Due to the debilitating side effects that can often accompany chemotherapy treatment exercising might seem like the last thing on your agenda. But what if we told you that exercise can actually help with mitigating these terrible side effects? Here we explain why everyone should be exercising during chemotherapy and how to do it safely and effectively.
What is chemotherapy?
Chemotherapy is a common treatment method for various types of cancer and involves the administration of medication through infusion (via needle or catheter) or orally. Chemotherapy can be performed before surgery (neoadjuvant) or after surgery (adjuvant) depending on the desired outcome. During chemotherapy, powerful drugs are used to target the rapidly dividing cells of the cancer in the body in order to kill the cancer or slow down its growth.
Unfortunately these powerful chemotherapy drugs are unable to differentiate between the bad rapidly dividing cells (cancer) and the good ones (such as the stomach lining, bone marrow, hair follicles, and nail cells), hence the often large number of nasty side effects with this type of treatment.
What is the role of exercise during chemotherapy?
Exercise is now recognised as a standard part of medical care for people with cancer due to its ability to counter the adverse effects of cancer and its associated treatment, including chemotherapy.
During chemotherapy exercise:
- Improves treatment tolerance of chemotherapy and completion rates
- Improves immune function and decreases rates of hospitalisation
- May improve sleep disturbances during and after treatment (emerging evidence)
- Reduces number and severity of related complications (including cancer-related fatigue and cardiotoxicities)
- Maintain physical function and quality of life during treatment
It is also considered that exercise may even aid in the efficacy of the chemotherapy drugs themselves, however this is yet to be confirmed and there is plenty of research currently being conducted looking into this.
How much exercise should I be doing during chemotherapy?
In 2019 the American College of Sports Medicine updated their guidelines on Exercise for Cancer Survivors, which encourage performing:
- AT LEAST 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity AEROBIC exercise (the stuff that makes you huff and puff). This includes brisk walking, jogging, cycling, and swimming.
- Two to three RESISTANCE exercise (the stuff that makes your muscles and bones strong) sessions, focussing on our larger muscle groups.
Both AEROBIC and RESISTANCE exercise is recommended as each type of exercise training has specific benefits and are considered safe during chemotherapy treatment.
Importantly these updated guidelines also reported that by performing 30-60 minutes of aerobic exercise 2-3 days per week OR 20-40 minutes of aerobic exercise combined with resistance training 2-3 days per week, cancer survivors can:
- Decrease cancer-related fatigue
- Reduce depression and anxiety symptoms
- Improve physical functioning
- Enhance health-related quality of life.
This is welcoming news as this lower level of activity may be more achievable to maintain for individuals undergoing concurrent chemotherapy treatment.
Finally, a SUPERVISED exercise program overseen by an oncology-trained Exercise Physiologist or Physiotherapist is known to be more effective at overcoming the common side effects of chemotherapy compared to a home-based program. Although supervised exercise is preferred, a home-based program still has benefits and is better than no exercise program at all!
Things we need to consider:
Due to the complexity of chemotherapy treatment there are many factors that need to be taken into account when prescribing an exercise program. Modifications may include:
- Adjusting exercise duration and intensity on “bad days”
- Performing several short exercise bouts per day rather than one single bout when exercising at home
- Reducing exercise intensity in the first week following chemotherapy as this is when symptoms are likely to be at their worst
- Incorporating a flexible exercise schedule to account for various medical appointments
Where the future is heading:
Currently there are an abundance of exciting studies looking into the benefits of exercise during/after chemotherapy. Promising research includes investigating the feasibility of exercising simultaneously to undergoing chemotherapy infusion, the advantages of exercise immediately before and/or after chemotherapy, the effects of high intensity interval training (HIIT) during chemotherapy, and the benefits of exercise on the effectiveness of chemotherapy. Early findings are extremely encouraging and have us very eager to see how the outcomes can further embed exercise as a standard part of care during chemotherapy!
Currently undergoing or about to undergo chemotherapy? We are here to help support you through your treatment and answer any further questions that you may have about exercise and chemo – our Exercise Physiologists are upskilled in oncology care.
Written by Michael Czaplowski, Accredited Exercise Physiologist at Movement Against Cancer
Campbell K.L., Kirkham A.A. (2020) During Infusion Therapy. In: Schmitz K. (eds) Exercise Oncology. Springer, Cham.
Campbell KL, Winters-Stone K, Wiskemann J, et al. American College of Sports Medicine expert consensus statement on exercise guidelines for cancer survivors: report from the international, multidisciplinary roundtable. Med Sci Sports Exerc 2019. 2019;51(11):2375–90
Courneya KS, McKenzie DC, Mackey JR, et al. Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial. J Natl Cancer Inst. 2013;105:1821–32.
Courneya KS, McKenzie DC, Reid RD, et al. Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Ann Behav Med. 2008;35:116–22.
Courneya KS, Segal RJ, Gelmon K, et al. Predictors of adherence to different types and doses of supervised exercise during breast cancer chemotherapy. Int J Behav Nutr Phys Act. 2014;11:85.
Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25:4396–404.
Kirkham AA, Beaudry RI, Paterson DI, Mackey JR, Haykowsky MJ. Curing breast cancer and killing the heart: a novel model to explain elevated cardiovascular disease and mortality risk among women with early stage breast cancer. Prog Cardiovasc Dis. 2019;62:116–26.
Kirkham AA, Bonsignore A, Bland KA, et al. Exercise prescription and adherence for breast cancer: one size does not FITT all. Med Sci Sports Exerc. 2018;50:177–86.
Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA. 2018;320:2020–8.
Riebe D, Ehrman JK, Liguori G, Magal M, editors. ACSM’s guidelines fo exercise testing and prescription. 10th ed. Philadelphia: Wolters Kluwer; 2018.
van Waart H, Stuiver MM, van Harten WH, et al. Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol Off J Am Soc Clin Oncol. 2015;33:1918–27.