Exercise During Cancer: Benefits of Physical Activity & Physiotherapy

Why Is Physical Activity Important During Cancer Treatment?

Physical activity during cancer treatment provides multiple proven benefits including reduced fatigue, improved treatment tolerance, better physical function, enhanced mood, and potentially improved survival outcomes. Research shows that exercise is safe for most cancer patients and is now considered a standard part of cancer care.

It is common to move less and want to rest more when you have cancer and are going through various treatments. While rest is sometimes necessary, research consistently demonstrates that maintaining physical activity leads to better outcomes across nearly every measure of health and well-being. The body functions better when it's used, and staying active helps you become stronger, maintain better balance, and have more energy to cope with treatment.

Physical activity during cancer can give you the strength to endure treatment and may even help your body fight the cancer itself. Importantly, being physically active is not harmful - this is a persistent myth that has been thoroughly debunked by modern research. In fact, the opposite is true: prolonged inactivity leads to muscle loss, decreased cardiovascular fitness, and worsening fatigue.

You can usually continue with more demanding activities if you enjoy them, though some adaptation may be needed. If you're used to intense training, you may need to reduce the pace or shorten the distance to find what feels right. Your body may respond differently than before cancer, both due to the disease itself and the treatments you're receiving. This is completely normal and expected.

The evidence is overwhelming

Hundreds of clinical trials have examined the effects of exercise during cancer treatment. The American College of Sports Medicine, American Cancer Society, and major oncology organizations worldwide now recommend exercise as a standard part of cancer care. The benefits are not marginal - they are substantial and well-documented across many different types of cancer and treatment protocols.

A landmark Cochrane systematic review examining data from over 11,000 participants confirmed that exercise during and after cancer treatment safely improves physical functioning, reduces fatigue, and enhances quality of life. These benefits apply to patients undergoing chemotherapy, radiation, surgery, and hormone therapy.

How Does Exercise Help Cancer-Related Fatigue?

Cancer-related fatigue affects 70-100% of patients during treatment and is characterized by persistent exhaustion that doesn't improve with rest. Paradoxically, physical activity is the most effective treatment for this type of fatigue, with studies showing 30-50% improvement through regular moderate exercise.

Many people with cancer describe feeling tired in a way they have never experienced before. This is a fatigue that cannot be slept away and is called cancer-related fatigue (also known as cancer fatigue or CRF). It's fundamentally different from normal tiredness - it's a whole-body exhaustion that affects physical, emotional, and cognitive function.

Cancer-related fatigue can be caused by the cancer itself, by treatments such as chemotherapy, radiation, or surgery, by anemia (low red blood cell count), by depression or anxiety, or by a combination of these factors. Sometimes the fatigue may be related to specific treatable conditions like anemia or depression, which require their own treatment approaches.

The counterintuitive but well-proven solution is physical activity. When you're exhausted, the last thing you might want to do is exercise. However, research consistently shows that appropriate physical activity is more effective than rest for managing cancer-related fatigue. The mechanism involves multiple pathways: exercise improves cardiovascular efficiency, stimulates energy production at the cellular level, reduces inflammatory markers, improves sleep quality, and enhances mood.

The science behind exercise and fatigue

When you exercise regularly, your body adapts by becoming more efficient at producing and using energy. Your heart pumps blood more efficiently, your muscles use oxygen more effectively, and your mitochondria (the energy factories in your cells) multiply and function better. These adaptations occur even during cancer treatment, helping to counteract the deconditioning effects of illness and therapy.

A meta-analysis of 113 randomized controlled trials found that exercise interventions reduced cancer-related fatigue by an average of 25-30%, with some studies showing improvements of up to 50%. This makes exercise at least as effective as any medication for fatigue, with the added benefits of improved physical function and no side effects.

What Activities Are Best During Cancer Treatment?

The best exercise is one you enjoy and will do consistently. Walking, swimming, cycling, yoga, and resistance training are all excellent options. Start with what feels manageable - even 5-10 minute sessions count - and gradually increase as your body adapts. The key is regularity rather than intensity.

