Promoting Healthy Behaviours (Physical exercise)

Exercise is safe during cancer treatment, and it has many benefits. It improves bone health, muscle strength, erectile dysfunction, and other quality-of-life measures. Before starting your exercise program, talk with your doctor or health care team. Ask them about when you can start to exercise and how you can be physically active during treatment. Your health care team will consider your condition and your personal preferences as they help you work out a plan. If you are receiving chemotherapy and/or radiation therapy and already have an exercise program, you may need to exercise at a lower intensity and/or for a shorter period of time for a while. The goal should be to be active as much as possible. Some doctors may suggest that you wait to see what side effects you have with chemotherapy before starting physical activity (ACS, 2012).

If you did not exercise before your diagnosis, you might start with low-intensity activities such as stretching and brief, slow walks and progress slowly.

Older adults and those with bone metastases, osteoporosis, arthritis, or peripheral neuropathies should pay careful attention to their balance and safety to reduce the risk of falls and injuries. Having a caregiver or exercise professional present during exercise sessions can be helpful.

If you are unable to exercise, you might ask about physical therapy. Physical therapy during bed rest will help to maintain strength and range of motion and can reduce fatigue and depression. 

Exercise for colorectal cancer (CRC) survivors reduces cancer recurrence, cancer-specific mortality, and all-cause mortality in dose-response fashion. The American College of Sports Medicine (ACSM), American Cancer Society (ACS), and National Comprehensive Cancer Network (NCCN) recommend all cancer survivors engage in 150-minutes of moderate-intensity or 75-minutes of vigorous-intensity aerobic exercise per week, perform two to three muscle strengthening sessions per week, and perform flexibility activities on days of exercise (Brown & Schmitz, 2014)

General physical activity recommendations for cancer survivors (ACS, 2022)

The American Cancer Society has a Nutrition and Physical Activity Guideline for Cancer Survivors. These Guidelines call for cancer survivors to:

• Avoid inactivity and return to normal daily activities as soon as possible after diagnosis and treatment.
• Take part in regular physical activity.
• Start slowly and build up the amount of physical activity over time.
• Build up to 150-300 minutes of moderate (or 75-150 minutes of vigorous intensity) activity each week.
• Exercise several times a week for at least 10 minutes at a time.
• Include resistance training exercise at least 2 days per week.
• Do stretching exercises at least 2 days each week.

Planning to be more active

Always check with your health care team before starting any exercise program, especially if you have any of the following:

• Heart or lung disease
• Ostomy
• Severe fatigue
• Unsteadiness on your feet or balance problems
• Weak bones or bone metastases (cancer that has spread to the bones)

Also ask whether any of the medicines you take might affect how physically active you can be.

Some people can safely begin or maintain their own exercise program, but many will have better results with the help of an exercise specialist, physical therapist, or exercise physiologist. Be sure to get your doctor’s OK first and be sure that the person working with you knows about your cancer diagnosis and any limitations you have. Specially trained professionals can help you find the type of exercise that’s right and safe for you. They can also help you figure out how often and how long you should exercise.

Whether you’re just starting to exercise or continuing to do so, be sure to talk with your health care team about what you can and can’t do. Keep your cancer team informed on how you’re doing in regard to your activity level and exercise throughout and after your treatment.

When starting to get active or becoming more active, there are some important things to think about.  

• Stay away from uneven surfaces that could make you fall
• If you plan to exercise outside, find someplace safe and well-lit
• If you are more at risk for infection, you may need to stay away from public gyms and crowds until your risk returns to normal.
• If you want to swim while getting radiation therapy, check with your radiation therapy team. If you don’t have any skin irritation or sores, you should be able to swim. Be sure to rinse off after getting out of a pool to lower the chance of skin irritation.
• Take someone with you when you exercise or make sure someone knows where you are in case you have trouble. It can also help to carry a mobile phone.

Start slowly

• Even if you can only be active for a few minutes a day it will help you. Increase slowly how often and how long you exercise. Your muscles will tell you when you need to slow down and rest or can do more.
• Exercise as you are able. Don’t push yourself while you are in treatment. Listen to your body and rest when you need to. If you feel very tired you can try doing 10 minutes of light exercises each day and build up.
• Do not exercise if you feel dizzy or are unsteady on your feet.
• Try short periods of exercise with frequent rest breaks. For example, walk briskly for a few minutes, slow down, and walk briskly again, until you have done 30 minutes of brisk activity. You can also divide your activity into three 10-minute sessions. You’ll still get the benefit of the exercise.
• Do not exercise above a moderate level of exertion without talking with your doctor. Moderate exertion is about as much effort as a brisk walk.
• Avoid any activity that puts you at risk for falls or injury. If you notice swelling, pain, dizziness, or blurred vision, call your doctor right away.
• If you have numbness in your feet or problems with balance, you are at higher risk for falls. Ask about devices that might help you.

