Surviving Cancer: Physical Realities

Cardiorespiratory (CR) fitness, also called aerobic capacity, is one of the most important indicators of health and longevity in humans. CR fitness refers to the body’s ability to transport oxygen from the air to the body’s cells in order to produce energy for a multitude of processes (e.g., muscle contraction, immune system function). The integrity of the lungs and the heart as well as the circulatory system dictates how well oxygen can be transported and utilized in the body. If you are a cancer survivor reading this, you should know that following cancer treatment, whether surgery or chemo- or radio-therapy and any combination thereof, aerobic capacity will be significantly reduced.After cancer treatment, CR fitness is reduced for a number of reasons. Most likely you were less physically active during your treatment. Secondly, radiation and chemotherapy may have altered normal heart function (contractility, perfusion or stroke volume, among others) and may have affected systemic circulation to some degree. Your body may have lost the ability to process oxygen and effectively distribute it to the rest of the body. As a result, your fitness level is lower than when you were first diagnosed. Therefore, one of your primary objectives post-cancer treatment is to increase cardiorespiratory fitness to pre-cancer levels and if possible, increase CR fitness to levels beyond pre-cancer diagnosis.

The American Cancer Society and American College of Sports Medicine (ACSM) convened a number of experts from the field of exercise science who reviewed the current status of what is known about physical activity and cancer survivorship and issued guidelines found here. From their extensive review, it is clear that if you adopt an active lifestyle and increase CR fitness, you can confer a number of health benefits (see a listing below) including decreasing the risk of developing cardiovascular disease by lowering body fat, increasing HDL-cholesterol, lowering LDL-cholesterol and triglyceride levels and lowering blood pressure. Benefits of exercise also include increasing bone mineral density, decreasing a phenomenon termed sarcopenia (loss of muscle mass) commonly seen in cancer patients, decreasing the risk of developing diabetes mellitus and important to this discussion, decreasing the risk of getting certain types of cancer. Additionally, there is emerging epidemiological evidence indicating that staying physically active during and after treatment may decrease the risk of cancer reoccurrence. This is an important point and bears repeating: Being physically active may prevent the risk of cancer reoccurrence for cancer survivors.

Exercise Guidelines for Cancer Survivors

The ACSM guidelines for cancer survivors include meeting the following criteria: > 150 minutes per week of aerobic exercise at a moderate-to-vigorous level or > 75 minutes per week of aerobic exercise at a vigorous intensity with specific exercise programming adaptations based on the disease and treatment-related adverse effects. These general guidelines are meant to be a starting point for the individual who has completed treatment. While exercise is encouraged during treatment, the number of variables affecting each individual’s health and capabilities is so vast that general guidelines have not been issued for cancer survivors who are in treatment.

Moving From the Guidelines to Practical Application

During cancer treatment, exercise programs and limitations can be complex and it is suggested that you confer with your oncology team and a cancer exercise specialist as to the modality, intensity and duration of your specific regime. Post treatment, it is suggested that you seek out cancer rehabilitation specialists (CRS) that can assist you with your program. The CRS can assist you in determining your starting level of cardiorespiratory fitness and create a comprehensive plan to address the specific issues unique to your particular treatments.

Not all fitness trainers know how to safely create cancer specific training programs, so locate an ACSM Certified Cancer/Health Specialist who understands cancer, cancer treatments and sound exercise prescription.

While it seems relatively simple to start an exercise program after your cancer treatments have ended, it is important that your rehabilitation team review the following: type of cancer and stage, treatment course, side effects, previous health (pre-cancer) and activity level. Also during your rehabilitation phase, your cancer rehabilitation specialist or team should be monitoring hematologic abnormalities (low platelets, hematocrit and hemoglobin levels, neutrophil counts), musculoskeletal disorders (recent bone, back or neck pain, unusual muscular weakness, extreme fatigue, severe cachexia [muscle mass loss]), gastrointenstinal disorders (severe nausea, vomiting and diarrhea, dehydration, poor nutrition), cardiovascular disorders (chest pain, elevated resting heart rates, elevated blood pressure [both systolic and diastolic] irregular heart beats, lymphedema), pulmonary disorders (severe difficulty breathing, coughing/wheezing) and neurological disorders (decline in cognitive status, dizziness/lightheadedness, disorientation, blurred vision, increased postural instability). Each one of these conditions warrants further investigation or referral back to the primary care physician and possible modification of the exercise plan. If your rehabilitation specialist does not understand these health conditions, find a qualified professional to assist you.


