Exercise and Chemotherapy
Staying Active During Treatment
by Berfin Mahmut, PT, DPT, CLT-LANA, OnCS
Chemotherapy is a systemic treatment, meaning it affects the entire body. While it is highly effective in treating cancer, it can also lead to a wide range of physical and emotional side effects. Some side effects, such as nausea or fatigue, improve after treatment is completed, while others may persist for months or even years. Although every survivor’s experience is different, one thing is clear: staying physically active throughout treatment can play an important role in supporting recovery.
Exercise is one of the most effective non-pharmacological interventions for managing many chemotherapy-related side effects. When performed safely and appropriately, it is well tolerated by most cancer survivors during and after treatment. Research has consistently shown that regular physical activity can reduce fatigue and anxiety, improve physical function and quality of life, support bone health, promote better sleep, and help reduce the risk of developing or worsening lymphedema.
Despite these well-established benefits, many survivors are unsure how to exercise safely during chemotherapy. Questions such as “How much should I do?,” “Is it safe to exercise when I’m receiving treatment?,” and “What if I’m too tired?” are common. The good news is that exercise does not need to be strenuous to be beneficial.
During chemotherapy, the primary goal is to preserve physical function, maintain strength and endurance, and minimize the impact of treatment-related side effects. Rather than focusing on improving fitness, the emphasis should be on maintaining activity in a way that is safe, manageable, and responsive to how your body feels each day. For many survivors, beginning with light-intensity aerobic activity is an appropriate starting point. As treatment is completed and recovery progresses, exercise intensity can gradually increase to light-to-moderate and eventually moderate intensity, as tolerated.
One practical way to monitor exercise intensity is by using the Borg Rating of Perceived Exertion (RPE) Scale. During chemotherapy, aim for an intensity that feels light, which should allow you to be able to comfortably carry on a conversation without becoming short of breath. As your strength and endurance improve after treatment, you can gradually progress to a pace where your breathing becomes more noticeable while you are still able to speak comfortably. Moderate-intensity exercise should feel challenging but controlled, allowing you to talk in short sentences without struggling for breath.
For most survivors, a reasonable long-term goal is to work toward approximately 150 minutes of moderate-intensity aerobic activity each week, along with resistance training at least two days per week and daily stretching when possible. During chemotherapy, however, this goal often needs to be modified based on how you are feeling. Starting with approximately 30 minutes of light activity three to five days per week is often well tolerated. If 30 continuous minutes feels overwhelming, dividing activity into shorter sessions throughout the day is equally effective and may be more realistic.
It is also important to recognize that meaningful improvements take time. While it is natural to hope for immediate results, research suggests that noticeable improvements in fatigue, strength, endurance, and physical function often occur after 8 to 12 weeks of consistent exercise. Progress may be gradual, but consistency is far more important than intensity.
Finally, remember that chemotherapy affects everyone differently. Factors such as fatigue, anemia, nausea, changes in blood counts, and other treatment-related side effects can influence your ability to exercise from one day to the next. Listening to your body and adjusting your activity accordingly is an important part of exercising safely.
Before beginning or advancing an exercise program, discuss your plans with your oncology team to ensure it is safe and appropriate for your individual circumstances. Exercise should be prescribed based on your diagnosis, treatment, medical history, current level of function, and recovery goals. When available, guidance from a physical therapist or exercise professional with expertise in oncology rehabilitation can help ensure your program is individualized, appropriately progressed, and adapted as your needs change throughout treatment and recovery.
Berfin Mahmut is a Doctor of Physical Therapy, a certified lymphedema therapist, and a cancer exercise specialist who specializes in cancer rehabilitation at Mount Sinai in New York, NY.
