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Starting an Exercise Routine

Physical activity is important in chronic disease prevention, and is associated with better outcomes for cancer patients. Being active is considered safe and beneficial for people undergoing cancer treatment.

Regular physical activity can help manage common side effects of cancer treatment, such as fatigue, pain, and nausea. For many, the feeling of tiredness does not get better with rest, and the severity of fatigue can limit activity. Too much inactivity can lead to muscle wasting and loss of function. Finding a regular, aerobic exercise regimen that works for your specific needs can help break the cycle of inactivity and reduce fatigue.

Light, regular exercise can also improve appetite, aid digestion, and prevent constipation. Even short bursts of movement throughout the day can promote stress relief, boost mood, and enhance quality and amount of sleep [i].


Current Recommendations

The American Cancer Society recommends that adults get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity physical activity each week, preferably spread throughout the week. Cancer survivors should aim for at least 150 minutes of exercise per week, which translates to about 30 minutes of physical activity, five days per week.

It is important to note that exercise guidelines for each person vary depending on your medical condition and past fitness level. It is important to get approval from your health care provider before starting a new physical activity regimen [ii].


The Role of Physical Activity in Cancer Prevention

Studies looking at the role of physical activity in cancer prevention have shown that physical inactivity can lead to obesity, and obesity leads to increased risk for cancer of the colon, pancreas, gallbladder, endometrium, breast (among postmenopausal women), kidney, and other types of cancer. For colon cancer in particular, the risk seems to be highest for people with accumulated body fat in the abdomen.

Other studies looking at the role of physical activity on cancer recurrence and long-term survival suggest that physically active cancer survivors have a lower risk of cancer recurrence and improved survival, compared with those who are inactive 

A good strategy for people undergoing cancer treatment or recovering after treatment is to be as active as your physical abilities allow. Try to do a little something every day—even for just 10 minutes—early in your cancer treatment so that you can maintain optimal strength throughout [iii].


Simple strategies to start incorporating exercise into the day:

  • Go for a walk around the block with your family and friends, or seek out a new area in town and explore by foot. Walking is one of the simplest ways to start and continue an exercise regimen. Walking has the lowest dropout rate of any type of exercise, and it costs nothing but a good pair of shoes to get started!
  • Park the car farther away or get off the bus or subway one stop earlier than your destination. Every extra step counts!
  • Pedal a stationary bike while watching television. Or, exercise in bed! Lie on your back, hold in your stomach muscles, and pedal your feet in the air as if you were riding a bicycle.
  • Take the stairs rather than the elevator or escalator. The average flight of stairs has about 12 steps. Going up three flights of stairs, three times per day can burn about 45 calories for a 150-pound person. Take more flights of stairs to burn extra calories and tone your calves and rear end! [iv].
  • If you sit for most of the day, take a break at least once an hour to stand up and stretch.
  • Get online. Tons of free exercise videos are available online from yoga and Pilates to cardio and toning routines. Set up a mat in the comfort of your own home and take a few minutes to move.


Starting an exercise routine

When beginning a regular exercise routine, it is important to start with small changes. A little movement a few days of the week is better than overexertion one day and inactivity on the remaining days of the week. Slowly, start incorporating physical activity into your daily life, working up to a moderate level of exercise as you are able. For many, adopting a regular exercise regimen helps reestablish a sense of autonomy that is sometimes lost during cancer treatment.


Usual activities versus exercise: the difference

Usual activities involve activities of daily living, such as walking to and from the car or subway, climbing a few flights of stairs at home or at work, and dressing and bathing. Usual activities are typically brief and of low intensity.

Intentional activities include those that are done in addition to usual activities. These activities are often planned and done at leisure as regularly scheduled exercise sessions, such as biking, running, or taking a group fitness class. Other intentional activities may involve adding more purposeful physical activity into the day and making lifestyle choices to add to or replace other routine activities, such as walking to use public transportation or taking the stairs instead of the escalator.


Exercise Intensity

Usual and intentional activities can both be beneficial. The most important factor to consider is the intensity of the exercise. Exercise intensity is a measure of how hard the body works during physical activity, and is often characterized as light, moderate, or vigorous activity. Aim to include a variety of exercise intensities in your routine, while keeping in mind your medical condition and your doctor’s recommendations [v].

  • Light intensity activities include housework, shopping, or gardening. At this intensity, you should be able to talk normally without any strain or heavy breathing.
  • Moderate intensity activities include those that require effort equal to a brisk walk. At this intensity, you should be able to hold a conversation easily.
  • Vigorous intensity activities generally use large muscle groups and result in a faster heart rate, deeper and faster breathing, and sweating. At this intensity, you may become winded or easily out of breath, making it difficult to talk.

