a time. When your white blood cell count is low (neutropenia), there is an increased risk of infection, so it is important to limit physical contact with other people and clean any shared equipment before use. When your immunity is severely compromised, gyms, swimming pools and training venues should be avoided.

Anaemia

Low red blood cell and/or haemoglobin count is another common side effect of cancer treatment. Symptoms of anaemia include unexplained tiredness and fatigue. Combined with good nutrition, exercise has been shown to improve anaemia. For mild or moderate anaemia, try a low-intensity exercise program, with gradual increases in intensity and/or duration. However, in cases of severe anaemia (when a blood test shows a haemoglobin level of less than 80 g/L), consult your doctor about whether you should avoid exercise until it improves.

Poor balance and coordination

If the cancer or its treatment has affected your coordination or causes dizziness, it is safer to avoid exercise that relies on balance and coordination, such as cycling outdoors or using a treadmill. It is also best not to lift free weights without a training partner.

Skin irritation

Areas of skin affected by radiotherapy can be extremely sensitive and often uncomfortable. Choose activities and clothing to minimise fabric rubbing affected areas. Chlorine can be irritating, so avoid pool-based exercise if your skin has a rash or is reddened after radiotherapy.

Bone weakness or pain

Some hormone treatments for breast and prostate cancer can increase the risk of fractures, as can osteoporosis (bone thinning) or primary or secondary bone cancer. In these cases, it is best to avoid contact sports and high-impact activities such as running and jumping.

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