How can cancer patients stay active during treatment? Which exercises are best for cancer survivors?
Dana-Farber exercise physiologist Nancy Campbell, MS, discusses tips for staying active during and after cancer treatment.
Q: What are the benefits of exercise for cancer patients and survivors?
Studies have shown that exercise may help reduce the risk of recurrence in cancer patients. It has also been shown to help elevate mood, reduce anxiety, improve sleep, boost energy, and help reduce symptoms of treatment-related side effects, such as neuropathy.
Q: Should cancer patients wait until they are done with treatment before starting an exercise routine?
If you feel well enough to start exercising, and if your oncologist and care team have approved of a fitness routine, then patients can certainly work out during treatment. It's important to start slow; try walking, yoga or stretching before working your way up to a more active routine.
Q: How do you recommend patients get started with fitness routines? Are there certain exercises that are best to start with?
Patients should start slow and work their way up to more rigorous exercise. I recommend starting with a regular walking routine or some yoga and stretching. Flexibility exercises, like yoga, can help you maintain mobility and get you ready for more vigorous exercises.
Once you feel comfortable, you can work your way up to aerobic exercises, like jogging, cycling (stationary bikes are fine), swimming, or brisk walks. These can help you burn calories, lose weight and build cardiovascular fitness.
Resistance training can also help maintain muscle and bone mass, which may be important during and after treatment.
It's important to talk with your oncologist and care team before starting a fitness routine. Seeking help from a personal trainer or exercise physiologist can also help you get started.
Q: What resistance training exercises do you recommend?
It's hard to answer this question without knowing specific about your cancer treatment or other medical history. But in general, focusing on the major muscle groups such as quads, hamstring, core and upper back. It is always best to seek professional help from a physical therapist or certified personal trainer if you have any injuries or limitations.
Q: How often do you recommend cancer patients and survivors should exercise?
The standard American College of Sports Medicine and American Cancer Society recommendations of 150 minutes per week of cardiovascular exercise and 2-3 days of strength training per week would apply. However, it's important to listen to your body and increase your exercise slowly, especially if you are still in treatment.
Learn more about exercise during and after cancer treatment.
Q: After three long years with breast cancer, I would like to start trying some gentle exercise. Would you recommend yoga or Pilates for someone who is still in treatment with chemotherapy?
I think either of those would be fine, provided that you share your surgical history and relevant treatment issues with the instructor. There are several poses/exercises that may not be a good fit for you depending on your cancer treatment.
Q: What about exercising during treatment for metastatic breast cancer? Is there anything different patients should consider?
You may want to pursue working with a physical or occupational therapist. Some of the biggest concerns occur if you have cancer that has metastasized to your bones, especially in the hips or spine. You want to be cautious of forward bending and twisting moves. In general, following the American College of Sports Medicine and American Cancer Society guidelines of aiming for 150 minutes per week of cardiovascular exercise is recommended.
Q: I have been exercising and doing yoga four times/week along with walking, but some days my tendons get so cramped I have to stop. It seems the more I exercise, the more my legs cramp and I have severe neuropathy in my feet. What do you suggest? I would like to get back to a normal activity level, if possible.
You may want to have a day of rest between your activities or decrease the intensity or duration until your leg cramps decrease. It might help to keep track of your activity in a journal or with an activity tracker like a pedometer or Fitbit etc. At Dana-Farber we offer classes like Energize Your Feet to help with the symptoms of neuropathy and other foot issues. It's also important to stay hydrated during activities and meeting with a nutritionist may help identify any dietary changes that could help with cramping.
Q: How hard can a patient work out while they are undergoing radiation for breast cancer?
There are many factors that go into an answer for this question; such as prior exercise and medical history. It is important to listen to your body and if you are experiencing significant fatigue, you need to rest and decrease your duration or intensity of exercise. You also want to focus on consistency and making sure you are doing some movement on most days or every other day. Don't do too much on one day; you'll want to avoid being too exhausted and doing nothing for several days.
Q: Do you have any recommendations of ways I can stay fit without having to leave the house?
Exercise DVDs and videos are a great way to get started without leaving the house. You can find these to rent at your local library, or you may be able to find them for free on YouTube. For anyone who is just starting a fitness routine, especially cancer patients, I recommend "walking workout" videos that involve marching in place for varying distances or amounts of time.
You can also incorporate household items into your workouts. Try walking up and down stairs, or up and down just two stairs at a time. Push-ups are also an easy way to build strength and can be done on the knees or off of a wall or coffee table. For more strength training, try using soup cans in place of dumbbells.
