Aerobic Exercise Program During Cancer Treatment

Author: Lora Packel, PhD, PT, CCS
Content Contributor: Chair and Associate Professor, Department of Physical Therapy at the University of the Sciences
Last Reviewed:

It is important to check with your provider before starting an exercise program during your cancer treatments, as there may be some days when you shouldn't exercise.

You should avoid inactivity and try to do a little exercise most days of the week during and after treatment.  

Warm Up

This is an important part of any exercise program. It is even more important if you are not used to exercising, if you have heart problems, or if you are older than 55. Warm up exercises help your body get ready by slowing increasing your heart rate, your body temperature, and warming your muscles to prevent injury.

Examples of a warm up:

  • Walk slowly for 5-10 minutes at an easy pace.
  • Bike slowly for 5-10 minutes at an easy pace.

Aerobic Exercise – Training Zone

In order to gain the benefits of exercise, you have to "overload" or push your body. It’s important to do this slowly to prevent injury. There are a number of ways to know if you are working hard enough to gain benefits including the Borg-RPE scale, heart rate response, or the talk test.

  • The chart below is called a Borg Scale. Look at the scale and ask yourself how hard you are working during your exercise.

If you haven’t been exercising, aim to work at a rating of 9-11 Very Light to Light work. Once you are able to walk for 20-30 minutes at this level, then gradually increase your intensity to 11-13. You can do this by walking or biking faster, including small hills in your walk, or swinging your arms during walking.

Borg-RPE-Scale® [PDF] (CDC)

Cool Down

At the end of your exercise, you need to cool down your heart, body temperature, and muscles. You should walk slowly for 5 minutes before stopping. If you have a heart condition, your provider may ask you to cool down for more than 5 minutes.

How many days each week should I exercise?

During treatment, you should try do some activity most days of the week. You might start at 3-5 minutes in the “training zone,” adding in 1-5 minutes per week so that eventually you are walking for 20-30 minutes at one time.  For some, this may be too aggressive, so think about getting 20-30 minutes of walking done each day by breaking it up into smaller pieces.  For example, walk 5 minutes, rest 5 minutes, and repeat.  If you have not exercised before, or you are having a lot of side-effects from treatment, you should start more slowly.

Exercise after treatment has stopped

Exercise can help you get back to the activities you enjoy. Always check with your provider before starting to exercise.

Your exercise program should change in a few ways after treatment has ended.

Warm Up

  • Walk slowly for 5 minutes.
  • You should take longer to warm-up if you have a heart condition or had a lot of side-effects from treatment.

Aerobic Exercise – Training Zone

  • You are now trying to sweat during activity for 30 minutes.
  • Use can use an exercise scale to see if you are working hard enough to get the most out of the program.


Heart Rate & Aerobic Exercise

  • If you don't use an exercise scale, you can use your heart rate to see if you are working hard enough during exercise.
  • By using heart rate, you will make an exercise program that is made just for you.

1. Subtract your age from 220. This is your maximum heart rate.

  • For example, if you are 60 years old, your maximum heart rate would be (220-60) = 160.

2. After sitting for a few minutes take your heart rate.

  • Put your pointer finger and middle finger at the top of your thumb.
  • Slide these two fingers down your thumb until you get to your wrist.
  • Count how many beats you feel under your fingers for 60 seconds or 1 minute. This is your resting heart rate. Most people will have a resting heart rate between 60 and 100.
  • Now you will figure out a heart rate range where you will break a sweat during exercise.

(HR max – HR rest) x .5 + HR rest = low end of training zone

(HR max – HR rest) x .65 + HR rest = high end of training zone

For example, I am a 60 year old woman who has finished treatment for colon cancer. I talked to my provider about exercise and she says that I can and should start a program.

My maximum heart rate is: 220-60 = 160.

I count 78 beats at my wrist in 1 minute. This is my resting heart rate.

My training zone is:

(HR max – HR rest) x .5 + HR rest = low end of training zone

(160-78) x .5 + 78 = 119

(HR max – HR rest) x .65 + HR rest = high end of training zone

(160-78) x .65 + 78 = 131

After my 5 minute warm-up, I will walk faster. When I walk faster, I will take my heart rate. My goal is to have my heart rate between 119 beats/minute and 131 beats/minute. If my heart rate is between these numbers, I am walking at the right speed to get the most out of my exercise program.