There may be periods when you have no problems doing what you want. But sometimes you may need to start with simple movements and small challenges, then gradually increase the training over time. The type of activity matters less than doing something regularly.

You can talk to your nurse or doctor if you have questions about physical activity and training. A physiotherapist with experience in oncology can provide tips and advice adapted to your specific conditions and treatment phase. Many cancer centers have exercise programs specifically designed for cancer patients.

Setting realistic goals

When you want to start moving more, it's helpful to first set realistic goals. If you are very tired and sitting or lying for long periods, you may need to break up your sedentary time for just a short while. Moving a little is a good start. Then you can try to be physically active for short periods several times a day.

Similarly, it's good to increase your activity gradually even if you're already active. Set sub-goals that make you feel that you're developing and progressing. Celebrate small victories - they matter more than you might think for maintaining motivation.

Adapting exercise to your situation

It can be difficult to get going again if you've rested a lot during a period. If you feel more tired when you move, it may be because your fitness has declined. Then you need to find a good balance between activity and rest. Starting too hard increases the risk of injury and can be discouraging.

Physical activity usually makes you feel better both immediately after being active and in the longer term. Having routines and fixed times can make it easier. Perhaps you can find someone to exercise with - accountability and social support are powerful motivators.

During chemotherapy treatment, blood values are commonly affected. How much they are affected depends on the type of treatment you receive. Generally, there's no reason to completely avoid exertion even if you have low blood values (low hemoglobin levels). You may also need to adapt your training if you're very susceptible to infections. If you feel tired and have less energy, you can continue being active but may need to reduce the intensity. Ask your doctor, nurse, or physiotherapist about what training suits you best.

It's never too late to start

If you haven't been active or trained during the treatment period, it's not too late to get started afterwards. Even then, you should increase training gradually since the risk of overexertion and injury is greater if you start too hard. The benefits of exercise apply at any point in your cancer journey.

What About Exercise After Treatment Ends?

After treatment, aim for at least 150 minutes of moderate aerobic exercise weekly plus strength training 2-3 times per week. The type of exercise matters less than consistency - regular activity several times a week provides the greatest benefits for long-term health and reducing recurrence risk.

When you feel that you can manage more, you can follow the general recommendations for physical activity that apply to the general population. What form of training you choose doesn't matter much - what's important is that the training becomes regular, preferably several times a week.

To improve your health, walking or any other physical activity that is moderately intensive is sufficient. In addition, strength training two to three times a week is also recommended. This combination of aerobic exercise and strength training provides comprehensive benefits for cardiovascular health, muscle maintenance, bone density, and metabolic function.

What is moderate intensity?

What constitutes moderate intensity varies from person to person and depends on how active you are. It should feel somewhat strenuous and your pulse should increase. For some, this means a slow walk, but if you're well-trained, you may need to jog for it to be moderately strenuous. A common description of moderate intensity is that you can carry on a conversation while being active - if you're too breathless to talk, you've exceeded moderate intensity.

A recommended goal is to be physically active for two and a half hours per week spread over several days. That's just over 20 minutes per day if you spread the time across all days of the week. But remember that all movement counts, and health improves with movement breaks if you sit still a lot.

You can, for example, walk a few bus stops if you're taking the bus, or take the stairs instead of the elevator. Working in the garden, shoveling snow, vacuuming, or cycling regularly also provides good physical exercise. Strength training can be exercises you do at home or at a gym.

How Can a Physiotherapist Help During Cancer?

Physiotherapists trained in oncology can help with cancer-related fatigue, muscle weakness, lymphedema, pain, stiffness, breathing difficulties, balance problems, and neuropathy. They create personalized exercise programs and provide hands-on treatments including massage, TENS therapy, and manual lymph drainage.

If you need help adapting your training or getting started, you can contact a physiotherapist. As long as you have closer contact with healthcare, you can consult with a doctor or nurse about who to contact. You can contact a physiotherapist by calling and booking an appointment yourself, though sometimes you may need a referral from a doctor depending on your healthcare system.

