Exercise Considerations for Cancer Survivors

Exercise Considerations for Cancer Survivors


Be it a close friend, family member, coworker, or your own personal encounter, most of us have been impacted by cancer at some point in our lives. The term ‘cancer survivor’ has been used to describe a person living with the condition at any point, from the time of diagnosis, until the end of their life.1 According to Statistics Canada, about 1 in 2 people will be diagnosed in their lifetime. Annually, just over 200,000 new cases are diagnosed (with colorectal, lung, prostate and breast cancer making up the majority), and due to an expanding and aging Canadian population, the prevalence continues to rise. Despite being the most common cause of death in the country however, cancer mortality rates have been gradually declining since the late 1980s as advances have occurred in detection and treatment.2 So as it stands, Canada is experiencing a growing population of cancer survivors.


While recurrence and mortality is top of mind for those with cancer, another main area of health concern is the side effects associated with treatment. In some, symptoms can persist for years and interfere with the quality of their life. Most common among survivors is cancer-related fatigue (i.e. tiredness, weakness, lethargy, or exhaustion), which at its worst can be quite debilitating. Other common treatment-related side effects could involve physical deconditioning, neuropathy, chronic pain, and diminished psychological wellbeing.3-6 The World Health Organization defines ‘health’ as “a state of complete physical, mental, and social wellbeing – not merely the absence of disease and infirmity.”7 Exercise is proven to be effective in managing the side effects of cancer and its treatment, demonstrating a positive impact on wellbeing encompassing both the physical and psychological.8 In fact, there is scientific literature that links exercising with reduced cancer-specific mortality reported as high as 27%.9,10


One of many organizations to acknowledge the exercise oncology research is the American Cancer Society, which encourages survivors to “avoid inactivity, take part in regular physical activity, and return to normal activities as soon as possible after surgery and adjuvant cancer treatments.”11 However, despite ample evidence and recommendations, many survivors are still not active enough. In fact, a substantial decrease in exercise levels has been observed in cancer survivors following diagnosis, with some studies reporting only about half (48%) participating in sufficient amounts.12,13 There are major hurdles that cancer survivors must overcome when attempting to follow exercise recommendations. Some of the most common barriers are treatment-related side effects, cancer-related fatigue, and unfamiliarity with the benefits of being active.14


Exercise is empowering in that it allows cancer survivors to gain a sense of control over their health and lives. Understanding the hurdles is a crucial part of the journey to becoming or staying active. Also important are the facilitators of exercise, so here are a few to consider:


Some is better than none

Performing short bouts of exercise on a more frequent basis is a great way to start. Before increasing your intensity, gradually progress the frequency and duration. Listen to your body (as some days may feel better than others), do what you can on the ‘good days’, and understand that you might not be able to do as much on the ‘not so good days’.


Manage your intensity

When going through active treatment, try to stay within a low to moderate exercise intensity (moderate on ‘good days’ and low on ‘not so good days’). Depending on your current physical condition, too vigorous of an intensity can potentially leave you feeling drained, which can deter you from staying regularly active. However, too low of an intensity may detract from the potential health benefits of your exercise. When starting off, begin at a lower intensity, then see how your body responds and make adjustments for the next workout.


One size does not fit all

Never assume that the exercise routine of someone with the same diagnosis as you is appropriate for you too. Those with osteoporosis or bony metastasis may require adjustments to their exercise routine (e.g. reduced impact and intensity) given the increased risk of bone fractures. Also, modification may be needed for those who are immunocompromised due to their treatment (e.g. exercising precaution when using public gym equipment to minimize risk of infection).


Seek advice from the experts

Prior to becoming more physically active, speak with your physician to identify any specific precautions you will need to take based on your diagnosis and treatments. If available, a qualified exercise professional with oncology experience can help you overcome your exercise barriers. They can prescribe the appropriate intensity, monitor your progress, and ensure that you are exercising safely. Given that some cancer survivors require frequent modifications to their exercise routine, this may be something to really consider.


William Hilton is a Registered Kinesiologist and Exercise Physiologist with a specialty in exercise therapy for cancer survivors. He has been a member of Medcan’s Sports Therapy and Rehabilitation Team and Fitness Team since 2013.