Try more than one kind of exercise

• Try to include physical activity that uses large muscle groups such as your thighs, abdomen (belly), chest, and back. Strength, stretching, and aerobic fitness are all important parts of a good exercise program.
• Try to include some exercises that will help you keep lean muscle mass and bone strength, like exercising with a resistance band or light weights.
• You might want to include exercises that will increase your flexibility and keep the range of motion in your joints.
• Always start with warm-up exercises for 2 to 3 minutes. Examples of warm-up exercises are shoulder shrugs, lifting arms overhead, toe tapping, marching, and knee lifts.
• End your exercise session with stretching or flexibility exercises. Hold a stretch for about 15 to 30 seconds and relax. Examples of stretching are reaching overhead, deep breathing, and bending over to touch your toes so that you relax all the muscle groups.

Special issues

• Drink plenty of fluids unless you’ve been told not to.
• If you have a catheter or feeding tube, avoid pool, lake, or ocean water and other exposures that may cause infections. Don’t play contact sports. Also, do not do resistance training that uses muscles in the area of the catheter to keep it from dislodging. Talk with your cancer team about what’s safe for you.
• Do not use heavy weights or do exercises that puts too much stress on your bones if you have osteoporosis, cancer that has spread to the bone, arthritis, nerve damage, poor vision, poor balance, or weakness. You may be more likely to hurt yourself or break a bone.

Keep exercise easy and fun

How much you should exercise is different for each person. We don’t know the best level of exercise for someone with cancer. The goal is to have your exercise program help you keep up your muscle strength and keep you able to do the things you want and need to do. The more active you are, the better you’ll be able to exercise and function. But even if planned exercise stops, it’s good to keep being active by doing your normal activities as much as you can. The key to staying active is to keep your exercise program simple and fun. Exercise and relaxation techniques are great ways to relieve stress. Reducing stress is an important part of getting well and staying well.

Tips to help you stick to your exercise program

• Set short-term and long-term goals.
• Focus on having fun.
• Do something different to keep it fresh. Try yoga, dancing, or tai chi.
• Ask for support from others, or get friends, family, and co-workers to exercise with you.
• Use charts or a fitness tracker to record your exercise progress.
• Recognize and reward your achievements.

Starting an exercise program can be a big task, even for a healthy person. It may be even harder if you have a chronic illness, especially if you weren’t used to exercising before your diagnosis. Start slowly and build up as you are able. If you were exercising regularly before you were diagnosed with cancer, you may need to reduce the intensity and length of your exercise sessions for a while. But you can build back up when you feel up to it.

Add physical activity to your daily routine

There are ways to add physical activity to the things you do every day. Remember, only do what you feel up to doing.

• Take a walk after dinner
• Ride your bike
• Mow the grass or rake the leaves instead of using a blower
• Scrub your bathroom
• Wash and wax your car
• Play active games with kids, like freeze tag, jump rope, and other games you played when you were a kid
• Walk a dog (one that can be controlled so that you don’t trip or get pulled off balance)
• Weed your garden
• Bust a move (dance) in your living room
• Use an exercise bike or treadmill, or do arm curls, squats, lunges, and crunches while watching TV
• Walk to lunch
• Park your car in the farthest parking space at work and walk to the building
• Use the stairs instead of the elevator or escalator
• Get off the bus several stops early and walk the rest of the way
• Make appointments for yourself in your daily planner for 10-minute walking breaks
• Form a walking club of co-workers to help you stay motivated to walk during the workday
• Use a fitness tracker to try to increase your daily steps

Cancer survivors may need to exercise less intensely and increase their workout at a slower rate than people who haven’t had cancer. Remember, the goal is to be as active as possible. Keep it safe, keep it fun, and make it work for you.

ACS, A. C. S. (2012). Nutrition and Physical Activity Guidelines for Cancer Survivors A Cancer Journal for Clinicians, 62, 275-276. https://doi.org/https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21146

ACS, A. C. S. (2022). Physical Activity and the Person with Cancer. https://www.cancer.org/cancer/survivorship/be-healthy-after-treatment/physical-activity-and-the-cancer-patient.html

Brown, J. C., & Schmitz, K. H. (2014). The prescription or proscription of exercise in colorectal cancer care. Med Sci Sports Exerc, 46(12), 2202-2209. https://doi.org/10.1249/mss.0000000000000355