Exercise is not a simple task if you have never been very active. It is more complex than deciding one day to start and sticking to it. There are many considerations, the most important of which is your safety. Not only must you decide what type of exercise is best for you and most enjoyable, you need to be sure that you are doing it in a way that contributes to your overall health and well-being, and does not place you at risk for injuries or other problems.
In this module, safety considerations that apply to people going through or having completed cancer treatment (National Comprehensive Cancer Network, 2013) are discussed. Cancer treatment is defined as ANYTHING done to your body to stop or slow cancer growth: any minor or major surgeries, chemotherapy, radiation, or any other medications or procedures.
Despite the precautions listed below, exercise is still very important. If you don’t feel confident in how to do it, there are many ways to find help. In most communities there are clubs, organizations, classes, senior centers, or other resources where you can obtain knowledgeable guidance and support.
The following precautions do not cover all the possible hazards with exercise, just the most common ones pertaining to cancer patients (Irwin, 2012). Other than when you are very sick or have another issue (such as an injury) that calls for avoidance of exercise, you can find a safe level of activity for even your lowest energy days. Some movement is better than doing nothing at all.
Note: The contents of this section are NOT medical advice. They are simply included to give you some explanations of why your doctor might recommend or advise against a certain activity. For specific guidance, each individual should speak with their licensed physician for advice.
General Exercise Precautions
- Don’t exercise alone, especially if you are lifting weights. Have a spotter watch you, or use machines instead of free weights.
- Warm up first, cool down after, and don’t stretch cold muscles. The best times to stretch are after you’ve warmed up and after the workout.
- Don’t hold your breath. Always breathe throughout an exercise.
- Wear sturdy, stable shoes with a firm sole, good traction on all surfaces, and that cover the toes.
- Use proper posture and form. If you’re not sure how to do an exercise, get help from a qualified fitness professional. It’s better to learn the proper way to do an exercise than to risk injuring joints and soft tissue that take time to heal and could keep you from exercising.
- Try different forms of exercise. Some people need variety in their routine to keep from getting bored. If the exercise is safe and works your muscles hard enough to get the benefit of moderate exercise without overdoing it or causing injury, then go ahead and try different things. Consult with a certified fitness professional who understands the needs of people with cancer to get guidelines on what is safe.
- Exercise on stable surfaces; avoid slick floors without traction where you might slip and fall.
- Aim for quality workouts, not quantity. It is better to do a few good, properly executed exercises than many sloppy ones.
- Sleep is important. If you are extremely sleep deprived, your concentration will be off, making you more prone to injury. If you feel so tired that you’re having a hard time focusing on what you are doing, choose a safer way to exercise or take the day off. You can even take a nap instead.
- If your doctor tells you that you should avoid exercise, there is usually a good reason for it. Make sure you ask why, understand why you should not exercise, and ask how long it will be before you are allowed to exercise again. As soon as you are cleared, start moving again!
What is overtraining?
Overtraining is a condition in which you are working out harder and more frequently than your body has the reserves to repair and recover before the next workout. It can lead to problems: difficulty sleeping, higher resting heart rate in the morning, tendency to get colds and upper respiratory infections, muscle and joint soreness that lasts longer or is more intense than usual, decline in performance, burnout, injuries, irritability, and changes in appetite (Bryant, Green, & Merrill, 2014).
If you have had lymph nodes removed or had radiation, you may be at risk for lymphedema, which is an excessive swelling and fluid buildup in a body part, usually in the extremities. If you are at risk for lymphedema, you will need to follow careful guidelines, especially when you first return to working out (National Lymphedema Network, 2012).
Radiation can lead to lymphedema because it changes tissue in the radiation field. The tissue can become fibrotic and less pliable, which can interfere with lymphatic drainage. For more information on this condition, see the Cancer Harbors module on lymphedema, or visit this link for the National Lymphedema Network website.
Under normal conditions, we do not give our lymphatic system much thought. We take it for granted that it does its job to remove debris, cells, waste products, and fluid from inflammation and injury. We never know how much work it does to keep our tissues drained and functioning normally until it is disrupted by injury, surgery, or radiation. Even an insect bite or a small cut can cause major swelling in a person with poor lymphatic drainage.
There are certain exercises you should avoid when getting started, specifically those that place a lot of strain on your arms, shoulders, and chest. Avoid full-weight pushups, dips, planks, and lifting heavy weights either with machines or free weights. Starting out with too much weight can trigger inflammation that will lead to swelling. The swelling occurs because the lymphatic system is unable to clear excess fluid as efficiently as it did before surgery. If you build up the weight you are lifting slowly and carefully—and this can take months or longer—you might eventually be able to do these exercises safely again. Every individual is different, and it is best to proceed with caution, working up slowly and maintaining your workouts consistently.
Starting with gentle, easy exercises and slowly building up the number of reps and sets is also necessary to avoid triggering lymphedema. If after you finish exercising, you feel a heaviness, warmth, or fullness in the affected limb, see a therapist trained and certified in manual lymphatic drainage to prevent the problem from getting worse. Treating it early makes it more manageable.
If you are at risk for lymphedema and take a long break from working out, you must return to your previous level slowly and cautiously because of your compromised lymphatic system, regardless of how strong you were before the break (National Lymphedema Network, 2012).
If you’ve had recent surgery, or are in the process of having reconstructive surgeries, be absolutely certain that you have been cleared to exercise by your plastic surgeon for the exact type and amount of exercise you plan to do. Consult a physical therapist for expert guidance, and read the online Cancer Harbors module on Exercise after Breast Surgery.