  1. NCI Dictionary of Cancer Terms. Retrieved May 10, 2019, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/survivor
  2. Canadian Cancer Statistics Advisory Committee. Canadian Cancer Statistics 2018.Toronto, ON: Canadian Cancer Society; 2018. Retrieved May 12, 2019, from cancer.ca/Canadian-Cancer-Statistics-2018-EN
  3. Bower, J. E., Ganz, P. A., Desmond, K. A., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2000). Fatigue in Breast Cancer Survivors: Occurrence, Correlates, and Impact on Quality of Life. Journal of Clinical Oncology,18(4), 743-753. doi:10.1200/jco.2000.18.4.743
  4. Ganz, P. A. (2006). Monitoring the Physical Health of Cancer Survivors: A Survivorship-Focused Medical History. Journal of Clinical Oncology,24(32), 5105-5111. doi:10.1200/jco.2006.06.0541
  5. Stanton, A. L. (2006). Psychosocial Concerns and Interventions for Cancer Survivors. Journal of Clinical Oncology,24(32), 5132-5137. doi:10.1200/jco.2006.06.8775
  6. Pachman, D. R., Barton, D. L., Swetz, K. M., & Loprinzi, C. L. (2012). Troublesome Symptoms in Cancer Survivors: Fatigue, Insomnia, Neuropathy, and Pain. Journal of Clinical Oncology,30(30), 3687-3696. doi:10.1200/jco.2012.41.7238
  7. World Health Organization. The Constitution of the World Health Organization: WHO Chronicles. 1947;1(29).
  8. Fong, D. Y., Ho, J. W., Hui, B. P., Lee, A. M., Macfarlane, D. J., Leung, S. S., . . . Cheng, K. K. (2012). Physical Activity for Cancer Survivors: Meta-Analysis of Randomised Controlled Trials. BMJ (Clinical Research Edition),344(E70). doi:10.1136/bmj.e70
  9. Ballard-Barbash, R., Friedenreich, C. M., Courneya, K. S., Siddiqi, S. M., Mctiernan, A., & Alfano, C. M. (2012). Physical Activity, Biomarkers, and Disease Outcomes in Cancer Survivors: A Systematic Review. JNCI Journal of the National Cancer Institute,104(11), 815-840. doi:10.1093/jnci/djs207
  10. Li, T., Wei, S., Shi, Y., Pang, S., Qin, Q., Yin, J., . . . Liu, L. (2016). The Dose–Response Effect of Physical Activity on Cancer Mortality: Findings from 71 Prospective Cohort Studies. British Journal of Sports Medicine,50(6), 339-345. doi:10.1136/bjsports-2015-094927
  11. Can I Do Anything to Prevent Cancer Recurrence? Retrieved May 15, 2019, from https://www.cancer.org/treatment/survivorship-during-and-after-treatment/understanding-recurrence/can-i-do-anything-to-prevent-cancer-recurrence.html
  12. Humpel, N., & Iverson, D. C. (2007). Depression and Quality of Life in Cancer Survivors: Is There a Relationship with Physical Activity? International Journal of Behavioral Nutrition and Physical Activity,4(1), 65. doi:10.1186/1479-5868-4-65
  13. Midtgaard, J., Baadsgaard, M. T., Møller, T., Rasmussen, B., Quist, M., Andersen, C., . . . Adamsen, L. (2009). Self-Reported Physical Activity Behaviour; Exercise Motivation and Information Among Danish Adult Cancer Patients Undergoing Chemotherapy. European Journal of Oncology Nursing,13(2), 116-121. doi:10.1016/j.ejon.2009.01.006
  14. Clifford, B. K., Mizrahi, D., Sandler, C. X., Barry, B. K., Simar, D., Wakefield, C. E., & Goldstein, D. (2018). Barriers and Facilitators of Exercise Experienced by Cancer Survivors: A Mixed Methods Systematic Review. Supportive Care in Cancer,26(3), 685-700. doi:10.1007/s00520-017-3964-5


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