If my heart rate is less than 119 beats/minute when walking, I should Walk Faster.

If my heart rate is more than 131 beats/minute when walking, I should Walk Slower.

If you are just beginning an exercise program or had a lot of side effects from cancer treatment, start at a lower intensity (30-40%).

You should not use this heart rate equation if you take Beta-Blockers. These medications are commonly used for people with heart conditions such as a heart attack, heart failure, or a-fib. 

Talk Test

Another easy way to determine if you are working hard enough is the talk test. When you are walking you should feel a little breathless and you may sweat. You should aim for a speed or pace that allows you to talk, but not sing. If you are able to sing, then your intensity is too low and you should quicken your pace.

Chemotherapy and Exercise - Important Considerations

If you have gotten chemotherapy to treat your cancer, you must talk to your provider about exercise. Each type of chemotherapy is different in how it affects your body. Some days, your provider might ask you not to exercise because of low blood counts or fever. Some side-effects of chemotherapy that may affect your exercise are:


  • If you have anemia, you may feel tired or short of breath.
  • Many people walk more slowly or walk for shorter amounts of time if they have anemia.
  • Ask your provider if you should exercise.

Low platelet counts (Thrombocytopenia)

  • Platelets help to stop bleeding.
  • Please talk to your provider about activity suggestions when your platelets are low.

Tingling in your hands or feet (Peripheral neuropathy)

  • Some types of chemotherapy cause tingling in your hands and feet.
  • Tingling may affect your balance.
  • Talk to your provider about exercise with peripheral neuropathy.
  • Find a physical therapist who understands chemotherapy and peripheral neuropathy. They may be able to help with the tingling feeling as well as improve your balance.

Food and Weight Loss

  • If you have lost weight during treatment, you have also lost muscle.
  • Exercise can help you get stronger.
  • Talk to a dietitian about what foods you should eat to help you have enough energy to exercise and to help regain any muscle you lost.

Radiation Therapy and Exercise

Radiation therapy is a common treatment for cancer. Most people who have radiation feel tired. Exercise can help you deal with feeling tired and give you more energy.

OncoLink has a large section on cancer related fatigue, with helpful tips and information.

Radiation and the sun. You are more likely to get a sunburn during and after radiation therapy. Talk to your provider about skin protection. You may want to exercise in the morning or in the early evening so that you are less likely to get a sunburn.

If you got whole body radiation therapy, you should be careful about exercising in hot weather. Your body may have trouble getting rid of the heat you make during exercise, which can be dangerous. Dress in light clothes and exercise in the morning or early evening. Talk to your provider about when and how you should exercise.

Your Bones and Cancer

Some cancers affect the bones in the body, making them weak. Other times, the treatment you get for cancer can cause the bones to be weak. Exercise, if done right, can help to strengthen your bones.

Cancers that MAY affect your bones are:

  • Multiple myeloma.
  • Lung cancer.
  • Sarcoma.
  • Breast Cancer.
  • Prostate Cancer.
  • Testicular Cancer.

It is important that you talk to your provider about the health of your bones.

Your provider may tell you it is safe to exercise.

Your provider may ask you to stop exercising until after treatment has ended.

You provider may tell you not to use heavy weights for strengthening.

Safety with Exercise - Important

  • Talk to your provider BEFORE starting an exercise program.
    • Have pain above your stomach while exercising (chest pain, left arm pain, jaw pain, neck pain or nausea).
    • Dizziness.
    • Fall.
    • Feel unsteady.
    • Bruise a lot.
    • Have a fever.
    • Have pain with walking.
    • Have pain with sneezing, coughing or laughing.
    • Have numbness or tingling.
    • Have diarrhea.
    • Have constipation.
    • Urinate or pee a lot.
    • Urinate or pee less than usual.
    • Have swelling.

Quick Tips for Exercise

  • Talk to your provider about an exercise program.
  • Do something that you find is fun and makes you happy.
  • Find a partner.
  • Talk to someone who has had cancer.
  • Listen to music while you exercise.
  • Do different types of exercise.
  • Seek out an exercise specialist who knows about cancer.
  • Set goals that you can reach.
  • Be kind to yourself.


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