TAKING CANCER ON THROUGH
Physical Activity
Benefits of activities throughout your journey, expert recommendations, practical tips and a step-by-step guide towards long-lasting, positive habits for a physically stronger you
Getting started on your physical activity journey
It can be daunting and worrying starting a programme of physical activity after a cancer diagnosis, or during or after treatment. The good news is that there are plenty of available resources to guide and support you along the way.
If you are starting a physical activity programme for the first time during your cancer care pathway, simple physical activities such as standing, walking and gentle stretching will be sufficient to build an early foundation for longer-term well-being and higher intensity activities, such as exercise and sport. The general principle is to sit less and to move more.
As you begin or resume regular physical activity, the general principle is to sit less and to move more.
It will gradually become a key component of your recovery plan. In most cases, you will notice the benefits quickly, such as feeling less anxious, better appetite and increased energy levels. Long-term success of physical activity will depend on being aware of these health benefits and using them to stay motivated.
Here is an overview of considerations and steps before getting started and for your physical activity journey.
Medical clearance
The first step in starting a programme of physical activity is to get medical clearance from your doctor, who will advise on whether you can exercise based on your medical history and current health.
Before starting your physical activity programme, it’s important to get medical clearance from your doctor. It’s also natural to be nervous about starting or even resuming a physical activity programme, so be sure to raise any concerns you have with your doctor. If you are worried that you are too tired or may injure yourself, it may be worth speaking to a qualified fitness professional who can provide additional advice and guidance on activity duration, intensity and technique. Research shows that even a small amount of activity is better than none, and as you start to feel more confident you can increase your volume and even begin to explore new activities.
In addition to getting medical clearance from your doctor, it is common practice for exercise referral programmes, community exercise classes, gyms, and leisure centres to require you to complete a pre-participation or physical activity readiness questionnaire if you plan to exercise at these facilities. In this instance, it may be useful to provide a copy of your medical clearance to the exercise professional for reference. Some facilities will also require signed waivers or release forms before you can start exercising. You can be reassured that if the exercise professional has any concerns about your safety during exercise, they will contact your doctor or healthcare provider to discuss this.
Getting medical clearance is the first step in your physical activity journey.
Finding support for your journey
You are not alone. There are plenty of people who can help you get started and support you on your physical activity journey to keep you safe and benefit in the long term.
There are a number of health and fitness professionals, organisations and tailored programmes that have the required training and knowledge to guide and support you safely:
Your doctor
Your cancer doctor, nurse or GP will always be your primary point of contact. They will provide medical clearance for you to safely start physical activity, as well as advise on any necessary precautions you need to take.
Physiotherapist
During or following cancer treatment (including surgery), your doctor or specialist nurse may refer you to a hospital or community-based physiotherapist, who will prescribe suitable exercises to help reduce the adverse effects of treatment and begin the process of physical rehabilitation and recovery. Cancer care physiotherapists will have experience in early-stage exercise prescription, and they will be able to guide you on specific physical activity needs. If you do not have a physiotherapist, your doctor may be able to refer you to one.
Occupational therapist
If you are returning to work during or after your treatment, you may find it useful to talk to a workplace or community occupational therapist. They will be able to advise you on how to make changes to your work environment to help manage tiredness and promote activity in the workplace. Occupational therapists can also make recommendations on modifying your home to support your physical activity programme.
Exercise referral programmes
A number of local GP surgeries and primary healthcare centres may have exercise referral programmes aimed at those with longer term health conditions. These programmes are run by fitness professionals who hold a specialist qualification, such as Cancer Exercise Specialist. Sessions are usually delivered at local community or leisure centres as group exercise classes and can range from chair-based exercises through to dancing and yoga. Talk to your doctor to find out if there’s a local exercise referral programme suitable for you.
Fitness professionals
Fitness professionals include fitness and group exercise instructors, personal trainers, strength and conditioning coaches, yoga and Pilates teachers, and swimming instructors. These professionals will often have university degrees in health, exercise and sport, and some may have additional qualifications in massage therapy or rehabilitation. As experts in their field, they will have a deep understanding of exercise prescription, and health promotion and coaching, making them best placed to design your physical activity programme and motivate you effectively. Fitness professionals will work within the guidance given by your cancer care specialist to ensure you are exercising safely and efficiently. You can contact a qualified fitness professional at a local gym or leisure centre, via industry professional organisations or through a simple online search.