Learn more ways to stay active close to home.
Q: Does my fitness routine have to include something that is cardio-focused, like running or cycling? Is it OK if I stick to yoga and stretching?
I believe it is important for your fitness routine to be well rounded. Many people find walking to be an easy and efficient way to get cardiovascular exercise. Ultimately, it needs to be an activity that you enjoy and is convenient for it to be successful. I would also recommend adding some strength training into your routine.
The Livestrong program at the YMCA might be a good fit, or looking into exercise programs at your local hospital or wellness center.
Q: What are your tips for staying motivated and keeping on track with an exercise routine?
Many people – not just cancer patients – find it hard to stay motivated when it comes to exercise. I recommend finding an exercise buddy who can accompany you on workouts or walks. Your buddy can also be someone who checks in with you to make sure you're sticking to a fitness routine.
Another way to stay motivated is to set goals and work slowly towards them. This could be a simple commitment to exercise three days a week, or a larger goal like a charity walk or 5K. The Boston Marathon® Jimmy Fund Walk in September is a great goal to work up to. The Ulman Cancer Fund for young adults has a great Cancer to 5K program.
To keep track of progress, try using a pedometer or fitness-tracking smartphone apps. Friends can also compare numbers in a friendly competition, which can help keep up motivation.
Q: Can exercise help with neuropathy? What exercises do you recommend?
Exercise is a great way to help deal with side effects of neuropathy. If you have neuropathy in your hands or fingers, I recommend exercises like:
- Finger rolls – Extend your arms in front of you at shoulder height with palms facing away from you. Then, starting with your little finger, curl your hand into a fist one finger at a time. After that, rotate the fist to face you and open up your hand, one finger at a time, and rotate the palm back out to the front.
- Finger taps – Extend your arms in front of you at shoulder height. Touch your little finger to your thumb and repeat with other fingers, then repeat the motion in reverse order (starting with index finger). You can also do finger taps sitting down; place your palms on your lap and lift each finger to tap twice on your lap.
If you have neuropathy in your feet, you can try:
- Ankle circles
- Calf raises/stretches
- Standing heel to toe – Place right foot directly in front of left foot, eyes open, arms at side or across chest. Look straight ahead at a stationary object and hold for up to 30 seconds before repeating with left foot in front of right foot. If you need to, hold on to a chair for support.
- Standing side leg – Stand next to a chair in an upright position with feet together. Then, raise your leg in an outward motion, as far as possible, making sure the foot is pointing forward. Hold this for two seconds before returning to the starting position. Keep your back straight and your abdominal muscles engaged. Then, repeat with the other leg.
Dana-Farber's Zakim center also offers great classes that can help with neuropathy symptoms.
Q: How do I find Pilates and yoga instructors who take my medical issues into account? Are there certain qualifications or certifications to look for?
There are several organizations like the Cancer Exercise Training Institute or Pink Ribbon Pilates that offer a certification. Also, some of the yoga or Pilates organizations offer special certifications for working with cancer survivors. It is important that you ask about an instructors experience working with survivors and share all your prior surgeries and medical history and speak up if certain movements cause pain. I would also recommend the book "Pilates for Breast Cancer Survivors" by Naomi Aaronson and Ann Marie Turo.
Q: I am a breast cancer survivor and I am having a very hard time losing weight. Are diet pills safe for cancer survivors? If not, what would you recommend?
I would not recommend using diet pills to assist with weight loss. Here at Dana-Farber, we offer a weight loss program.
Learn more about breast cancer, exercise, and diet.
Q: What exercises or other lifestyle recommendations do you have for someone who is a thyroid cancer survivor? My thyroid was removed and I have gained 60-80 pounds that I would like to lose.
The standard ACSM and ACS recommendations of 150 minutes per week of cardiovascular exercise and 2-3 days of strength training per week would apply. Seek professional assistance from a nutritionist or registered dietician who has experience working with cancer survivors.
Learn more about healthy ways to lose weight after cancer treatment.
Q: Do you have any recommendations for mobile apps to help stay on track with a fitness routine?
My Fitness Pal and Map My Fitness are popular options for tracking both diet and exercise, and both are free. Keep in mind that some apps do require payment for advanced features. If you own a Fitbit, I would also recommend using the mobile app that goes along with the device.
There are also many Couch to 5K apps available that can help you stay on track and build up endurance.
More Information on Exercise
- Learn more about exercise programs at Dana-Farber.
- Learn more about the link between exercise and quality of life for cancer survivors.