Safety first

While some physical activity during and after cancer treatment can help you along the way, it’s important to ensure you are safe. Even if you have previously exercised, you may now be dealing with symptoms of cancer and side effects of treatment. Here are some tips on staying safe during physical activity.

Overview of key safety principles 

• Whatever your current level of fitness, build up activity slowly and gradually
• Don’t start activities if you feel unwell or have any new symptoms that concern you
• If you have bone problems, avoid excessive weight bearing, high impact activity and activities on uneven surfaces
• Stay hydrated before, during and after activity
• Wear suitable footwear for the activity you are doing
• If training outdoors, pay attention to your environment and protect yourself in the sun
• If training outdoors, pay attention to your environment and protect yourself in the sun
• Replenish energy after activity with a healthy snack, if needed. Explore
• Stop your activity and speak to your doctor if you:
  - feel dizzy or sick
  - have a racing heart or chest pain
  - have difficulty breathing
  - have unusual bone or muscle pain
  - have a headache that doesn’t go away
  - have any other unusual symptoms 

In some cases, you may need to avoid certain exercises, so talk to your doctor or care specialist for advice before starting physical activity.

Considerations during treatment

When you are undergoing treatment, you will need to consider some additional safety points when planning your physical activities.

• Surgery – Some physical activity before surgery may be recommended by your doctor to support your recovery. You will also benefit from some light physical activity as soon as possible after surgery to help reduce the risk of complications such as blood clots. However, with some operations, such as a stoma, you may have to avoid some activities. In any case, talk to your surgeon or physiotherapist who will advise you on what to avoid and for how long. Your physiotherapist will also provide you with specific exercises to do at home 
• Chemotherapy – Chemotherapy temporarily reduces the rate at which your bone marrow produces blood cells, including red blood cells, white blood cells and platelets. A reduced number of blood cells increases your risk of the following:
  - Anaemia – If your red blood cell count is low, you may feel tired and breathless even when doing light physical activity. While you may be able to manage simple day-to-day activities, it’s important to rest where necessary until the condition improves
  - Infection – If your white blood cell count is low, you will be at an increased risk of infection. During this time, your doctor may advise you to avoid busy, public places including leisure centres and gyms. While minimising your risk of infection is the priority, you may still be able to do physical activity at home or outside in open spaces
  - Bruising and bleeding – If your platelet count is low, you may be at increased risk of bruising and bleeding. In this instance, your doctor may advise you to exercise gently and avoid high impact activities until your platelet count is back to normal
• Radiotherapy – This can often cause skin reactions and/or skin sensitivity that can become sore on contact. Therefore, wear loose clothing during exercise to avoid excessive rubbing; you may also have to avoid swimming as pool chemicals can also irritate skin

Side effects and other conditions

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, so you can make appropriate modifications to activity type, duration and intensity to ensure that your activities are continuing to contribute to your well-being.

• Lymphoedema – Some cancer treatments can cause a build-up of fluid in certain parts of the body, called lymphoedema. While physical activity can help you manage lymphoedema, you should talk to your doctor or specialist nurse for further advice, and consider the following:
  - Wear a suitable compression sleeve during exercise and build up exercise slowly with the affected limb
  - Strength training is safe but avoid heavy, repetitive movements using the affected limb
  - Avoid prolonged positional holds during activity, such as the plank exercise
  - Gentle stretching, walking, swimming and yoga can also be beneficial in promoting fluid drainage
• Heart and lung problems – If you have any pre-existing heart or lung problems or have experienced these brought on by the side effects of cancer and its treatment, talk to your doctor and get medical clearance before starting a programme of physical activity. However, for most affected people, physical activity is both safe and beneficial 
• Bone problems – Avoid high impact physical activities (including running-related and contact sports) if you have bone cancer or a bone thinning condition, as this will increase your risk of a bone fracture or break. In addition to high impact movements, you may also be advised to avoid high repetition movements of the affected limb. Some people will have a higher risk of fracture than others, so talk to your doctor who will advise on which activities are safe and which to avoid. In most cases, however, it is usually safe to begin with low impact activities such as walking, climbing stairs, swimming and cycling. 
• Nerve damage – Some cancer treatments can cause damage to nerves that control sensation and movement in the arms, hands, legs and feet (also called peripheral nerves). Common symptoms include tingling and numbness, loss of muscle strength and disturbances in balance and coordination. While a small amount of numbness in the fingers or toes may not affect your ability to do light activity, if your legs and arms are affected or you have difficulty balancing, then you should avoid activities that rely on balance and coordination. These include brisk walking and running; instead focus on low impact activities such as swimming or cycling. If the hands are affected, holding weights may also become challenging; however, exercise bands can be appropriately modified as a strength training alternative.  
• Stoma – If you’ve had a stoma fitted following surgery, you will need time to adjust to the change and learn how to manage this during physical activity. Your stoma care nurse or doctor will be able to guide you on how to exercise with a stoma and advise you on any activities you initially need to avoid

Considerations for advanced cancer

For those with advanced cancer, physical activity is also safe and will have many benefits, including reduced tiredness, improved appetite, increased bone health and better aerobic capacity and muscle strength.

As with any physical activity programme, start by sitting less and moving more – especially around the house. When you feel ready, begin with short walks, gradually increasing the amount you do. This will slowly develop a level of aerobic capacity that will support daily activities such as getting dressed or doing housework. The addition of some strength training will further build your capacity and will aid heavier tasks, such as getting in/out of the bath, climbing stairs and gardening.