For most cancer patients and survivors, exercise is safe. If you are suffering from serious adverse side effects of treatment or are a stage IV patient, consult your oncology team before starting any exercise. For concerns about lymphedema (excess fluid build-up in the extremities), Dr. Kathryn Schmitz, a lead author on the new ACSM exercise guidelines led a major study that found careful weight training can protect against lymphedema. Our work has generally found that exercise does not exacerbate lymphedema when the individual is closely monitored.

How Much?

Meeting the ACSM recommendations is relatively simple; increase physical activity to at least 150 minutes of exercise per week (i.e., 5 sessions/week x 30 minutes/session). This may be as simple as walking 30 minutes per day, 5 days a week. This should be considered the minimum level you need to set as a goal for your post-cancer treatment rehabilitation exercise program. We suggest you start with a walking program and progress to any other modality (e.g., jogging, running, cycling, swimming, skiing) as your fitness level dictates.

How Hard?

The current guidelines suggest ‘moderate-to-vigorous’ intensity for 150 minutes per week. However, moderate-to-vigorous intensity is not uniform from individual to individual. This is where the cancer rehabilitation specialist will be valuable. At our center, all cancer survivors complete a cardiopulmonary stress test giving us a precise measure of their initial level of fitness and helping us establish intensity guidelines. This service may not be available to you but our philosophy is that an initial assessment of your health status should be part of your rehabilitation program. If you cannot have an initial assessment completed by a trained professional there are alternative methods to determine where your rank with regards to fitness and appropriate general intensity guidelines for your plan.

What Type of Exercise?

Aerobic exercise is heavily emphasized in our programs. Why? Circulating oxygenated blood (aerobic activity) is the best method we have to help the body heal itself. The benefits of emphasizing an aerobic based cancer rehabilitation program are: increased cardiorespiratory fitness, augmented immune system functioning, increased red and white blood cell production from bone marrow and the better circulation to aid the body in removing cytotoxic agents.

Because cancer treatments also affect bone mineral density and overall muscle mass integrity, we prescribe a strength training component for most of our clients exercise programs. Our strength training programs are based on three pillars of body function: posture, mobility and stability. For instance, a women who has undergone chemotherapy, radiation and surgery for breast cancer will need comprehensive strength training to improve posture (neutral spine position), upper body exercises to increase range of motion (mobility) on both sides of the body and muscular endurance (imagine holding a child in your arm for a prolonged period of time). As most of our clients are 50+ years, combining improved posture, greater mobility of the hips and upper body musculature and spinal stability with neuromuscular‘re-education’ results in improved movement patterns. These better movement patterns allow the older adult to exercise and move safely and to avoid falls and future orthopedic problems. It also allows our clients to engage safely in other aerobic activities.

Finally, we highly suggest exercising with someone. Why? Researchers believe that exercising together may increase exercise compliancy while improving physical function and mental wellbeing.


In summary, the evidence is rather convincing that exercise should be a critical component of cancer rehabilitation programming. It is suggested that you consult with your oncology team while also seeking out certified cancer rehabilitation specialists to assist with the development of your rehabilitation program. Guidelines have been issued that should be seen as the minimum level of physical activity for the cancer survivor with alterations made for each individual based on their unique history and current health status. Ideally, we encourage cancer survivors to engage in five days of aerobic activity per week for 30 minutes per session at moderate-to-vigorous levels. These levels should be established by a trained exercise professional. Additionally, most cancer survivors will benefit from a twice-a-week strength training program designed to increase posture, mobility and stability.

Good luck and good health!

Now….The Benefits of Exercise for the Cancer Survivor:

Improved physical function/physical fitness
Improved aerobic fitness
Increased muscular strength
Improved flexibility
Improved/maintain ideal body size (weight, BMI, body composition, muscle mass)
Increased bone health
Help with lymphedema-related outcomes
Increased quality of life
Increased energy level or vigor/vitality
Decreased cancer-related fatigue
Improved sleep patterns
Decreased depression
Decreased anxiety
Improved physiological outcomes (e.g., hemoglobin, blood lipids, IGF pathway hormones, oxidative stress, inflammation, or immune parameters; includes PSA for prostate cancer)
Decreased symptoms/adverse effects (including pain)

The information found here is not intended to provide nor should it be interpreted to provide professional medical, legal or financial advice. You should consult a trained professional for more information.

Category: Experts Speak

Tags: American Cancer Society, Breast Cancer, cancer exercise specialist, cancer rehabilitation specialist, cancer reoccurrence, CancerForward, CancerForward Expert Article, cardiorespiratory fitness, exercise, fitness, lyphedema, Riggs J. Klika PhD, sarcopenia