Cancer care organisations and charities
There are a number of national and international cancer care organisations and charities that offer a wealth of information on physical activity and exercise, including online resources, information centres and support lines.
You may also want to find activities in your area, especially if you are new to physical activity, or wish to explore different options. There are a number of resources that can help you find out about activities near you:
- Local council - Contact your local council to find out about suitable activities that are offered in local leisure centres, outdoor gyms and parks. Many councils will also be affiliated with local and national initiatives and campaigns to promote physical activity, including cycling schemes and running events
- Leisure centres and gyms - Local leisure centres and gyms may offer a range of activities to suit you, including specialist group exercise classes and 1-2-1 personal training
- Cancer charities - A number of cancer charities run regular physical activity campaigns and events that you can get involved with. Many also offer a range of physical activity resources on their websites
- Your doctor - Ask your doctor about any local exercise referral programmes. These programmes are often run by qualified physical activity specialists and may include both group and 1-2-1 activities
- Local activity groups - If you are interested in becoming active with others, there may be a number of organisations in your area that you can reach out to, including walking, cycling and running groups. Many of these groups will meet on a regular basis, offering an enjoyable and social way to exercise
- Sports organisations - If you’re interested in taking up a particular sport, contact local sports clubs or national sports organisations and governing bodies to find out about local resources
Important considerations before you start
The type of physical activity you do will largely depend on what you can manage and what you enjoy. Making small, sustainable changes will help you create long-lasting positive habits. Following are some key considerations that will help you determine what you can do safely for best benefit.
At what stage you are with your cancer treatment: before, during or after treatment?
Physical activity is important at all stages of the cancer care pathway. It can help with some of the adverse effects of cancer and its treatment, as well as continue to improve health outcomes well beyond treatment completion.
Before treatment
At the point of cancer diagnosis, your doctor may encourage you to start a programme of physical activity to help improve your baseline fitness level. Being active before your treatment begins may result in fewer or less severe side effects, and may also help you to feel mentally prepared and more in control. Because exercise positively affects cardiorespiratory and musculoskeletal health, it may also help you recover more quickly.
If you are new to exercise, begin your programme gradually, starting with sitting less and moving more. Lighter activities such as short walks and gardening are ideal and will allow you to increase duration and frequency as you build aerobic capacity. During this time, look for ways to incorporate some strength training, such as lifting heavy bags, in order to maintain muscle strength and endurance.
If you’re currently active, you can continue with your exercise programme and aim to meet the recommended physical activity guidelines for healthy adults (150 minutes per week of aerobic activity and resistance training twice per week).
In some cases, where treatment needs to begin immediately, talk to your doctor about starting or maintaining physical activity and exercise. They will be able to support you and provide guidance on how to manage your activity alongside your treatment schedule.
During treatment
Physical activity and exercise during treatment will help you maintain your cardiorespiratory health and muscle strength and is generally safe. However, depending on your cancer type and treatment plan, there may be some activities you need to avoid or modify. There may also be times during your treatment when you have to do less activity due to timings of treatment, or changes in energy levels or mood. Try not to see these as setbacks – instead, focus on making small, sustainable increases in activity to ensure you can maintain long-term habits.
The level of activity you can manage during treatment will depend on your current level of fitness and treatment plan. If you had the opportunity to start exercise before treatment or were previously active, you may have to exercise at a slower pace or lower intensity during treatment. If you are unfit or experiencing treatment-related fatigue, take things slowly with lighter activities.
If you are unsure about exercising during treatment, talk to your doctor. They will be able to provide guidance on managing expectations as well as refer you to a physiotherapist or physical activity specialist.
After treatment
As patients move to the post-treatment phase, the focus of physical activity should move towards improving functional ability, maximising quality and quantity of life, and promoting health. Maintaining regular activity after treatment is an important part of your recovery plan and will not only improve your general health but may also reduce the risk of certain cancers coming back.
Long-term cancer patients may be faced with side effects that can last many months or years after treatment. These will not affect everyone but maintaining physical activity will help you manage these effects if you do experience them or even reduce the risk of them occurring.