Aerobic Exercise Precautions
If you are severely anemic (that is, if your hemoglobin count is very low), your blood does not have sufficient capacity to carry oxygen to your muscles and tissues. Hemoglobin is a substance in your blood that carries oxygen to the red blood cells. Learn more about anemia in the Cancer Harbors module on Anemia.
Exercise places an extra demand on your heart muscle. This is because your body needs your heart to pump additional oxygen-rich blood to fuel the muscles. Your heart and brain also need oxygen, and if there is not enough hemoglobin in your blood to carry oxygen to all the organs and tissues that need it, your heart will attempt to work harder to make up for the hemoglobin deficiency.
As the heart works harder and harder, trying to pump more oxygen through the body, it can strain it or even lead to a heart attack. Chest pain and shortness of breath are two possible indicators that your heart is not getting enough oxygen. If you experience chest pain or shortness of breath with exertion, stop exercising immediately and rest. If it does not subside, seek medical attention immediately by calling 911, or your emergency services outside of the U.S.
Finally, if you have been told you have a blood clot, do not exercise until you get clearance from your doctor.
Do not exercise with a fever. Your body is already struggling to fight off an infection, and it needs its reserves to fight it.
If you have open wounds, drains, lines into your body or bloodstream such as PICCs or catheters, tubes, or ostomies, check with your doctor to make sure certain kinds of exercise are okay. Water activities in pools or open water can be infection risks, as are public facilities like gyms. If you have a port implanted and it has healed, and your immune system is functioning normally, you should be able to swim.
Medications and Exercise
Exercise is generally good for your overall health, but if you are on certain medications, you may need to use extra caution with exercise. Always check with the doctor who prescribed the medication about any special precautions to take. Exercising can change the amount of a drug needed to manage certain conditions, such as high blood pressure or diabetes. In that case, you must communicate with your doctor so he or she can adjust the dose safely for your needs.
The most common drugs taken by cancer patients that can affect your ability to exercise safely include blood pressure medications, diuretics, electrolyte replacements, diabetes medications, immunosuppressants, steroids, blood thinners, bone-building drugs, and hormone therapies. If you are on any of these medications, you should talk to your doctor about any exercise precautions you might need to take.
A physical therapist can show you how to perform exercises safely and which to avoid, if you are at risk for injury from certain exercises. Ask for a physical therapy referral from your doctor; it can keep you from being set back due to injury.
In warm weather, remember to use bug spray, sunscreen, hats, and sunglasses when outside. If your immune system is weak, you may be more susceptible to tick- or mosquito-borne illnesses. Certain drugs can cause sun sensitivity. If you have lost your hair, wear something over your head, and remember that lack of eyebrows, eyelashes, and body hair results in less protection for places you normally do not think to cover, such as your scalp and ears.
In cool weather, also remember sunscreen, sunglasses, and gloves. Wear extra layers because you will tend to get cold more easily if you have lost hair. If there are icy surfaces, have good traction on your shoes to avoid slips and falls.
Precautions with Active Cancer Treatment
Cancer treatment is defined as ANYTHING done to your body to stop or slow cancer growth: any minor or major surgeries, chemotherapy, radiation, medications or procedures.
Despite the number of precautions needed, exercise is still very important. Please refer to the Cancer Harbors Module on Exercise Safety During Chemotherapy and Radiation. Other than when you are very sick or have an issue that calls for avoidance of exercise, you can still find a safe level of activity to do, even on your lowest energy days. Some movement is better than doing nothing at all. Most of the time, mild to moderate exercise is beneficial, but there are certain times when it is a good idea to avoid it or rest. The module on exercise during active treatment talks about the common problems encountered by patients during treatment that can make exercise riskier.
On the days you are feeling lousy and don’t want to get out of bed, the Lemonade Routine Video is a good set of exercises to do. If you are in treatment, always check with your oncologist before doing any exercise.
- Bryant, C. X., Green, D.J., & Merrill, S. 2013. ACE Health Coach Manual. American Council on Exercise (ACE).
- Irwin, M. L. 2012. ACSM’s Guide to Exercise and Cancer Survivorship. Human Kinetics.
- National Lymphedema Network. 2012. Position Statement of the National Lymphedema Network: Lymphedema Risk Reduction Practices. http://lymphnet.org
- National Comprehensive Cancer Network. NCCN Guidance for Risk Assessment: Considerations for Specific Populations. January 2013.
Not all exercise is suitable for everyone. Before attempting any new exercise, flexibility, strength, and overall health must be considered to determine if a specific exercise is appropriate for you. Any exercise is inherently dangerous and can result in personal injury. Any injury sustained from proper or improper use of the exercises in this video is solely the responsibility of the exerciser. Cancer Harbors™, Sunspirit Wellness Services LLC and their staff, representatives, successors and assigns disclaim any liability from injury sustained from the use of the exercises in this video and suggest that you consult your physician before attempting any exercise or exercise program.
As with any exercise program, if at any point during your workout using the exercises in this video you begin to feel dizzy, faint, lightheaded, or have physical discomfort, you should stop immediately. You are responsible for exercising within your limits and seeking medical advice and attention as appropriate. The content in this video and the exercise tips and instructions are not a substitute for medical advice. If you are concerned about whether the exercises in this or any exercise program are right for you, do not do them until you have received clearance from your physician.