A physiotherapist can work at the hospital where you receive treatment, at a primary care facility, or at a private practice. Cancer clinics often have physiotherapists with special knowledge of cancer diseases. If you want to see a physiotherapist at a primary care facility or private practice, it's helpful if a nurse or doctor at the hospital writes a referral. This way, the physiotherapist knows if there's anything special they need to consider due to your cancer disease.

What conditions can physiotherapy help with?

You can also get help from a physiotherapist if you have other issues such as:

• Pain and stiffness - from cancer itself, surgery, or radiation treatment
• Nausea - certain techniques can help manage treatment-related nausea
• Anxiety and stress - relaxation training and breathing techniques
• Swelling (lymphedema) - specialized treatment for fluid accumulation
• Hot flashes - management strategies for hormone therapy side effects
• Breathing difficulties - respiratory therapy and exercises
• Neuropathy - numbness, tingling, and weakness from chemotherapy
• Balance problems - fall prevention and confidence building

What Can Help With Pain and Stiffness?

Pain and stiffness from cancer or treatment can be managed through exercise programs for strength and mobility, stretching, relaxation training, TENS (transcutaneous electrical nerve stimulation), massage, and appropriate use of mobility aids. Movement generally reduces pain better than prolonged rest.

There are medications that can help if you're in pain due to your cancer disease or the treatments you receive. But you can also get advice and help from a physiotherapist. Many approaches work best when combined.

Stiffness and pain can be connected. When you try to move after surgery or if you haven't moved at all for a while, it can hurt. Radiation treatment can cause stiffness, especially if a joint in the body has been irradiated, and it hurts sometimes. If you feel pain, it easily leads to you moving less and becoming stiffer. Pain can also cause a changed body posture and strain that makes you hurt in other parts of the body.

Exercises for strength and mobility

You can get exercises that train strength and mobility to do according to a program. The exercises help support the skeleton and joints. Training can also improve balance. You can better handle the daily strain the body is exposed to if you use your muscles and do exercises.

For the same reason, it's good to maintain or increase your mobility. You can do this through exercises where you make large or small movements in the joints. Sometimes you may also need to do stretching exercises if muscles or other tissues around the joints are tight.

Problems with aches and stiffness in the joints are sometimes worst in the morning and after you've been sitting still. Then it can be good to do stretching exercises, for example, before your regular daily activities begin. It helps to increase blood flow, and the muscles become a little softer. Often the problems with morning stiffness feel less once you've gotten started during the day and are moving.

You can also get help with pain and stiffness by training relaxation and practicing body awareness. This can happen individually or in a group. These approaches address the mind-body connection that often amplifies pain perception.

Preventing stiffness from radiation treatment

Stiffness after radiation treatment can to some extent be prevented through a movement program that you do already before or during the treatment period. Stiffness in the part of the body that was irradiated occurs especially if you've been operated on in the same place before and if a joint has been irradiated. The stiffness can occur a month or even later after treatment and is due to the tissue contracting as it heals after radiation.

The movement program can, for example, help if you have breast cancer and the shoulder joint risks becoming stiff. It can also help if you have cancer in the mouth, throat, or larynx so that the jaw joints risk becoming stiff. It's important that you continue to train mobility as the tissues can become stiffer in the future.

You can contact a physiotherapist if you become stiff in joints some time after radiation treatment has ended. They can give advice and suggestions for exercises to improve mobility.

TENS therapy for pain

TENS is an abbreviation for transcutaneous electrical nerve stimulation. This means that electrodes are attached to the skin and connected with cables to a device that gives weak electrical impulses. In this way, the body's own pain relief system is activated. You can use TENS for large parts of the day and you handle the treatment yourself once you've had help trying it out.

Massage for temporary relief

Massage can be a pleasant treatment that gives a moment of well-being. The muscles and joints are softened so that you get better blood flow and become less stiff, which in turn can make you hurt less. Massage can be obtained from masseurs and sometimes from a physiotherapist in combination with other treatment or training.

Walking aids for pain relief

You can use a walker, crutches, or walking frame for relief and pain reduction if it hurts when you walk. Sitting or lying still often increases the pain, while movement and physical activity reduces it.