Palliative care
During palliative care, appropriate physical activity can be feasible and beneficial in reducing the effects of some cancer-related symptoms, maintaining physical function and improving quality of life. In these cases, regular physical activity can have a positive and supportive impact on psychological health, improving energy levels, mood and a sense of control.
Are you new to or returning from previously being active?
The optimal physical activity settings (home-based, supervised, group exercise) for your best positive physical and emotional outcomes will depend on your previous exercise experience, your current functional ability and personal preferences. Independent of your previous experience, making small, sustainable changes is key to achieving lasting benefits.
What are your current energy levels?
Key to the success of any physical activity programme are your energy levels, and this is especially important during and following cancer treatment. Many of the common adverse effects of treatment such as fatigue/tiredness, loss of sleep and reduced respiratory function may significantly impact your energy levels. With this in mind, it’s important to listen to your body on a daily basis and choose activities that are manageable, enjoyable and appropriate to your energy levels.
Do you experience any side effects of treatment?
Some side effects of treatment and other medical conditions can affect the type of activities you can do. It is important that you discuss side effects and any medical condition with your doctor.
How much activity do I need?
The focus should always be on what you can manage and what you enjoy. Making small, sustainable changes will help you create long-lasting positive habits.
The American College of Sports Medicine (ACSM) in collaboration with leading cancer care experts have developed international guidelines and recommendations for physical activity for people with cancer. These recommend that you return to physical activity as soon as possible, and to a level that your condition and ability allows.
The current guidelines are recognised and supported by several global organisations, charities and initiatives, and advise that:
- inactivity should be avoided
- activity is safe during and after treatment
- you should return to normal activities as soon as possible after treatment
- when possible, gradually build up to the current physical activity recommendations for overall health
Physical activity guidelines
This section provides a more in-depth look at the current physical activity guidelines for adults, and how they form the basis for further recommendations for those living with cancer.
Globally recognised physical activity guidelines exist for adults, which include recommendations for aerobic, strength and balance training activities:
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Guidance for aerobic activity focuses on a weekly minimum of 150 minutes (moderate intensity) or 75 minutes (high intensity) exercise, or a combination of the two. Aerobic activity should be performed in sessions of at least 10 minutes, preferably spread throughout the week
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Guidance for strength training is to perform a minimum of two sessions per week that include resistance exercises for major muscle groups.
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Guidance for older adults and adults with disabilities is to follow the above guidelines for adults. If this is not possible due to limiting conditions, then they should be as physically active as their abilities allow and avoid inactivity. Older adults should also do exercises that maintain or improve balance if they are at risk of falling.
For those living with and beyond cancer, the above guidelines for physical activity remain the same, with the following additional recommendations:
- Avoid inactivity and return to usual activities as soon as possible
- Be as physically active as your condition and ability allows
- Aim to stay active for as long as possible during treatment
- Build up to the general guidelines for physical activity following treatment, taking into account any side effects or late effects of treatment, or as advised by your doctor
Exercise prescription for aerobic activity
- Do 30 minutes of moderately intense aerobic activity, 5 days a week, or 25 minutes of vigorously intense aerobic activity, 3 days a week.
- Moderately intense aerobic activity means working hard enough to raise your heart rate and break a sweat, while still able to hold a conversation. Aim for level 6 intensity on a scale of 1–10 (with 10 being the highest intensity).
Exercise prescription for strength training
- Do 8–10 strength training exercises for 8–12 repetitions, twice a week. Aim to work major muscle groups.
- You should still be able to hold a conversation during exercise (level 6 intensity).
What is the best activity for me?
Before you choose your activities, think about what you are interested in, what is right for you, and what you would enjoy doing. In general, activities will focus primarily on maintaining or improving aerobic capacity and muscular strength.
Global physical activity guidelines generally recommend two types of activity for health – aerobic activity and muscle strengthening. In simple terms, aerobic activity is anything that makes your heart beat faster and causes you to become breathless and sweat more. Muscle strengthening (resistance training) is any activity that makes your muscles work harder than usual.
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Examples of aerobic activity: walking, gardening, swimming and cycling, with more vigorous activities including hiking, running and sport
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Examples of muscle strengthening: yoga, weight training and carrying/lifting loads (e.g., gardening, DIY).