The chart listed below provides some examples of moderate and vigorous intensity level exercises for a variety of common activities that can help you to find fun ways that suit your interests and lifestyle:

  Moderate Intensity Vigorous Intensity
Exercise and Leisure Walking, dancing, leisurely bicycling, ice and roller skating, canoeing, yoga, using a manual wheelchair Jogging or running, fast dancing, fast bicycling, circuit weight training, aerobic dance, martial arts, jumping rope, swimming, hiking uphill
Sports Volleyball, golfing, softball, baseball, badminton, doubles tennis, downhill skiing Soccer, field or ice hockey, lacrosse, singles tennis, racquetball, basketball, cross-country skiing
Home Activities Mowing the lawn, general yard and gardening maintenance, mopping and sweeping the floors, vacuuming Digging, carrying and hauling, carpentry
Work Activities Walking and lifting as part of a job (custodial work, farming, auto or machine repair, restaurant work [dishwashers, servers, cooks]) Heavy manual labor (construction, fire fighting)

A well-rounded activity plan includes aerobic exercises, strength training with weights, and flexibility exercises. This type of varied plan offers a balanced range of exercise intensities. Remember, exercise can be accomplished in 10-minute increments throughout the day, so let’s get moving!



As you get stronger and feel more confident about your exercise routine, try slowly adding more physical activity to your schedule. Think about getting F.I.T.T., a term that stands for frequency, intensity, time, and type, four key components of a physical activity program [vi].


Personalizing the exercise during treatment

  • Because of fatigue, some people in chemotherapy may feel like waiting and finishing their chemotherapy before starting an exercise program. It is generally better to try to include some level of activity throughout therapy. Even 10 minutes of stretching each day may help. Establishing a habit of activity early on will make it easier to continue even if fatigue sets in.
  • Older people and those with conditions like arthritis should pay careful attention to balance exercises that can help prevent falls. A caregiver or exercise professional may be able to help those who need assistance.
  • If you have severe anemia, wait to exercise until you have recovered from treatment.
  • If you have compromised immune function, avoid public gyms and other public places until your WBC counts are back to normal.
  • If you have significant peripheral neuropathies, you may not be able to exercise your affected limbs. You may feel off balance and may prefer pedaling a reclining bicycle, for example, rather than walking on a treadmill.
  • If you are in bed because of your cancer or treatment, talk to your health care team about physical therapy in bed to keep up your strength and maintain range of motion. Physical activity can help lessen fatigue and depression often experienced by some people confined to bed.


Even with limited activity, make sure to drink plenty of liquids to keep you feeling strong and hydrated.

Set small, manageable goals for your exercise routines within the framework of F.I.T.T. At the start of each week or month, think about how many times a week you can squeeze in physical activity. Think about whether you want to exercise at low or moderate intensity or add in a set of vigorous intensity exercise once or twice a week.

Start with a goal of 10 to 15 minute bouts of physical activity, and work up to 30 or 45 minutes as able. Jot down some of your favorite ways to be active, and keep that list hanging on the refrigerator or at your desk to motivate you to make exercise fun. Starting small can lead to big changes!


Be sure to speak with your physician and health care team before starting any new exercise regimen or making changes to your current routine.


[i] Physical Activity and the Cancer Patient. American Cancer Society website. http://www.cancer.org/treatment/survivorshipduringandaftertreatment/stayingactive/-physical-activity-and-the-cancer-patient Last Medical Review: March 24, 2014. Last Revised: March 24, 2014. Accessed: October 21, 2014.
[ii] ACS Guidelines for Nutrition and Physical Activity. American Cancer Society website. http://www.cancer.org/healthy/eathealthygetactive/acsguidelinesonnutritionphysical-activityforcancerprevention/acs-guidelines-on-nutrition-and-physical-activity-for-cancer-prevention-guidelines Last Medical Review: January 11, 2012. Last Revised January 11, 2012. Accessed October 21, 2014.
[iii] Grant B, Bloch A, Hamilton K, Thomson C. Complete Guide to Nutrition for Cancer Survivors. 2nd ed. Atlanta, GA: American Cancer Society/Health Promotions; 2010.
[iv] Calories burned walking a flight of stairs. NH DHHS-DPHS-Health Promotion in Motion website. http://www.dhhs.nh.gov/dphs/nhp/worksite/documents/calories.pdf Accessed October 17, 2014.
[v] Reduce Your Cancer Risk: Physical Activity. American Institute for Cancer Research website. http://www.aicr.org/reduce-your-cancer-risk/physical-activity/reduce_physical_add.html Published August 15, 2011. Accessed October 21, 2014.
[vi] HEAL Well Guide. American Institute for Cancer Research, pages 17-20. http://www.aicr.org/assets/docs/pdf/education/heal-well-guide.pdf Accessed October 17, 2014.
Stephanie Forsythe MS, RDN, CNSC, CDN

Stephanie Forsythe MS, RDN, CNSC, CDN is a Registered Dietitian Nutritionist who works as a Clinical Dietitian and Nutrition Coordinator at a hospital in Brooklyn. She helps patients meet their nutritional needs during their stay in the intensive care units. Aside from developing recipe and blog content for Savor Health, Stephanie also has worked as pastry cook in California and New York City. Stephanie received her undergraduate degree from the University of California, Berkeley and her Master of Science in Nutrition Education from Teachers College Columbia University. She completed a Dietetic Internship and training through Teachers College.


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