Exercise Precautions During Cancer Treatment

Last Modified: March 7, 2010


Dear OncoLink "Ask The Experts,"

I had stage 3 breast cancer, surgery and am now getting chemo. Surgeon has cleared me to resume working out- I always went to the gym at least 4x a week. I am sure I will need to do less and not as intense, but it will help me get a little normalcy back. My question is for precautions. Everyone mentions infection risk, but I can go at not busy times of day, wipe the machine down with disinfectant wipe before using, so I think I have that covered. What else do I need to be concerned about?


Lora Packel MS, PT, Assistant Professor of Physical Therapy at the University of the Sciences in Philadelphia, responds:

Getting back to the gym is an excellent idea for many reasons. First, exercise can help you regain any losses in strength or endurance you may have incurred as a result of your recent treatment. Second, exercise can help manage cancer related fatigue and improve mood.

You are right to ask about precautions. There are two main areas to consider; precautions due to the surgery, and precautions due to the chemotherapy.

Chemotherapy regimens vary in the type of agents they use, how often they are given and their “strength.” I will go over general precautions with chemotherapy, but it is important to ask your oncologist for any special issues for your particular treatment. All chemotherapies lower your white blood cell count (WBC), which increases the risk of getting colds and other infections. You should ask your oncologist whether you should exercise at home or in your neighborhood or if you can return to the gym. If you go to the gym, wipe off the equipment before and after your workout. Also consider wearing flip flops in the dressing room and showers, as locker rooms can have a lot of germs.

A second consideration with chemotherapy is the effect it has on your red blood cells (RBC). Chemotherapy can reduce red blood cell counts, causing anemia. RBC’s help carry oxygen to your muscles, so if there are fewer RBC’s in your body, you may not have the endurance or stamina for some exercises. You may get short of breath earlier in your exercise routine.

Finally, some chemo regimens also drop your platelet count, which makes it easier to bruise or bleed. If your platelets are below 50,000, avoid weight/strength training. In terms of surgery, you want to make sure the incision is fully healed. Some people are concerned with lymphedema, or arm swelling, if they have had lymph nodes removed or received radiation as part of their treatment. If this is the case, present recommendations are to start with very low weights (1-2lbs) and add small amounts of weights very slowly. When starting a strength program, you should monitor for any signs of swelling in your arm, breast or trunk. Depending on the extent of the lymph node dissection, some suggest exercising with a compression sleeve.

This question and answer was part of the OncoLink Brown Bag Chat Series, Exercise, Nutrition and Cancer Webchat. View the entire transcript here.