There are many different types of physical activity, ranging from daily activities through to recreation and sport. Physical activity can also be structured or unstructured, as well as individual or group based. With so many types available, it can often be challenging to know what activity is best for you, and how well it fits in with your current treatment plan.
Regular physical activity and exercise has a positive effect on almost every physiological system in the body, with the greatest overall benefits for cardiorespiratory and musculoskeletal health. As a result, activity prescribed by a healthcare practitioner will often focus primarily on maintaining or improving aerobic capacity and muscular strength.
Aerobic capacity
The maximum amount of oxygen the body can use during exercise; it is a useful measure of current cardiorespiratory health.
Muscular strength
The amount of force a muscle can produce with a single effort; it represents one of many ways of assessing muscle function.
Because the adverse effects of cancer and its treatment can have both short- and long-term effects on aerobic capacity and muscular strength, the maintenance or development of both these elements will be a primary focus before, during and after treatment. This is to reduce the severity of side effects, preserve the existing function of the patient in this regard and improve quality of life.
Current global physical activity guidelines make clear recommendations about both aerobic and strength exercise, and experts agree about the benefits across a number of populations, including those who are undergoing or who have finished cancer treatment. Whether you are new to exercise or were previously active, your experience of cancer before, during and after treatment will be unique.
Aerobic activity will help develop aerobic capacity and can be regarded as any activity that makes your heart and lungs work harder and faster.
Common aerobic activities:
- Daily activities – Sometimes referred to as Non-Exercise Physical Activity (NEPA), these include housework, gardening, walking the dog or playing with children
- Outdoor walking – One of the most effective forms of aerobic exercise. It’s also weight-bearing, which is good for strengthening the bones of the spine, pelvis and legs
- Gardening – A good form of aerobic and strength exercise, especially if lifting loads, digging or mowing the lawn. Spending time outdoors in the fresh air may also help with feelings of stress and anxiety
- Swimming and cycling – Popular forms of non-weight bearing exercise that will develop aerobic capacity and muscular strength, but with less stress on the bones and joints. Swimming may be beneficial if you have lymphoedema
- Running – Considered a vigorous form of aerobic activity, but may not be suitable for those with bone or joint problems
- Group exercise – Usually in the form of indoor exercise classes, such as dance or yoga, or outdoor-based, such as walking/hiking clubs. They can be a great way to meet new people and socialise
- Sport – Includes competitive one-on-one or team activities, such as tennis, golf, bowls or archery. A great way to make positive changes in your life by learning a new skill
Strength training will help develop muscular strength and can be thought of as any activity that makes your muscles work harder and will involve some form of resistance training.
Common strength activities:
- Lifting bags – The simple act of carrying shopping bags can be enough to start rebuilding strength. If you are unfit or deconditioned, fill up some bags or boxes and lift/carry them around the home
- Heavy gardening – Can build high levels of functional strength when it includes lifting loads such as bags or wheelbarrows
- Weight training – Probably the most common form of strength exercise usually performed at gyms using machines and free weights, or at home using smaller equipment
- Yoga – An extremely versatile and progressive form of bodyweight-based strength training that is also beneficial for mobility, balance and stress management
- Exercise bands – One of the most adaptable yet underrated forms of strength training. They are cheap and portable, and can be used in almost every position, including sitting
- Circuit training classes – High-intensity group strength training that often uses a mix of weight training, bodyweight exercises and exercise bands
In order to safely progress through your physical activity or exercise programme, it’s important to understand the concept of intensity. Up to this point, we have talked about increasing or maintaining physical activity. We have also referred to activity as being light, moderate or vigorous activity – but what does this actually mean? This is where intensity comes in and getting this right will ensure you maximise the benefits of physical activity and remain motivated throughout your treatment plan and beyond.
During physical activity, intensity simply means how hard you are working, or how much effort you are putting in. It is commonly measured using a heart rate monitor, but fortunately there is a much easier way to monitor intensity by paying attention to your breathing:
- Light intensity – During this activity you are working at a low level, but you can breathe comfortably and talk easily. For most people, examples include walking or light gardening
- Moderate intensity – During this activity you are working harder and your breathing is quicker, but you can still talk. Your body will be warmer and you may have a light sweat
- Vigorous or high intensity – During this activity you are working and breathing hard and cannot hold a conversation. You will be significantly warmer and sweating more, with a high heart rate
As you become familiar with intensity, it will become more than just a way of categorising different types of activity – it’s also a useful tool for progression. For example, you may enjoy walking but now find it’s getting easy. Instead of increasing your walking time, try increasing the intensity by walking uphill or off-road, or even carrying a light rucksack. In this way, you can still do the activity you enjoy while continuing to get fitter.
