Let ‘Em See You Sweat

Let ‘Em See You Sweat

When and How to Get Started with an Exercise Program after a Cancer Diagnosis

by Erik Hanson, PhD, CSCS, and Claudio Battaglini, PhD, FACSM

More than three decades ago, researchers began looking to exercise as a recovery aid for cancer survivors. Since then, exercise has only grown in popularity as a complementary therapy, due in part to its non-invasive, low-cost nature, not to mention its numerous benefits. Many cancer survivors report improved physical function, reduced fatigue, and higher quality of life after incorporating exercise into their care plan. More importantly, reports of adverse effects are low, which means that exercise is safe too.

However, one question still remains: When is the best time to start exercising?

Before treatment.

One option is to begin your exercise program before any treatment begins. This approach may be considered by cancer survivors who are awaiting surgery. Often referred to as prehabilitation, this approach to exercise is based on the belief that exercise helps improve a cancer survivor’s overall fitness prior to treatment, allowing them to recover more quickly after cancer treatment and experience a reduced risk of complications during treatment. While, theoretically, this reasoning seems logical, there is currently limited evidence showing that exercise prior to treatment translates into effective post-operative outcomes.

During treatment.

Exercise training during cancer treatment is more common. This approach has several demonstrated benefits, including decreased fatigue, less nausea, reduced anxiety and depression symptoms, and better quality of life. The major drawback to this approach is that exercise may be more difficult during this time due to certain treatment side effects, such as fatigue, difficulty maintaining proper calorie intake, and poor sleep. During cancer treatment, physical activity may need to be broken into shorter, more frequent sessions to help cancer survivors accumulate an effective overall dose of exercise. If cancer survivors do engage in exercise during treatment, the focus should be to maintain current fitness levels rather than seeking improvements.

After treatment.

Starting an exercise program after completing treatment is the most frequent approach, with strong, compelling evidence demonstrating significant improvements in a variety of physical, mental, and functional outcomes in cancer survivors using many different types of exercise after treatment. As side effects are often less severe once active treatment ends, cancer survivors may be able to more consistently engage in exercise training and may regain some of the fitness losses that frequently occur during treatment. Another benefit of increasing physical activity after cancer treatment is that it reduces your risk of developing comorbidities (such as cardiovascular disease or diabetes) that can arise following treatment.

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With several options to consider, you should talk with your doctor about when the best time is for you to begin a regular exercise routine. And no matter when you begin exercising, remember to start slowly. As you get comfortable, you can gradually increase your exercise duration and intensity.

Current exercise guidelines for cancer survivors recommend that you get at least 75 minutes of vigorous physical activity, or 150 minutes of moderate physical activity, per week. Your exercise program should include both aerobic and strength-training exercises. Depending on your current fitness level, you may need to build up to this amount of exercise over time. It’s important that you respect your own physical limitations, listen to your body, and talk with your doctor about what types of exercise (and how much) are right for you.

Exercise has many benefits for cancer survivors – notably, improvements in physical function and quality of life – that have the potential to increase your overall survival. There is no one right way to exercise. Each training program needs to be individualized to your specific cancer, treatments, and physical limitations. Talk with your oncologist to see if regular exercise training is a safe activity for you to participate in before, during, or after cancer treatment. Once you get the all-clear from your doctor, you can meet with an exercise-and-cancer specialist about getting started with an exercise plan that will give you the best quality of life possible.

Dr. Erik HansonDr. Erik Hanson is a Kulynych/Story Fellow assistant professor in the Department of Exercise and Sport Science at the University of North Carolina at Chapel Hill, as well as a certified strength and conditioning specialist.


Dr. Claudio Battaglini is a professor in the Department of Exercise and Sport Science at UNC-Chapel Hill, director of the UNC Get REAL & HEEL Breast Cancer Exercise Program, and an American College of Sports Medicine fellow. Both Dr. Hanson and Dr. Battaglini are members of the Cancer Prevention and Control program at the UNC Lineberger Comprehensive Cancer Center and, together, codirect the UNC Exercise Oncology Research Laboratory.

This article was published in Coping® with Cancer magazine, March/April 2020.