To try out walking aids, you need to contact a physiotherapist or occupational therapist.

What Can Help With Tingling and Numbness?

Chemotherapy-induced peripheral neuropathy (CIPN) causes tingling, numbness, and sometimes pain in hands and feet. Physical activity helps manage symptoms, though it may require adaptation. Cycling may be easier than walking, compression stockings can help, and balance training is important for safety.

Certain chemotherapy treatments can cause sensory disturbances, called neuropathy. You may feel tingling and numbness, but also pain and weakness in the muscles. Sometimes you may also get swelling. It's important to tell your nurse or doctor if you have these problems, as you may need to have your treatment changed.

Physical activity can help against sensory disturbances. It may be better to cycle than to walk, or to divide the walk into parts with breaks in between. Since the ground can be uneven outdoors, an alternative is to walk on a treadmill indoors. You may also need to train balance and mobility and do stretching exercises.

You can relieve the symptoms by, for example, trying compression stockings. You can also try with light massage under the soles of the feet or use TENS on the leg above the place where your sensation has changed. Sometimes you may benefit from insoles in your shoes or some form of walking aid to more easily be physically active.

It's not possible to get rid of the symptoms with the help of these treatments. But they can make you feel better and make everyday life feel easier. If neuropathy affects your balance, take extra precautions to prevent falls.

How Is Lymphedema Managed?

Lymphedema occurs when lymph fluid accumulates due to surgery or radiation affecting the lymphatic system. Treatment includes compression garments, specialized massage (manual lymph drainage), and exercise. Importantly, exercise does not increase the risk of lymphedema - strength training is safe and beneficial.

When you're operated on or receive radiation treatment, you may get lymphedema, meaning swelling in the body due to lymph fluid accumulating there. You may get lymphedema in the arm after treatment for breast cancer, for example, but lymphedema can also develop in other parts of the body.

In addition to swelling, you may get numbness and a feeling of heaviness and tension in the body part. You may also feel stiff and weak, sometimes also have aches. It's usually not possible to become completely free of lymphedema, but if the problems are discovered early and you receive treatment, the symptoms can decrease significantly.

Treatment approaches

The most common treatment is so-called compression. This means that the tissues around the lymphedema are compressed with the help of compression garments. As a supplement to compression treatment, you may receive manual lymph drainage or treatment with a lymph pulsator. These types of treatments are provided by physiotherapists who have special training in lymph therapy.

Training does not increase the risk of getting lymphedema. When you strength train, it's important as always to start with lighter loads so that the body gets used to it before you increase the load. The same advice applies if you've already developed lymphedema. You can choose for yourself whether you want to wear the compression garment during training or not, but it's important to put it on right after.

What Can Help With Breathing Problems?

Breathing exercises can help if you have trouble breathing or need to clear mucus. Sitting upright rather than lying down improves breathing. A walker can help by providing support when walking, and specific devices can help with mucus clearance.

Breathing exercises can help if you have problems with breathing and have a lot of mucus that you need to cough up. It's good to try to sit up if you're lying in bed a lot and to move around if you're sitting still a lot.

Sometimes you may get a so-called valve or similar that you breathe out into so that there's resistance when exhaling. Then you can use the lungs better, and it also becomes easier to cough up mucus. Sometimes you may also inhale medicine through the mouth to widen the airways.

It may be easier to breathe if you have a walker to hold onto if you're short of breath and have difficulty getting enough air when walking. Breathing can also be facilitated if you lean your arms against your knees or against a table when sitting or standing.

What Helps With Hot Flashes and Sweating?

Hot flashes and sweating from hormone treatment (common in breast and prostate cancer) can be reduced through regular physical activity, relaxation exercises, and acupuncture. Many patients find that these approaches also improve sleep quality.

You may experience problems with sweating and hot flashes if you receive hormone treatment, such as for breast cancer or prostate cancer. Through physical activity and moving around, you can feel better.

Relaxation exercises can also help. There are different types of relaxation that may suit. Acupuncture can also relieve hot flashes and sweating. Many who are helped by acupuncture say that sleep also becomes much better. This can ease everyday life and provide better quality of life.