For some people with cancer, activities that develop muscle and bone strength may be more suitable than aerobic activity; for others, activities that promote cardiovascular health may be needed. This will depend on the stage of cancer or treatment and your doctor, a physiotherapist or fitness professional will be able to give you additional advice on where to begin.
The type of activity that is best for you will depend on the following:
- The type of cancer and any side effects of treatment. This will affect what exercises you can manage and what is safe to do
- Any other cancer-related or underlying health conditions you may have, such as heart disease or diabetes
- Any longer-term effects of cancer and its treatment, including bone problems, lymphoedema or a stoma
- Your fitness level before diagnosis. While some people will be able to quickly resume previous activities, others will need to build back their fitness slowly at a pace that suits them
- Your energy levels. These can fluctuate on a daily basis, especially during treatment, so it’s important to assess how you feel and, when needed, balance lighter activities with adequate rest
Don’t forget to choose activities you enjoy and set some realistic goals. Look for ways to incorporate aerobic and strength activities into your daily life, and, most importantly, listen to your body and pick activities that feel right for you
What are your preferences? Would you prefer a home-based activity or joining a gym? Would you get more benefit from doing group activity or would you prefer to exercise alone? These are important questions to ask yourself, along with considerations of time, energy levels and your treatment plan. Remember, there is no single activity that is best for everyone – it’s about finding what’s right and sustainable for you. Completing 5 short walks every day will motivate you more than struggling with 1 long walk a week.
Always listen to your body – if you feel tired the day after activity or exercise, it may be a sign that you are doing too much, too soon. Rest when you need to, and over time you’ll be able to increase the amount of activity you do.
Here are some suggestions for physical activities and their key benefits to help with choosing the right physical activity for you:
Try to include some aerobic activity and strength exercises in your physical activity programme to maintain or improve cardiorespiratory and muscular function. Different types of cancer and their treatment may also affect other components of health and fitness such as decreased mobility and loss of balance. When choosing the right type of aerobic and strength activities, look for options that also develop mobility and balance. Please always talk to your doctor before starting a physical activity programme.
The following table highlights some common physical activities and the associated components of fitness – aerobic capacity, muscular strength, mobility and balance. Note that many activities will incorporate more than one component of fitness, which means you don’t have to perform many different activities to get the benefits.
ACTIVITY |
Aerobic capacity |
Muscular strength |
Mobility/flexibility |
Balance |
|---|---|---|---|---|
Brisk walking |
✔︎ | - | - | - |
Climbing stairs |
✔︎ | ✔︎ | - | ✔︎ |
Hiking |
✔︎ | ✔︎ | - | ✔︎ |
Light gardening |
✔︎ | - | ✔︎ | - |
Heavy gardening |
✔︎ | ✔︎ | ✔︎ | ✔︎ |
DIY/heavy housework |
✔︎ | ✔︎ | ✔︎ | ✔︎ |
Cycling |
✔︎ | ✔︎ | - | ✔︎ |
Swimming |
✔︎ | ✔︎ | ✔︎ | - |
Running |
✔︎ | - | - | ✔︎ |
Tennis |
✔︎ | - | ✔︎ | ✔︎ |
Badminton |
✔︎ | - | ✔︎ | ✔︎ |
Golf |
- | - | ✔︎ | ✔︎ |
Bowls |
- | - | ✔︎ | ✔︎ |
Football |
✔︎ | ✔︎ | - | ✔︎ |
Weight training |
- | ✔︎ | ✔︎ | - |
Group exercise class |
✔︎ | ✔︎ | ✔︎ | ✔︎ |
Group exercise class |
✔︎ | ✔︎ | ✔︎ | ✔︎ |
Dancing |
✔︎ | ✔︎ | ✔︎ | ✔︎ |
Yoga |
- | ✔︎ | ✔︎ | ✔︎ |
Tai chi/Qi gong |
- | - | ✔︎ | ✔︎ |